【摘要】 目的 探究轻度创伤性颅脑损伤患者脑结构网络的改变与未来睡眠障碍的关联。方法 前瞻性搜集轻度创伤性颅脑损伤患者198例（mTBI组）及与之匹配的健康对照者60名（HC组）。以出院3个月后的匹兹堡睡眠质量指数量表（PSQI）为评估手段，将轻度创伤性颅脑损伤患者分为睡眠障碍组（mTBI-SD组）和无睡眠障碍组（mTBI-ND组）。利用方差分析比较3组受试者脑结构网络属性。构建Logistic回归模型探究脑结构网络属性与未来睡眠障碍发病风险的关联。采用Pearson相关分析探究脑结构网络属性与PSQI评分的相关性。结果 3组受试者脑结构网络属性存在显著的组间差异。与mTBI-ND组相比，mTBI-SD组表现出较高的特征路径长度，较低的左前扣带回和旁扣带回节点效率。Logistic回归模型显示特征路径长度(OR_{特征路径长度}=0.74,95%CI:0.63～0.94,P<0.001)、左前扣带和旁扣带回的节点效率(OR_ACG.L=0.70,95%CI:0.65～0.80,P<0.001)可以显著预测mTBI-SD的发生，受试者工作特征曲线下面积分别为0.75、0.74。相关分析结果显示mTBI-SD组的特征路径长度（r=-0.41,P<0.01）、左前扣带和旁扣带回的节点效率（r=-0.50,P<0.01）与发病后3个月的PSQI评分相关。结论 mTBI显著改变患者的脑结构网络连接属性，存在特征路径长度、左前扣带回和旁扣带回的节点效率改变的患者更容易在未来发生睡眠障碍。更多还原

【Abstract】 Objective To investigate the association between changes in brain structural network of patients with mild traumatic brain injury and future sleep disorders（mTBI-SD）. Methods A total of 198 patients with mild traumatic brain injury（mTBI group） and 60 matched healthy controls（HC group） were prospectively collected. Using the Pittsburgh Sleep Quality Index（PSQI） three months after discharge as an assessment tool, mTBI patients were divided into a sleep disorder group（mTBI-SD group） and a non-sleep disorder group（mTBI-ND group）. Analysis of variance（ANOVA） was used to compare the brain structural network properties among the three groups. The logistic regression model was constructed to explore the association between brain structural network properties and the risk of future sleep disorders. Pearson correlation analysis was performed to investigate the correlation between brain structural network properties and PSQI scores. Results Significant differences in brain structural network properties were observed among the three groups. Compared to the mTBI-ND group, the mTBI-SD group showed higher characteristic path length and lower node efficiency in the left anterior cingulate gyrus（ACG.L）. The logistic regression model revealed that characteristic path length(OR_{characteristic path length}=0.74, 95%CI:0.63-0.94, P<0.001) and node efficiency in ACG.L(OR_ACG.L=0.70, 95%CI:0.65-0.80, P<0.001) could significantly predict the occurrence of mTBI-SD, with area under the receiver operating characteristic curve（AUC） values of 0.75 and 0.74, respectively. Correlation analysis showed that the characteristic path length（r=-0.41, P<0.01） and node efficiency in ACG.L（r=-0.50, P<0.01） in the mTBI-SD group were correlated with PSQI scores three months after the onset of the disease. Conclusion mTBI significantly alters the brain structural network connectivity properties of patients, and those with changes in characteristic path length and node efficiency in ACG.L are more likely to develop sleep disorders in the future.更多还原