多模态磁共振成像视角下脑结构-功能网络特征与脑小血管病患者执行功能损害的相关性研究

A study on the correlation between brain structural-functional network characteristics and executive function impairment in patients with cerebral small vessel disease from a multimodal MRI perspective

摘要

目的 探讨多模态磁共振成像（MRI）视角下脑结构-功能网络特征与脑小血管（CSVD）病患者执行功能损害的相关性。方法 选择2024年6月至2025年12月在广西中医药大学第一附属医院神经内科就诊的30例CSVD患者及30例健康对照者（HC）作为研究对象。收集两组一般资料，采用认知量表和多模态MRI对患者进行评估。其中认知量表包括简易精神状态检查量表（MMSE）、Stroop色-词干扰测试B/C（Stroop B/C）、血管性痴呆认知评估量表（VADAS-cog）等。选取显著性、额顶叶及背侧注意网络为感兴趣区域（ROI），提取功能连接（FC）值。分析FC在白质高信号负荷与执行功能损害间的潜在中介作用。2组比较采用独立样本 t检验、Mann-Whitney U检验或 χ²检验。FC与认知评估评分的相关性采用偏相关分析。Bootstrap法检验中介效应。结果 CSVD组在右侧上颞回（ t = 3.874， P ＜ 0.001）、左侧岛盖区（ t = 4.820， P ＜ 0.001）、右侧角回（ t = 5.829， P ＜ 0.001）、右额中回（ t = 3.087， P = 0.004）、左侧外侧枕叶上部（ t = 5.494， P ＜ 0.001）、右侧中央前回（ t = 6.511， P ＜ 0.001）、右侧外侧枕叶上部（ t = 2.755， P = 0.008）、右侧后部缘上回（ t = 2.720， P = 0.010）的FC较HC组减弱。相关性分析显示，CSVD患者右额中回FC值与Stroop B（ r = 0.759， P ＜ 0.001）、Stroop C（ r = 0.745， P ＜ 0.001）以及VADAS-cog评分（ r = 0.529， P = 0.005）呈正相关。中介效应分析显示，右额中回在WMH负荷对VADAS-cog[间接效应−0.017 9，95%CI（−0.043 3，−0.000 2）]、Stroop B[间接效应−0.020 8，95%CI（−0.042 0，−0.002 5）]、Stroop C[间接效应−0.045 8，95%CI（−0.090 1，−0.006 5）]的影响中均起中介作用。结论 CSVD患者存在以额顶网络为核心的执行控制功能网络FC异常，右额中回是连接白质结构损伤与执行功能障碍的关键中介节点。

Abstract

Objective To investigate the correlation between brain structural-functional network characteristics and executive function impairment in patients with cerebral small vessel disease (CSVD) from a multimodal magnetic resonance imaging (MRI) perspective. Methods Thirty patients with CSVD treated in the Department of Neurology of the First Affiliated Hospital of Guangxi University of Chinese Medicine from June 2024 to December 2025 and 30 healthy controls (HC) were selected as the study participants. General clinical data of two groups were collected, and cognitive scales and multimodal MRI were used for assessment. The cognitive scales included the Mini-Mental State Examination (MMSE), Stroop Color-Word Interference Test B/C (Stroop B/C) and Vascular Dementia Assessment Scale-cognitive Subscale (VADAS-cog). The salience, frontoparietal and dorsal attention networks were selected as regions of interest (ROI), and functional connectivity (FC) values were extracted. The potential mediating role of FC between white matter hyperintensity (WMH) burden and executive function impairment was analyzed. Comparisons between the 2 groups were performed using the independent-samples t test, Mann-Whitney U test or χ ² test. Partial correlation analysis was used to assess the correlations between FC and cognitive assessment scores. The mediating effect was tested using the Bootstrap method. Results Compared with the HC group, the CSVD group showed reduced FC in the right superior temporal gyrus ( t = 3.874, P ＜ 0.001), left opercular cortex ( t = 4.820, P ＜ 0.001), right angular gyrus ( t = 5.829, P ＜ 0.001), right middle frontal gyrus ( t = 3.087, P = 0.004), left superior lateral occipital cortex ( t = 5.494, P ＜ 0.001), right precentral gyrus ( t = 6.511, P ＜ 0.001), right superior lateral occipital cortex ( t = 2.755, P = 0.008) and right posterior supramarginal gyrus ( t = 2.720, P = 0.010). Correlation analysis showed that the FC value of the right middle frontal gyrus in patients with CSVD was positively correlated with Stroop B ( r = 0.759, P ＜ 0.001), Stroop C ( r = 0.745, P ＜ 0.001), and VADAS-cog scores ( r = 0.529, P = 0.005). Mediation analysis showed that the right middle frontal gyrus mediated the effects of WMH burden on VADAS-cog [indirect effect = −0.017 9, 95% CI (−0.043 3, −0.000 2)], Stroop B [indirect effect = −0.020 8, 95% CI (−0.042 0, −0.002 5)], and Stroop C [indirect effect = −0.045 8, 95% CI (−0.090 1, −0.006 5)]. Conclusions Patients with CSVD exhibit abnormal FC in executive control networks centered on the frontoparietal network, and the right middle frontal gyrus is a key mediating node linking white matter structural damage to executive dysfunction.

关键词

脑小血管病 / 认知障碍 / 多模态MRI / 功能连接 / 执行功能

Key words

Cerebral small vessel disease / Cognitive impairment / Multimodal MRI / Functional connectivity / Executive function

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基金资助

广西科技项目重点研发项目(桂科AB20297055)

广西自然科学基金面上项目(2023GXNSFAA026064)