抗N-甲基-D-天冬氨酸受体(抗NMDAR)脑炎会导致严重的神经精神症状和持续的认知障碍;然而,潜在的机制仍未完全理解。本研究利用了度中心性(DC),功能连接(FC)和多变量模式分析(MVPA),以进一步探索抗NMDAR脑炎患者的神经功能症状。共纳入29例抗NMDAR脑炎患者和26例健康对照(HCs)进行神经心理学评估和静息状态功能MRI(rs-fMRI)扫描。DC,检查了FC和MVPA,以研究脑功能活动,并根据rs-fMRI数据区分患者和HC组之间的神经影像学特征。与HC相比,患者表现出认知缺陷,焦虑和抑郁。在DC分析中,患者在左直肌回表现出明显的DC强度下降,左尾状核(LCN)和双侧内侧额回,以及小脑前叶的DC强度增加,与HC相比。在随后的FC分析中,LCN显示双侧额中回和右前肌的FC强度降低。此外,相关分析表明,脑功能活动中断与警觉效应和汉密尔顿抑郁量表评分显著相关。利用直流映射和接收机工作特性曲线分析,MVPA分类器曲线下面积为0.79,分类准确率为76.36%,敏感性为79.31%,特异性为78.18%。本研究揭示了小脑中枢和相关网络的功能活动中断,包括默认模式网络和执行控制网络,抗NMDAR脑炎患者的认知和情绪缺陷。总之,本研究为抗NMDAR脑炎的病理和代偿机制提供了影像学证据和主要诊断标志物,目的是提高对这种疾病的认识。
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis results in severe neuropsychiatric symptoms and persistent cognitive impairment; however, the underlying mechanism is still not fully understood. The present study utilized the degree centrality (
DC), functional connectivity (FC) and multivariate pattern analysis (MVPA) to further explore neurofunctional symptoms in patients with anti-NMDAR encephalitis. A total of 29 patients with anti-NMDAR encephalitis and 26 healthy controls (HCs) were enrolled for neuropsychological assessment and resting-state functional MRI (rs-fMRI) scans.
DC, FC and MVPA were examined to investigate cerebral functional activity and distinguish neuroimaging characteristics between the patient and HC groups based on the rs-fMRI data. Compared with the HCs, the patients exhibited cognitive deficits, anxiety and depression. In the
DC analysis, the patients exhibited significantly decreased
DC strength in the left rectus gyrus, left caudate nucleus (LCN) and bilateral superior medial frontal gyrus, as well as increased
DC strength in the cerebellar anterior lobe, compared with the HCs. In the subsequent FC analysis, the LCN showed decreased FC strength in the bilateral middle frontal gyrus and right precuneus. Furthermore, correlation analysis indicated that disrupted cerebral functional activity was significantly correlated with the alerting effect and Hamilton Depression Scale score. Using
DC maps and receiver operating characteristic curve analysis, the MVPA classifier exhibited an area under curve of 0.79, and the accuracy classification rate was 76.36%, with a sensitivity of 79.31% and a specificity of 78.18%. The present study revealed that the disrupted functional activity of hub and related networks in the cerebellum, including the default mode network and executive control network, contributed to deficits in cognition and emotion in patients with anti-NMDAR encephalitis. In conclusion, the present study provided imaging evidence and primary diagnostic markers for pathological and compensatory mechanisms of anti-NMDAR encephalitis, with the aim of improving the understanding of this disease.