基于近红外成像的意识障碍诊断、预后及疗效评价研究

How to treat and manage chronic disorder of consciousness (DOC) is one of the currently important problems in medical. Neuroimaging has opened new opportunities to look for the biomarkers of consciousness for reaching the quantitative and correct diagnosis, pronouncing an evidence-based prognosis, and thoughtfully evaluating a medical interference. Although there has been some optimistic findings based on PET/fMRI/EEG techniques, they still have some limitations in clinical application. In this project, we plan to use functional near-infrared spectroscopy technique to measure the local brain activation and functional connectivity between remote brain areas for patients with DOC during resting state and turbulent state with transcranial magnetic stimulation. We will first estimate the relationship between these fNIRS parameters and the level of consciousness. And by comparing with the fNIRS parameters with the GOS-E/CRS-R scales and comparing with the assessment results based on fNIRS and based on the fMRI and EEG, we evaluate the feasibility of fNIRS to quantitative diagnosis and prognosis of DOC. Finally, focused on the brain intervention therapy of spinal cord stimulation, we will quantitative evaluate the different hemodynamic responses effect of different stimulation parameters by using fNIRS. We try to establish a pipeline for assessing brain intervention parameters and to provide a suggestion to optimize the protocol of neuromodulation. Based on our a little previous work of fNIRS-DOC and taking together with several unique advantages of fNIRS in clinical application, we believe that this project will promote the technology development of DOC clinical evaluation while fNIRS could be an important supplementary tool for clinical evaluation of DOC in future.

意识障碍（DOC）患者的促醒治疗是当今医学难题之一。精准的诊断分类与预后判断以及客观的治疗方案评估对于DOC促醒治疗至关重要。但是目前这些还主要通过对病人行为的主观观察完成，误诊率高，缺乏稳定可信的定量生物学标记。本项目计划借助近红外脑成像（fNIRS）技术，度量DOC患者在静息态和经颅磁刺激扰动下的局部脑活动及跨区域脑功能连接，分析这些指标和意识水平的关系，并通过和行为量表以及和基于fMRI/EEG的评估结果对比，分析fNIRS用于DOC临床诊断和预后判断的可行性。同时在我们前期工作的基础上，针对新兴的脊髓电刺激脑调控治疗方式，利用fNIRS定量评价不同刺激参数的即时刺激效果差异，建立通过脑血氧评估程控参数的方法，拟为脑调控技术的程控参数设定提供科学依据。凭借fNIRS在临床使用中的诸多独特优势，我们相信本项目将推进fNIRS成为DOC临床评估的重要辅助手段，弥补传统成像技术的不足。

在本项目的资助下，围绕基于近红外成像的意识障碍诊断、预后及疗效评价研究，已利用主动式运动想象范式下的脑活动采集，成功区分出了意识障碍患者的对“是/否”问题的回答，实现脑信号解码，为进一步通过脑机接口实现意识障碍患者与外界交流奠定基础；同时发现了植物状态（MCS）与微意识状态（UWS）患者的脑血氧活动特征的差异，可以为临床意识障碍的诊断分类提供可能的客观指标。另外，利用静息态脑功能连接分析，发现可以功能连接的时空动态变化分析大脑内功能组织模式，为未来接评估患者脑功能组织模式变化提供可能工具。最后，针对SCS程控参数的定量分析，本项目利用fNIRS发现了SCS以频率特异性的方式调节血流动力学反应和长距离连接（70 Hz显然更好），可能是通过改善脑血容量和通过网状结构-丘脑-皮层通路的信息传递，基本验证了基于fNIRS评估SCS程控参数的可行性。综上所述，已基本完成本项目既定研究目标。