心理性ED神经病理环路时空特征的多模态脑影像学研究及rTMS定位治疗模型的建立

The morbidity rate of psychogenic erectile dysfunction (pED) is rising, however, its etiology is still unclear. There is only a few studies about the relationship between the changes of brain functional activity and specific stimulus. The use of multimodal brain magnetic resonance imaging in exploring the dynamic evolution process of specific pathological loops of pED has not been reported. We had made a preliminary exploration about the characteristics of the functional activity in local brain regions by using the resting state magnetic resonance imaging. The results show that the abnormal changes of the neural circuit between cortical and subcortical regions are deviated. Nevertheless, the understanding of the spatiotemporal pattern for whole neural networks that are responsible for the regulation of penile erection is very limited. The project aims to use the methods of resting and task state of brain imaging to observe the characteristic changes of cerebral function activity: (1) Exploring the dynamic characteristics of cortical and subcortical circuits in terms of the order, scope and connectivities; (2) Analysising the correlation between the abnormal circuits and the specific clinical symptoms, cognitive, psychopathic and psychological factors, to find indicators that are available for early recognition; (3) Choosing abnormal brain regions to provide evidences for physical therapy means about the orientated treatment of pED.

心理性勃起功能障碍（psychogenic erectile dysfunction, pED）的患病率日益上升，但其病因不明。目前仅有少数关于pED脑功能活动改变与特定刺激关联性的研究，尚未见到利用多模态脑影像学技术对特定神经环路功能的动态演变过程进行探索的报道。我们前期利用静息态核磁共振对pED局部脑区功能活动的变化特征进行了初步探索，发现皮层-皮层下神经环路间存在分离性异常改变，但对于脑内调控阴茎勃起的整个中枢神经网络的时空连接模式了解还非常有限。本项目旨在结合静息态与任务态脑影像学，在体观察pED脑神经功能活动的变化特征：（1）探讨皮层-皮层下特定神经环路在功能活动次序、范围和连接等方面存在的变化；（2）分析与特定临床症状以及认知、精神、心理因素相关的脑影像学改变，寻找有助于疾病早期识别的指标；（3）挑选出功能异常脑区作为靶点，为建立定位治疗pED的的物理手段提供理论依据。

心理性勃起功能障碍（pED）目前发病机制不明。既往研究大多从器质性ED入手，pED涉及很少。本研究项目对pED患者中枢性病理神经机制进行初步探索，发现pED患者大脑情绪环路与认知网络存在功能与结构异常。（1）脑白质结构网络研究发现：pED患者大脑中左侧前额叶-边缘系统神经环路拓扑属性的异常与ED的发生相关，并与其抑郁情绪严重程度、病程相关；（2）脑功能网络研究发现：pED患者脑网络中额-顶叶子网络与额-边缘系统环路“小世界”属性和模块化属性受损，导致患者大脑对性唤起的情绪、认知处理功能紊乱，并与其疾病严重程度、病程相关；（3）多模态脑影像学研究发现：pED患者脑结构与功能网络整体拓扑属性与正常对照者无明显异常，但其存在重要脑区及其间结构连接的受损，导致患者脑网络稳定性下降，尤其是功能性脑网络，这些中枢性病理神经改变与异常心理因素，可能共同导致pED的发生。pED的中枢性病理神经机制探索工作已完成，在此基础上可发展更加有效的辅助pED诊断的影像学指标，使得pED的诊断更加科学客观，有利于ED的早期诊断，提高诊断的正确率，可广泛地应用在男科临床和科研工作。