南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (9): 1629-1635.doi: 10.12122/j.issn.1673-4254.2023.09.22

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宫颈癌放疗后癌因性失眠患者的大脑功能网络与个体-经颅磁刺激干预的相关性：基于图论分析

刘 欢，饶 阳，孙传铸，王洋涛，齐 顺，李 想，田 萌，禹 汛，穆允凤   

  1. 西安交通大学数学与统计学院，类脑智能研究中心，生命科学与技术学院//健康与康复科学研究所//生物医学信息工程教育部重点实验室，陕西 西安 710049；陕西脑控脑科学研发中心，陕西 西安 710075；陕西省中医医院米氏内科，陕西 西安 710003；陕西省肿瘤医院妇瘤病院，陕西 西安 710065
  • 出版日期:2023-09-20 发布日期:2023-09-28

Changes of brain network in patients with insomnia following radiotherapy for cervical cancer and their correlation with IT-TMS treatment efficacy: a graph-theory analysis

LIU Huan, RAO Yang, SUN Chuanzhu, WANG Yangtao, QI Shun, LI Xiang, TIAN Meng, YU Xun, MU Yunfeng   

  1. School of Mathematics and Statistics, Research Center for Brain- Inspired Intelligence, School of Life Science and Technology//Institute of Health and Rehabilitation Science//The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Xi'an Jiaotong University; Shaanxi Brain Modulation and Scientific Research Center; Mi Shi Internal Medicine, Shaanxi Academy of Traditional Chinese Medicine; Department of Gynecological Oncology, Shaanxi Provincial Cancer Hospital
  • Online:2023-09-20 Published:2023-09-28

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摘要： 目的 基于图论分析探讨宫颈癌放疗后癌因性失眠患者脑功能网络小世界和节点属性的变化，并明确功能网络与个体-靶向经颅磁刺激（IT-TMS）治疗失眠效果的相关性。方法 采集30名患者和30名相匹配的健康对照者的静息态功能磁共振（rs-fMRI）数据，患者接受加速智能神经调节TMS疗法治疗；使用图论分析，通过GRETNA软件提取失眠中小世界网络的属性特征和构建功能连通性矩阵；收集患者IT-TMS治疗前后的和健康对照者的匹兹堡睡眠质量指数（PSQI）、失眠严重程度指数（ISI）、焦虑自评量表（SAS）和抑郁自评量表（SDS）等量表，研究失眠改善与功能网络的相关性；统计分析采用SPSS软件及基于网络的统计分析方法。结果 两组在年龄和受教育程度方面差异均无统计学意义（P>0.05），在PSQI、ISI、SAS和SDS量表数据差异有统计学意义（P<0.05）；两组均符合小世界网络属性，与对照组相比，在基线时患者组小世界网络全局属性表现出σ、EI、Cp和Lp显著减少（P<0.05），Eg显著增加（P<0.05），这些特征在IT-TMS治疗后均有所改善，且失眠症状显著改善；经IT-TMS治疗后节点网络功能连接减少，且右侧岛叶和左侧额上回之间的功能连通性减少与ISI评分的改善相关。结论 宫颈癌放疗后癌因性失眠患者大脑网络信息整合能力受损，IT-TMS通过降低默认网络和突显网络的超连通性，显著改善了失眠症状。

关键词: 宫颈癌；放疗；癌因性失眠；图论分析；小世界网络；个体-经颅磁刺激

Abstract: Objective To analyze the changes of brain small-world and node function network properties in patients with insomnia following radiotherapy for cervical cancer based on graph theory analysis and explore the correlation between functional networks and the clinical efficacy of individual- target transcranial magnetic stimulation (IT-TMS) for treatment of insomnia. Methods The resting state functional magnetic resonance imaging (rs-fMRI) data were collected from 30 patients with insomnia following radiotherapy for cervical cancer and 30 matched healthy individuals. All the patients received accelerated intelligent neuromodulation TMS therapy. Using graph theory analysis and GRETNA software, the functional connectivity matrices were constructed and the attribute features were extracted. The scores on the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Self- Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) of the participants were collected before and after IT-TMS, and the correlation between improvement in insomnia and the functional network was investigated. Results The two groups matched for age, gender, and education level (P>0.05) showed significant differences in PSQI, ISI, SAS and SDS scores (P<0.05). Both groups showed attributes of the small-world network. Compared with the healthy individuals, the patients showed significantly decreased σ, EI, Cp and Lp (P<0.05) and increased Eg (P<0.05) at baseline, which, along with insomnia symptoms, were all improved after IT-TMS treatment. The patients showed reduced functional connections of the node network at follow-up compared with the baseline, and the low functional connectivity between the right insula and left superior frontal gyrus was correlated with the improvement of ISI scores. Conclusion The patients with insomnia following radiotherapy for cervical cancer have impaired information integration ability of the brain network, IT-TMS can significantly improve insomnia symptoms by reducing the hyperconnectivity between the default mode network and the salience network.

Key words: cervical cancer; radiotherapy; insomnia; graph theory analysis; small-world network; individual-transcranial magnetic stimulation