老年特发性正常压力脑积水患者gBOLD-CSF耦合异常与临床症状的相关性研究

Study on correlation between abnormal gBOLD-CSF coupling and clinical symptoms in older adults with idiopathic normal pressure hydrocephalus

中文关键词: 特发性正常压力脑积水    多模态磁共振成像    脑脊液动力学    脉络丛    认知功能障碍

英文关键词: idiopathic normal pressure hydrocephalusmultimodal magnetic resonance imagingcerebrospinal fluid dynamicschoroid plexuscognitive dysfuction

中文摘要:

      目的 探讨老年特发性正常压力脑积水(iNPH)患者全脑血氧水平依赖(gBOLD)信号与脑脊液(CSF)流入信号之间耦合强度的异常改变，并分析其与临床症状的相关性。方法 回顾性纳入62例老年iNPH患者及36名年龄匹配的健康对照者(HC)。基于多模态磁共振影像，分别提取宏观结构指标(Evans指数、侧脑室体积及脉络丛体积)与微观功能指标(gBOLD-CSF耦合强度)。比较2组间各影像指标的差异，绘制受试者操作特征曲线并计算曲线下面积(AUC)，以评价各指标的诊断效能;采用偏相关分析及多元线性回归分析探讨gBOLD-CSF耦合强度与临床症状的关联。结果 iNPH组的gBOLD-CSF耦合强度显著弱于HC组，脉络丛体积占比显著增大(均P <0.01)。gBOLD-CSF耦合强度(AUC=0.73)与脉络丛体积占比(AUC=0.70)均对区分iNPH与HC具有诊断效能。在控制性别、年龄及受教育程度等协变量后，gBOLD-CSF耦合强度越弱代表患者的认知功能越差，其与简易精神状态检查量表评分(r=-0.407,P=0.001)及特发性正常压力脑积水分级量表认知评分(r=0.474,P <0.001)均显著相关。多元线性回归分析显示，gBOLD-CSF耦合强度是iNPH患者认知功能下降的独立危险因素(B=-19.857,β=-0.419,P=0.001)。结论 与HC相比，iNPH患者的gBOLD-CSF耦合强度显著降低，脉络丛体积显著增大。此外，gBOLD-CSF耦合强度的减弱可作为反映该群体认知功能损伤的关键CSF动力学指标。

英文摘要:

      Objective To investigate the abnormal changes in coupling strength between global blood-oxygen-level-dependent(gBOLD)signals and cerebrospinal fluid(CSF)inflow signals(gBOLD-CSF coupling)in older patients with idiopathic normal pressure hydrocephalus(iNPH)and analyze its correlation with clinical symptoms.Methods A total of 62 older iNPH patients and 36 age-matched healthy controls(HC)were retrospectively included.Based on multimodal magnetic resonance imaging,macrostructural indices(Evans index,lateral ventricle,and choroid plexus volumes)and a microfunctional index(gBOLD-CSF coupling)were extracted.Differences in imaging indicators were compared between the two groups.Receiver operator characteristic curves were plotted and the area under the curve(AUC)was calculated to evaluate the diagnostic performance of each indicator.Partial correlation analysis and multiple linear regression analysis were used to explore the correlation between gBOLD-CSF coupling and clinical symptoms.Results The gBOLD-CSF coupling in the iNPH group was significantly weaker than that in the HC group,while the proportion of choroid plexus volume was significantly larger(both P＜0.01).Both gBOLD-CSF coupling(AUC=0.73)and proportion of choroid plexus volume(AUC=0.70)demonstrated diagnostic efficacy in distinguishing iNPH from HC.After controlling for covariates such as gender,age and educational level,the weaker the gBOLD-CSF coupling intensity,the worse the cognitive function of the patients.It was significantly correlated with the score of the mini-mental state examination(r=-0.407,P=0.001)and the cognitive score of the idiopathic normal pressure hydrocephalus grading scale(r=0.474,P＜0.001).Multiple linear regression analysis revealed that gBOLD-CSF coupling is an independent risk factor for cognitive decline in iNPH patients(B=-19.857,β=-0.419,P=0.001).Conclusion Compared with HC,iNPH patients exhibit significantly reduced gBOLD-CSF coupling and significantly increased choroid plexus volume.Furthermore,the weakening of gBOLD-CSF coupling may serve as a key CSF dynamic indicator reflecting cognitive impairment in this population.