背景:没有使用中度或强烈证据的诊断评估程序,目前治疗长期意识障碍(pDOC)的方法的证据很少。这可能与pDOC的机制研究不够深入、不够清晰有关。因此,本研究旨在利用功能近红外光谱(fNIRS)技术探讨pDOC的作用机制,为pDOC的治疗提供依据,以及探索确定pDOC患者唤醒的临床前标志物。
方法:使用fNIRS从10名pDOC患者和13名健康成人收集5分钟静息状态数据。根据时间序列中氧合血红蛋白(HbO)和脱氧血红蛋白(HbR)的浓度,计算两组的静息状态皮质脑功能连接强度,并在感觉运动网络(SEN)上比较了同源和异源脑网络的功能连接强度,背侧注意网络(DAN),腹侧注意力网络(VAN),默认模式网络(DMN),额顶叶网络(FPN),和视觉网络(VIS)级别。对具有统计学显著性差异的脑网络进行单变量二元逻辑回归分析,以识别与pDOC患者的觉醒相关的脑网络。进一步分析受试者工作特征(ROC)曲线以确定相关脑网络的截止值,从而为pDOC患者的觉醒预测提供临床生物标志物。
结果:结果表明,基于氧合血红蛋白(HbO)的SEN~SEN,VISVIS,丹·丹,DMN~DMN,SEN-VIS,SEN〜FPN,SENtoDAN,SEN~DMN,可见FPN,VIS〜DAN,可见,DMN,基于HbR的SEN~SEN,在pDOC组中,SEN〜DAN显着降低,并且是可以反映参与者意识状态的因素。通过ROC曲线分析计算的静息状态功能连接强度的截止值可以用作预测受试者唤醒状态的潜在临床前标志物。
结论:pDOC患者皮质网络的静息状态功能连接强度显著降低。静息状态功能连接强度的截止值是预测pDOC患者唤醒的潜在临床前标志物。
BACKGROUND: There is no diagnostic assessment procedure with moderate or strong evidence of use, and evidence for current means of treating prolonged disorders of consciousness (pDOC) is sparse. This may be related to the fact that the mechanisms of pDOC have not been studied deeply enough and are not clear enough. Therefore, the aim of this study was to explore the mechanism of pDOC using functional near-infrared spectroscopy (fNIRS) to provide a basis for the treatment of pDOC, as well as to explore preclinical markers for determining the arousal of pDOC patients.
METHODS: Five minutes resting-state data were collected from 10 pDOC patients and 13healthy adults using fNIRS. Based on the concentrations of oxyhemoglobin (HbO) and deoxyhemoglobin (HbR) in the time series, the resting-state cortical brain functional connectivity strengths of the two groups were calculated, and the functional connectivity strengths of homologous and heterologous brain networks were compared at the sensorimotor network (SEN), dorsal attention network (DAN), ventral attention network (VAN), default mode network (DMN), frontoparietal network (FPN), and visual network (VIS) levels. Univariate binary logistic regression analyses were performed on brain networks with statistically significant differences to identify brain networks associated with arousal in pDOC patients. The receiver operating characteristic (ROC) curves were further analyzed to determine the cut-off value of the relevant brain networks to provide clinical biomarkers for the prediction of arousal in pDOC patients.
RESULTS: The results showed that the functional connectivity strengths of oxyhemoglobin (HbO)-based SEN∼SEN, VIS∼VIS, DAN∼DAN, DMN∼DMN, SEN∼VIS, SEN∼FPN, SEN∼DAN, SEN∼DMN, VIS∼FPN, VIS∼DAN, VIS∼DMN, HbR-based SEN∼SEN, and SEN∼DAN were significantly reduced in the pDOC group and were factors that could reflect the participants\' state of consciousness. The cut-off value of resting-state functional connectivity strength calculated by ROC curve analysis can be used as a potential preclinical marker for predicting the arousal state of subjects.
CONCLUSIONS: Resting-state functional connectivity strength of cortical networks is significantly reduced in pDOC patients. The cut-off values of resting-state functional connectivity strength are potential preclinical markers for predicting arousal in pDOC patients.