目的 分析未用药原发性失眠(PI)患者静息态功能磁共振成像(rs-fMRI)脑区比率低频振幅(fALFF)的变化,探讨其脑功能损伤及代偿的神经机制. 方法 选择广东省第二人民医院神经内科自2015年11月至2016年11月收治的PI患者59例(PI患者组)和社区招募性别、年龄、受教育程度与PI患者匹配的健康志愿者47例(正常对照组).采用匹茨堡睡眠质量指数(PSQI)量表、失眠严重程度指数(ISI)量表评估受试者的睡眠质量;采取焦虑自评量表(SAS)、抑郁自评量表(SDS)评估受试者的情绪;采用rs-fMRI技术结合fALFF的分析方法,比较2组受试者脑局部功能区域活动的差异;相关性分析显示PI患者fALFF值与PSQI、SAS、SDS量表得分的相关性. 结果 PI患者组中轻度失眠患者2例,中度失眠患者41例,重度失眠患者16例,正常对照组受试者ISI评分均小于7分.PI患者组PSQI、SAS、SDS、ISI量表得分均高于正常对照组,差异有统计学意义(P＜0.05).与正常对照组比较,PI患者组受试者多个脑区出现明显增高的fALFF值,包括右侧海马、右侧海马旁回、右侧杏仁核及双侧丘脑.相关性分析显示PI患者fALFF值与PSQI、SAS、SDS量表得分呈正相关关系(r=0.582,P=0.000;r=0.617,P=0.000;r=0.653,P=0.000). 结论 静息状态下PI患者多个功能脑区存在异常激活的改变,提示PI患者局部大脑神经活动变化.%Objective The aim of this study is to understand the impairment and compensation mechanism of brain function in untreated primary insomnia (PI) patients.The approach of fractional amplitude of low frequency fluctuation (fALFF) is used to analyze raw data between the PI patients and the normal control group in resting state using functional magnetic resonance imaging (fMRI).Methods Fifty-nine PI patients,admitted to our hospital from November 2015 to November 2016,and 47 age-,education-,and gender-matched normal healthy subjects were chosen in our study.Pittsburg sleep quality index (PSQI),insomnia severity index (ISI) were employed to evaluate the sleep quality.Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to evaluate the emotion.Resting state fMRI and fALFF analyses were used to compare the functional regional activities.The correlations of fALFF data with PSQI,SAS and SDS scores were analyzed.Results In PI patients,2 had mild to moderate insomnia,41 had moderate insomnia,and 16 had serious insomnia.ISI scores in the normal healthy subjects were less than 7.The PSQI,SAS,SDS and ISI scores in the PI patients were significantly higher than those in the normal healthy subjects (P＜0.05).As compared with the control group,the PI group had significantly increased fALFF value in the right hippocampus (HIP),right parahippocampa gyms,right amygdala,and bilateral thalamus.The fALFF value was positively correlated PSQI,SASandSDSscores (r=0.582,P=0.000;r=0.617,P=0.000;r=0.653,P=0.000).Conclusion Some brain regions in the PI patients are abnormal in the resting state,which can reflex functional regional activities of PI patients.
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