原发开角型青光眼患者视觉注意缺陷的脑重组及机制研究

Primary open angle glaucoma (POAG) is the most common type of glaucoma, being the leading cause of irreversible vision loss globally. More than 50% patients with POAG had severe visual impairment at the first diagnosis. Approximately 22.0% and 17.1% of patients were accompanied by depression and anxiety, which seriously affected the patients’ quality of life. Recent evidence suggested that visual impairment and psychological disorders were closely related to the visual attention deficit of POAG patients. However, what changes had occurred in the visual attention network? Were these changes correlated with visual impairment and psychological disorders? To answer these questions, we hypothesize that there is a cross-modal reorganization among visual attention, visual and emotional networks in POAG patients, and these changes are associated with visual impairment and psychological disorders. We will apply task related simultaneous EEG-fMRI imaging to explore the visual attention deficit and its temporal-spatial dynamic response characteristics of POAG patients, and analyze the causality and interaction among attentional, visual and emotional networks. Furthermore, we explore the correlations between these changes and visual impairment and psychological disorders. The results will provide objective evidences for revealing reorganization and mechanism of brain in patients of POAG with visual attention deficit, intervening and slowing the development of disease and improving the quality of life.

原发开角型青光眼（POAG）是最常见的青光眼亚型，为全球首位不可逆致盲性眼病，超半数患者首诊时已有严重的视功能损伤，约22.0%和17.1%的患者伴发抑郁和焦虑等心理精神问题，严重影响患者生存质量。研究表明视功能损伤及焦虑、抑郁等症状与POAG患者的视觉注意缺陷有密切关系且相互影响并逐渐加重，但视觉注意网络及相关脑区究竟发生了怎样的改变以及这些改变与视功能损伤、心理精神障碍之间有何关系尚无明确定论。据此提出假说：POAG患者视觉注意网络与视觉及情绪相关脑网络发生了跨模态重组，并与视功能损伤和心理精神障碍程度相关。拟联合心理物理学刺激及同步EEG-fMRI技术研究POAG患者视觉注意网络的时-空间动态响应特点，探讨视觉注意网络、视觉网络及情绪相关网络的因果关系及交互作用的改变特点，验证假说，揭示POAG患者视觉注意缺陷的脑重组特征及发生机制，为临床干预减缓疾病进展过程及提高生存质量提供依据。

原发开角型青光眼（POAG）是最常见的青光眼亚型，为全球首位不可逆致盲性眼病，超半数患者首诊时已有严重的视功能损伤，约22.0%和17.1%的患者伴发抑郁和焦虑等心理精神问题，严重影响患者生存质量。研究表明视功能损伤及焦虑、抑郁等症状与POAG患者的视觉注意缺陷有密切关系且相互影响并逐渐加重，但视觉注意网络及相关脑区究竟发生了怎样的改变以及这些改变与视功能损伤、心理精神障碍之间有何关系尚无明确定论。本项目基于POAG患者视觉注意网络与视觉及情绪相关脑网络发生了跨模态重组，并与视功能损伤和心理精神障碍程度相关的假说，采用心理物理学刺激EEG成像、fMRI技术，探讨视觉注意网络、视觉网络及情绪相关网络的因果关系及交互作用的改变特点。研究发现：青光眼患者从初级视觉皮层到高级皮层的信息流减少，自上而下的处理得到增强；其信息流改变与视皮质的微结构损伤有关。脑血流异常脑区累及视觉通路之外，包括体感皮层、情绪、注意及其他高级认知网络。患者视觉网络、体感皮层、情绪、注意及其他高级认知网络的神经血管单元复合体损伤，且视觉区的神经血管单元复合体损伤与视野缺损显著相关。双侧初级视觉皮层、腹侧及背侧视觉皮质、顶下小叶及右侧额下回稳定性异常。POAG风险基因与多发性硬化症、阿尔兹海默症存在重叠；而POAG风险基因中与自发脑活动局部一致性相关的基因涉及少突胶质细胞基因表达谱，且与帕金森病遗传位点显著相关。基于多模态磁共振成像的研究，证实了POAG患者视觉、情绪及注意网络相关脑区的脑微细结构、功能及脑灌注的异常且与疾病严重程度显著相关，为POAG患者视觉注意缺陷的脑重组提供了理论依据，并通过探究脑改变相关的基因和神经递质系统，为POAG患者脑功能改变提供了潜在的生物学机制。进一步为POAG是神经退行性疾病的假说提供证据支撑，为提出针对性的临床干预措施、提高患者生存质量提供理论指导和参考依据。