【摘要】 目的 应用静息态功能磁共振成像(rs-fMRI)-低频波动振幅(ALFF)技术分析失眠障碍(ID)患者应用益生菌干预前后局部脑区神经活动的强度变化，探讨益生菌对ID患者睡眠、情绪的改善作用。方法 2022年12月—2023年12月河南省人民医院诊治ID患者32例，随机分为观察组20例和对照组12例。观察组给予多菌种益生菌(由瑞士乳杆菌、副干酪乳杆菌、嗜热链球菌组成),对照组给予包装及规格与多菌种益生菌相同的安慰剂，均每日晚饭后温水冲服或直接口服，6 g/d,连续4周。比较2组干预前、干预4周后匹兹堡睡眠质量指数(PSQI)、失眠严重程度指数(ISI)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分；采集2组干预前、干预4周后rs-fMRI数据进行ALFF分析，计算ALFF值。结果 干预前观察组PSQI[(14.400±2.872)分]、ISI[(15.950±5.083)分]、HAMA[(10.200±8.575)分]、HAMD [(12.150±7.842分)]评分与对照组[(13.250±2.340)、(13.917±4.316)、(14.167±9.331)、(11.833±4.529)分]比较差异均无统计学意义(t=0.492,P=0.488;t=1.484,P=0.233;t=0.746,P=0.359;t=1.856,P=0.183)。观察组干预后PSQI[(9.200±2.984)分]、ISI[(10.750±5.693)分]、HAMA[(9.465±7.300)分]、HAMD[(8.350±7.205)分]评分均低于干预前(t=7.984,P<0.001;t=4.690,P=0.001;t=2.610,P=0.017;t=2.916,P=0.009);对照组干预后HAMA评分[(11.167±7.481)分]低于干预前(t=2.324,P=0.040),PSQI[(12.667±2.535)分]、ISI[(13.250±5.561)分]、HAMD[(12.250±5.011)分]评分与干预前比较差异均无统计学意义(t=1.541,P=0.152;t=0.842,P=0.417;t=-0.392,P=0.702)。干预后观察组PSQI评分低于对照组(t=-3.358,P=0.002),ISI、HAMA、HAMD评分与对照组比较差异均无统计学意义(t=-1.213,P=0.235;t=-1.205,P=0.238;t=-1.646,P=0.110)。观察组干预后右侧颞上回ALFF值低于干预前(GRF校正，体素水平P<0.01,团块水平P<0.05);对照组未发现干预前后ALFF值差异有统计学意义的脑区。结论 ID患者应用多菌种益生菌后睡眠质量改善，焦虑、抑郁情绪缓解，可能与多菌种益生菌改变了睡眠、情绪相关脑区神经活动的强度有关；rs-fMRI-ALFF技术可客观评估干预前后脑功能变化。更多还原

【Abstract】 Objective To analyze the changes in the intensity of neural activity in local brain regions of insomnia disorder(ID) patients by resting-state functional magnetic resonance imaging(rs-fMRI)-amplitude of low-frequency fluctuation(ALFF) technique before and after probiotic intervention,and to invesitage the effect of probiotics on improving sleep and mood of ID patients.Methods Thirty-two ID patients were diagnosed and treated in Henan Provincial People’s Hospital from December 2022 to December 2023,and were randomly divided into observation group(n=20) and control group(n=12).The patients in observation group received multi-strain probiotics(composed of Lactobacillus Swiss,Lactobacillus paracaseus and Streptococcus thermophilus),and the patients in control group took 6 g/d placebo which had the same packaging and specifications as the multi-strain probiotics,in warm water or directly swalloned after dinner,for 4 consecutive weeks.The Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),Hamilton Anxiety Scale(HAMA),and Hamilton Depression Scale(HAMD) scores were compared between two groups before and 4 weeks after intervention.The rs-fMRI data were collected for ALFF analysis before and 4 weeks after intervention,and the ALFF value was calculated.Results The scores of PSQI,ISI,HAMA and HAMD showed no significant differences between observation group(14.400 ± 2.872,15.950 ± 5.083,10.200 ± 8.575,12.150 ± 7.842) and control group(13.250 ± 2.340,13.917 ± 4.316,14.167 ± 9.331,11.833±4.529) before intervention(t=0.492,P=0.488;t=1.484,P=0.233;t=0.746,P=0.359,t=1.856,P=0.183),and were lower in observation group after intervention(9.200±2.984,10.750±5.693,9.465±7.300,8.350±7.205) than those before intervention(t=7.984,P<0.001;t=4.690,P=0.001;t=2.610,P=0.017;t=2.916,P=0.009).In control group,the HAMA score was lower after intervention(11.167 ± 7.481) than that before intervention(t=2.324,P=0.040),and the scores of PSQI,ISI and HAMD were not significant different after intervention(12.667 ± 2.535,13.250 ± 5.561,12.250 ± 5.011) compared with those before intervention(t=1.541,P=0.152;t=0.842,P=0.417;t=-0.392,P=0.702).After intervention,the PSQI was lower in observation group than that in control group(t=-3.358,P=0.002),the scores of ISI,HAMA and HAMD showed no significant differences between groups(t=-1.213,P=0.235;t=-1.205,P=0.238;t=-1.646,P=0.110).The ALFF value of the right superior temporal gyrus in observation group was lower after intervention than that before intervention(GRF-adjusted,voxel level P<0.01,mass level P<0.05).No brain regions with different ALFF values before and after intervention were found in control group.Conclusions The application of multi-strain probiotics can improve the sleeping quality,and relive anxiety and depression,which might be correlated with the changes of intensity of sleeping-and emotion-related neural activity in brain regions of ID patients after application of multi-strain probiotics.The rs-fMRI-ALFF technique can objectively reflect the changes of brain function before and after intervention.更多还原