卒中后焦虑的脑网络定位研究

Brain Network Localization of Post-Stroke Anxiety

摘要: 卒中后焦虑(Post-stroke anxiety, PSA)是卒中后常见的神经精神并发症，显著影响患者的功能恢复和生活质量。传统病灶–症状定位方法受限于病灶空间异质性，难以稳定揭示卒中后焦虑的神经基础。本研究基于病灶网络映射(Lesion Network Mapping, LNM)方法，将急性缺血性脑卒中患者病灶映射至大样本健康人群静息态功能连接组数据，构建PSA病灶衍生功能网络。研究纳入33例，病灶主要分布于额叶、顶叶及基底节区域。网络映射结果显示，PSA相关功能网络以双侧岛叶–前扣带回为核心的突显网络(Salience Network, SN)和基底节环路为核心，核心网络收敛显著，高级视觉网络呈现负功能连接显著特征，是PSA过程中未受功能扰动的核心保留脑网络。PSA网络与焦虑障碍灰质萎缩坐标网络的空间相似性(Dice系数0.36)，提示部分共享结构基础。研究结果表明，卒中后焦虑的发生与SN-基底节功能网络异常密切相关，而非单一区域病灶所致，为卒中后焦虑的神经机制解析及基于网络的精准干预提供理论依据。

Abstract: Post-stroke anxiety (PSA) is a common neuropsychiatric complication following stroke that significantly impacts patients’ functional recovery and quality of life. Traditional lesion-symptom mapping methods are limited by the spatial heterogeneity of lesions, making it difficult to reliably identify the neural basis of post-stroke anxiety. This study employed the Lesion Network Mapping (LNM) method to map lesions from patients with acute ischemic stroke onto resting-state functional connectivity data from a large healthy control cohort, thereby constructing a lesion-derived functional network for PSA. The study included 33 participants, with lesions primarily distributed in the frontal, parietal, and basal ganglia regions. Network mapping results revealed that the PSA-associated functional network consists of a salience network (SN) centered on the bilateral insula-anterior cingulate cortex and a basal ganglia loop. The core network showed significant convergence, while the higher-order visual network exhibited significant negative functional connectivity, representing a core preserved brain network that remains functionally intact during the PSA process. The spatial similarity between the PSA network and the gray matter atrophy coordinate network associated with anxiety disorders (Dice coefficient 0.36) suggests a partially shared structural basis. The findings indicate that the occurrence of post-stroke anxiety is closely associated with abnormalities in the SN-basal ganglia functional network, rather than being caused by lesions in a single region, providing a theoretical basis for elucidating the neural mechanisms of post-stroke anxiety and for network-based precision interventions.