遗忘型轻度认知障碍不同中医证型的神经影像学特征研究

Amnestic Mild Cognitive Impairment (aMCI) is an important period of early identification and intervention of dementia. Traditional Chinese medicine(TCM) based on the overall concept and syndrome differentiation and treatment has unique advantages in the treatment of aMCI. However, accurate syndrome differentiation is the premise of effective treatment. At present, aMCI syndrome classification still lacks objective diagnosis indexes, which affects the stability of the syndrome diagnosis and the reproducibility of the curative effect, which has become a serious problem that hinders the popularization of Chinese medicine in the prevention and treatment of aMCI. The disease location of aMCI is in the brain, thus association among characteristics of different types of cerebral palsy injury, is of great significance to improve the accuracy of differentiation. With the development of neuroimaging, multimodal magnetic resonance imaging can provide systematic information of brain structure and function at the same time, and provide the key technology for the study of syndrome differentiation based on the neuroimaging characteristics of MCI different syndromes. This study intends to perform multi-modality neuroimaging scans (sMRI, fMRI, DTI) on aMCI patients with syndromes of kidney essence deficiency syndrome, phlegm stasis syndrome, heart and spleen deficiency syndrome, and stasis and blood stasis syndrome. The imaging evidence of different syndrome types of aMCI will be used to identify different syndrome-specific imaging markers, to build classification prediction model, and further to screen high-differentiation, high-sensitivity imaging parameters, providing dialectical evidence for aMCI treatment by TCM.

遗忘型轻度认知障碍（aMCI）是痴呆早期识别和干预的重要时期，中医药基于整体观念，辨证论治，对aMCI的治疗具有独特的优势，但准确辨证是有效施治的前提，目前aMCI辨证分型缺乏客观化诊断指标，影响辨证的稳定性和疗效的可重复性，制约了中医药防治aMCI的成果在临床实践中的推广。aMCI病位在脑，确定并关联不同证型脑损伤客观特征，对aMCI临床辨证具有重要意义。随着神经影像学的发展，多模态磁共振成像可同时提供脑结构与功能的系统脑成像信息，为建立aMCI不同证型的神经影像学特征及证候客观化研究提供了关键技术。本研究拟对中医辨证为肾精亏虚证、痰浊阻窍证、心脾两虚证及瘀血阻络证之aMCI患者进行多模态的神经影像扫描（sMRI，fMRI，DTI），获取aMCI不同证型的影像学证据，确定不同证型特异性影像学标记，并建立分类预测模型，筛选高区分度、高敏感度影像学指标，为中医药治疗aMCI提供辨证依据。

遗忘型轻度认知障碍（aMCI）是痴呆早期识别和干预的重要时期，中医药基于整体观念，辨证论治，对aMCI的治疗具有独特的优势。但目前aMCI辨证分型缺乏客观化诊断指标，影响辨证的稳定性和疗效的可重复性，制约了中医药防治aMCI的成果在临床实践中的推广。aMCI病位在脑，确定并关联不同证型脑损伤客观特征，对aMCI临床辨证具有重要意义。本项目结合神经心理学测评和神经影像学技术，对中医辨证为肾精亏虚证、痰浊阻窍证、心脾两虚证及瘀血阻络证的aMCI患者进行认知功能评估和多模态脑功能磁共振扫描，通过分析aMCI不同中医证型的认知功能损伤和影像学特征，融合行为学和影像学特征因素建立aMCI证型分类预测模型，为中医药治疗aMCI提供辨证依据。本项目的结果发现：不同中医证型的aMCI患者在多项认知领域存在特异性认知损伤，尤其是肾精亏虚证在记忆、视空间、执行功能等认知领域损伤显著；痰浊阻窍证在执行、注意和语言能力相关的认知领域损伤显著。且不同证型在大脑额叶、顶叶、楔前叶等关键脑区存在结构差异，在海马、颞中回、扣带回等关键脑区的功能连接指标存在差异。aMCI不同证型建模分类结果发现结合行为学和影像学特征因素比单一特征分类准确性更高。项目进一步将脑影像指标对aMCI中医证型分类作用应用于中医辨证治疗aMCI的临床研究，为中药治疗脑病的临床疗效评价提供新的研究策略和方法学参考。综合而言，本项目为确定不同证型aMCI脑损伤的客观化证据提供了科学数据支撑，研究结果对阐释aMCI不同中医证的病因病机、制定不同认知损伤类型的中医药治疗方案、完善中药干预认知障碍类疾病的疗效评价体系具有重要的意义。