基于静息态磁共振功能成像对阿尔茨海默病轻度认知障碍期默认网络与内侧颞叶区脑功能连接研究的Meta分析

doi:10.3969/j.issn.1006-9771.2026.05.003

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (5): 522-533.doi: 10.3969/j.issn.1006-9771.2026.05.003

基于静息态磁共振功能成像对阿尔茨海默病轻度认知障碍期默认网络与内侧颞叶区脑功能连接研究的Meta分析

韩天星¹, 刘昊天¹, 徐子淇¹, 彭晓涵¹, 王杨², 曹丹娜²()

¹ 黑龙江中医药大学第一临床医学院，黑龙江哈尔滨市 155040
² 黑龙江中医药大学附属第一医院CT磁共振科，黑龙江哈尔滨市 155040

收稿日期:2025-11-19 出版日期:2026-05-25 发布日期:2026-05-26
通讯作者: 曹丹娜，E-mail：hljanna@126.com
作者简介:韩天星(2001-)，男，汉族，辽宁辽阳市人，硕士研究生，主要研究方向：中枢神经系统的临床与医学影像学研究。
曹丹娜(1980-)，女，博士，副主任医师、教授，硕士研究生导师，主要研究方向：中枢神经系统的临床与医学影像学研究、腧穴特异性影像学研究。
基金资助:
黑龙江省自然科学基金联合引导项目(LH2021H101)

Functional connectivity in default mode network and medial temporal lobe in mild cognitive impairment stage of Alzheimer's disease based on resting-state functional magnetic resonance imaging: a meta-analysis

HAN Tianxing¹, LIU Haotian¹, XU Ziqi¹, PENG Xiaohan¹, WANG Yang², CAO Danna²()

¹ The First Clinical Medical College of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 155040, China
² The CT and MRI Department of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 155040, China

Received:2025-11-19 Published:2026-05-25 Online:2026-05-26
Contact: CAO Danna, E-mail: hljanna@126.com
Supported by:
Joint Guidance Project of Heilongjiang Natural Science Foundation(LH2021H101)

摘要/Abstract

摘要：

目的探讨静息态功能磁共振成像(rs-fMRI)对阿尔茨海默病(AD)轻度认知障碍(MCI)期影像学诊断价值，探索在默认网络(DMN)与内侧颞叶区(MTL)脑功能连接变化特征。
方法系统检索2020年1月至2025年10月中国知网、PubMed、Medline、Embase等多个数据库，基于rs-fMRI比较MCI患者与健康对照(HC) DMN和MTL功能连接的相关研究。由2名研究人员独立采用QUADAS-2筛查并提取文献，将纳入文献进行方法学质量检测。采用Review Manager 5.4对MCI患者和HC受试者神经影像指标进行Meta分析，通过Stata、SDM软件进行诊断效能合并和脑功能连接坐标整合分析，计算合并敏感性、特异性、集成受试者工作特征曲线下面积(SROC-AUC)，绘制Deeks漏斗图，分析文献权重并进行亚组分析。
结果最终纳入10篇文献，涉及MCI患者1 010例，HC 1 714例。MCI患者在DMN存在血氧水平依赖信号下降或异常，以双侧内侧前额皮质(mPFC)和后扣带回为核心，SROC-AUC=0.91。在MTL存在与海马区之间的自发神经功能连接减少，反映MCI患者从情景记忆中提取信息至DMN中枢节点的信息传递过程受阻。DMN和MTL的功能连接异常会引起其他子网络或局部功能连接代偿性增强，以额顶网络和海马体-顶叶网络最为明显，mPFC的异常激活提示了海马区萎缩或脑功能活动异常。DMN和MTL功能连接可以提示MCI从早期发展到记忆障碍、信息加工功能衰退等临床进展。
结论 DMN和MTL间早期功能解耦是AD-MCI期关键的神经机制，为研究AD早期诊断提供重要神经影像学依据。

关键词: 阿尔茨海默病, 静息态功能磁共振成像, 默认网络, 内侧颞叶区, Meta分析

Abstract:

Objective To explore the diagnostic value of resting-state functional magnetic resonance imaging (rs-fMRI) for mild cognitive impairment (MCI) stage of Alzheimer's disease (AD), and to investigate the changes in brain functional connectivity in default mode network (DMN) and medial temporal lobe (MTL) regions.
Methods Literatures were retrieved from multiple databases including CNKI, PubMed, Medline, and Embase, etc. from January, 2020 to October, 2025, investigating the changes in functional connectivity of DMN and MTL in patients with MCI compared to health control (HC) using rs-fMRI. Two researchers independently screened and extracted the literatures and methodological quality was assessed using QUADAS-2. Review Manager 5.4 was used to perform a meta-analysis of neuroimaging indicators in MCI patients and HC subjects. Stata and SDM were utilized to summarize diagnostic efficacy and brain functional connectivity, calculating the over all sensitivity, specificity and summary receiver operating characteristic-area under the curve (SROC-AUC). Deeks funnel plots were drawn, literature weights were analyzed, and subgroup analyses were conducted.
Results A total of ten literatures were ultimately included, involving 1 010 patients with MCI and 1 714 HC subjects. MCI patients showed decreased or abnormal blood oxygen level dependence signals in DMN, focusing on bilateral medial prefrontal cortex (mPFC) and posterior cingulate cortex. The SROC-AUC was 0.91. In MTL, there was a characteristic decrease of spontaneous neural functional connectivities between the hippocampus and other regions, reflecting the obstruction of information transmission from episodic memory to the central nodes. Abnormal functional connectivity in DMN and MTL resulted in compensatory resting-state functional connectivity enhancement in other subnetworks or local functional connections, such as frontoparietal network and the hippocampal-parietal network. Abnormal activation of mPFC suggested atrophy of the hippocampus or abnormal brain function. The decline in functional connectivity between DMN and MTL indicated impairment of memory and information processing in the early stage.
Conclusion The early functional decoupling between DMN and MTL is a crucial neural mechanism at the MCI stage of AD, providing important neuroimaging evidence for the early diagnosis of AD.

Key words: Alzheimer's disease, resting-state functional magnetic resonance imaging, default mode network, mesial temporal lobe, meta-analysis

中图分类号:

R749.1

韩天星, 刘昊天, 徐子淇, 彭晓涵, 王杨, 曹丹娜. 基于静息态磁共振功能成像对阿尔茨海默病轻度认知障碍期默认网络与内侧颞叶区脑功能连接研究的Meta分析[J]. 《中国康复理论与实践》, 2026, 32(5): 522-533.

HAN Tianxing, LIU Haotian, XU Ziqi, PENG Xiaohan, WANG Yang, CAO Danna. Functional connectivity in default mode network and medial temporal lobe in mild cognitive impairment stage of Alzheimer's disease based on resting-state functional magnetic resonance imaging: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(5): 522-533.

图/表 10

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纳入文献的影像特征和文献质量评价"

纳入文献	敏感性/%	特异性/%	影像特征	异常脑区MNI坐标与团块大小				NOS评分
纳入文献	敏感性/%	特异性/%	影像特征	x	y	z	体积/mm³	NOS评分
Cao等^[29](2021)	95.30	74.49	DMN中双侧内侧前额皮质、后扣带楔前叶、腹侧前扣带回BOLD活动降低；mPFC与PCC之间FC下降；楔前叶与PCC fALFF下降；前额叶皮质ReHo降低	3	-47	22	442	8
Liao等^[30](2022)	88.43	78.21	右中额回、右扣带后回BOLD活动降低；PCC和MTL FC下降；内侧前颞叶fALFF升高不显著，楔前叶与PCC fALFF下降；后部DMN、海马区、前额叶皮质ReHo下降	6	-55	30	376	8
Xiong等^[31](2022)	96.90	81.20	尾状核与小脑亚区、尾状核与额下回、尾状核、内侧前额叶皮质BOLD活动降低；DMN内部FC广泛降低；双侧内侧前额皮质和PCC之间fALFF下降，后扣带皮质ReHo降低	-4	-47	24	209	9
Sendi等^[32](2021)	95.00	72.00	视交叉上核、运动神经元存活基因、自动决策支持系统、细胞间基质蛋白族BOLD活动降低；后扣带楔前页和腹侧前扣带回存在FC下降情况，内侧前颞叶ReHo变化不一致，楔前叶ReHo下降	±47	-57	33	588	9
Soman等^[33](2020)	89.30	73.50	DMN、运动神经元存活基因、顶网络、背侧注意网络BOLD活动降低；PCC与海马体之间FC下降；尾状和前额叶皮质之间fALFF下降，DMN内ReHo普遍性降低	±38	-66	28	381	7
Ghahremani等^[34](2023)	95.35	80.15	DMN、脑皮质区域BOLD活动降低；MTL内FC下降；右扣带后回fALFF下降；海马体边缘与楔前叶ReHo下降	2	-46	24	761	8
Hojjati等^[35](2025)	91.40	77.30	视觉网络、运动网络、背侧注意网络、凸显网络、控制网络、边缘网络和DMN中tau蛋白和Aβ蛋白沉积，BOLD活动降低；楔前叶ReHo下降	-5	46	-13	447	8
Takao等^[36](2021)	91.90	74.30	感觉运动网络、执行控制网络、视觉网络、DMN、背侧注意网络、凸显网络、双侧内侧前额皮质BOLD活动降低；MTL及海马区fALFF下降	4	47	-9	736	8
Saberian等^[37](2025)	92.40	80.70	神经丝轻链、DMN BOLD活动降低，右扣带后回fALFF下降，PCC与海马体之间FC下降，多基因风险评估显示AD风险增加	±66	-60	28	337	9
Mohammadian等^[38](2023)	87.80	83.60	DMN、凸显网络、背侧注意网络、视觉网络、前额顶叶、语言中枢和小脑皮质神经元BOLD活动降低；PCC、内侧前额叶皮质和颞顶联合区存在不同程度FC下降；MTL特别是海马旁回和海马体之间ReHo降低、fALFF下降	3	55	-11	509	7

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条目	是^a	否^b	不能回答^c	不适用^d
1.研究对象是否为连续或随机样本?	√
2.研究对象的选择是否避免了不恰当的选择标准?	√
3.待评价试验的测量方法是否有效和可靠?	√
4.待评价试验的结果判读是否是在不知晓结局的情况下进行的?	√
5.测量结局的方法是否有效和可靠?	√
6.衡量所有研究对象结局的方法是否相同?	√
7.结果判读是否使用了盲法?	√
8.所有进行评价试验后的研究对象是否都避免了治疗?	√
9.是否所有的研究对象均纳入统计分析?	√
10.是否采用了恰当的方法来说明删失?	√

纳入文献	种子点	样本量(男/女)/n		平均年龄(C/T)/岁	诊断标准
纳入文献	种子点	C	T	平均年龄(C/T)/岁	诊断标准
Cao等^[29](2021)	PCC、HIP、MTL	40/29	25/13	(69.16±4.96)/(68.46±4.97)	AD临床评估、ADAS-Cog
Liao等^[30](2022)	PCC、右HIP、mPFC、PFcm	37/36	76/64	(68.28±9.64)/(66.30±9.52)	MMSE、MoCA
Xiong等^[31](2022)	PCC、PF	6/10	17/15	(68.28±9.64)/(66.30±9.52)	ADNI、MMSE、GDS、CDR、FAQ、NPI-Q
Sendi等^[32](2021)	PCC	498/530	166/191	(75.1±7.85)/(69.83±8.64)	影像数据分析、CDR
Soman等^[33](2020)	PCC、MTL	12/19	26/34	(65.7±6.0)/(65.1±6.7)	ACE-M
Ghahremani等^[34] (2023)	PFcm、Pfop、PFt、PFm、 Pga、PGp	35/28	18/14	(73.9±8.1)/(70.6±6.7)	MBIC、MoCA
Hojjati等^[35](2025)	PCC、HIT、MTL	176/185	88/80	(68.41±6.15)/(64.96±3.17)	MMSE、MoCA
Takao等^[36](2021)	mPFC、PCC、HIP	18/13	38/42	(71.9±7.0)/(76.0±7.2)	MMSE
Saberian等^[37](2025)	PCC、MTL	13/15	23/51	(71.74±6.51)/(72.26±5.95)	CDR、MMSE
Mohammadian等^[38](2023)	PCC、HIT、MTL	4/10	12/17	(72.87±4.34)/(71.17±2.59)	MMSE

结局指标	结果	异质性检验		SMD(95%CI)	效应模型
结局指标	结果	I²值/%	P值	SMD(95%CI)	效应模型
合并敏感性	0.92	46.66%	<0.001	0.88~0.94	随机效应
合并特异性	0.79	52.33%	<0.001	0.75~0.83	随机效应
LR+	0.89	39.73%	<0.001	0.82~0.93	随机效应
LR-	0.31	41.49%	<0.001	0.25~0.38	随机效应
DOR	0.66	55.13%	<0.001	0.58~0.75	随机效应
SROC-AUC	0.91	—	—	0.88~0.93	固定效应

亚组变量	纳入分析数量	合并敏感性(95%CI)	合并特异性(95%CI)	Meta回归联合P值
病例来源 ADNI数据库非ADNI数据库	566 789	0.88 (0.82, 0.89) 0.84 (0.81, 0.92)	0.94 (0.92, 0.96) 0.93 (0.87, 0.95)	0.67
场强 1.5 T 3.0 T	842 204	0.85 (0.82, 0.88) 0.90 (0.88, 0.91)	0.91 (0.88, 0.95) 0.95 (0.91, 0.99)	0.03
线圈类型 PA ER	649 703	0.86 (0.82, 0.88) 0.89 (0.86, 0.90)	0.90 (0.88, 0.93) 0.90 (0.86, 0.92)	0.86

基于静息态磁共振功能成像对阿尔茨海默病轻度认知障碍期默认网络与内侧颞叶区脑功能连接研究的Meta分析

Functional connectivity in default mode network and medial temporal lobe in mild cognitive impairment stage of Alzheimer's disease based on resting-state functional magnetic resonance imaging: a meta-analysis

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