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目的应用静息态功能磁共振分析原发性闭角型青光眼(PACG)患者小梁网联合周边虹膜切除手术前后自发性脑活动的变化。方法 40例术前PACG患者及40例年龄、性别匹配的正常健康对照组(HC)均接受静息态fMRI检查,10例PACG患者于术后3个月复查静息态fMRI。计算所有受试者全脑ReHo值,采用两样本t检验比较40例术前PACG患者与HC组ReHo值差异;同时,采用配对样本t检验比较10例PACG患者术前与术后ReHo值差异。结果与HC组对比,术前PACG组ReHo减低的脑区包括右侧梭状回,双侧枕中回,左侧枕下回,左侧颞中回,双侧中央前回,左侧顶上小叶,右侧中央后回,左侧中央旁小叶;ReHo升高的脑区包括双侧小脑后叶,双侧额上回(Alpha Sim校正,P<0.01,33个体素)。10例PACG患者术后与术前对比,右侧颞中回、左侧楔叶神经活动一致性增加,右侧额上回、右侧额下回神经活动一致性减低(Alpha Sim校正,P<0.01,33个体素)。结论 PACG患者术前存在视觉以及情感认知调节相关脑区局部一致性异常;此外,通过青光眼手术,PACG患者视觉区域出现脑功能活动重塑,为进一步研究PACG的神经病理机制以及监测PACG的治疗提供了一定帮助。
Objective To analyze the changes of spontaneous brain activity in patients with primary angle-closure glaucoma (PACG) before and after trabeculectomy combined with resting state functional magnetic resonance (MR). Methods Forty patients with preoperative PACG and 40 age-matched and normal-matched healthy controls (HC) underwent resting fMRI, and 10 patients with PACG underwent resting fMRI at 3 months after operation. The ReHo values of whole brain were calculated in all subjects. The difference of ReHo value between 40 patients with preoperative PACG and HC group was compared by two-sample t-test. Meanwhile, the differences of ReHo value between preoperative and postoperative patients with PACG were compared using paired-samples t-test. Results Compared with HC group, the decreased brain regions of ReHo in PACG group included the right fusiform gyrus, bilateral occipital gyrus, left inferior occipital gyrus, left temporal gyrus, bilateral central anterior gyrus, left apical lobule , Right middle back, left middle centrilobular lobes; ReHo elevated brain regions including bilateral posterior cerebellar folds, bilateral frontal gyrus (Alpha Sim correction, P <0.01, 33 voxels). In 10 patients with PACG, postoperative and preoperative comparison of right and left medial wedge-shaped nerve activity consistency increased, right upper frontal gyrus, right lower frontal nerve activity consistency reduced (Alpha Sim correction, P < 0.01, 33 voxels). Conclusions PACG patients have preoperative visual and emotional cognitive-related local abnormalities in brain regions. In addition, brain functional activity remodeling in the visual area of PACG patients through glaucoma surgery is of great significance for further study on the neuropathological mechanism of PACG and the monitoring of PACG treatment Provided some help.