本文關鍵詞：帕金森病伴嗅覺障礙患者腦結構和腦功能改變的MRI評價　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 帕金森病 嗅覺障礙 結構磁共振 灰質體積 功能磁共振 功能連接

【摘要】：背景和目的帕金森病是一種常見的中樞神經(jīng)系統(tǒng)變性疾病,多見于中老年人,平均發(fā)病年齡約為60歲。其臨床表現(xiàn)主要包括靜止性震顫、運動遲緩和肌強直等,同時患者可伴有嗅覺障礙、睡眠障礙和認知障礙等非運動癥狀。帕金森病患者不能治愈和逆轉,患者晚期容易失去獨立自主能力,給家庭及社會造成嚴重負擔。嗅覺功能障礙是帕金森病患者最常見的前期臨床非運動癥狀之一。帕金森病患者的嗅覺磁共振研究有助于其臨床早期診斷、鑒別診斷以及發(fā)病機制的探究,具有重要的研究意義和臨床診斷價值。近年來研究者們使用磁共振各種成像技術,發(fā)現(xiàn)了帕金森病伴嗅覺障礙患者存在腦結構和腦功能的改變。本研究采用高分辨磁共振成像技術、基于體素的形態(tài)學分析(VBM)及功能連接(FC)相結合的分析方法,探究帕金森病伴嗅覺障礙患者的嗅球、大腦灰質結構及腦功能的變化。材料與方法本研究共收集56例帕金森病伴嗅覺障礙患者和43例年齡、性別相匹配的正常對照。采用Prisma 3.0 T磁共振掃描儀對所有被試進行高分辨磁共振成像(T2-spc-cor)序列、3D-T1WI結構像(T1-mprage)序列和靜息態(tài)功能磁共振(rs-fMRI)序列掃描。掃描時盡可能固定住被檢查者的頭部,同時囑其閉眼、保持清醒、精神放松、全身靜止。1.在T2-spc-cor序列圖像上逐層手工勾畫出嗅球輪廓,各層面內嗅球面積乘以層厚相加得到嗅球體積,每例均測量3次取平均值。2.采用基于Matlab平臺的SPM8軟件對3D-T1WI結構像行預處理:分割配準、空間標準化、重采樣和空間平滑。3.采用DPARSFA和SPM8軟件對rs-fMRI數(shù)據(jù)進行后處理。選取兩組大腦灰質體積有差異的腦區(qū)作為ROI,然后與全腦進行靜息態(tài)功能連接分析。4.統(tǒng)計學分析:運用SPSS 19.0軟件,對病例組和對照組的嗅球體積行兩獨立樣本t檢驗。運用Spearman相關分析法對嗅球體積結果和臨床指標的相關性進行分析。采用SPM8軟件進行兩獨立樣本t檢驗,分別比較病例組和對照組大腦灰質體積及靜息態(tài)功能連接的差異。各統(tǒng)計分析過程以α=0.05為檢驗水準,當P0.05時,認為差異有統(tǒng)計學意義。結果1.帕金森病伴嗅覺障礙組的左、右側及平均嗅球體積,與正常對照組相比明顯減小,差異有統(tǒng)計學意義(t值分別為-3.804,-4.945,-4.593,P均0.05);與臨床病程、H-Y分級、UPDRS總分均未發(fā)現(xiàn)相關關系(P均0.05);與嗅覺測試分值呈正相關(P0.05)。2.與正常對照組相比,帕金森病伴嗅覺障礙組的雙側顳上回(STG)灰質體積(GMV)顯著減小(P0.05,cluster size1004voxels)。3.將雙側顳上回(STG)作為感興趣區(qū)(ROI)進行全腦體素水平的靜息態(tài)功能連接分析,發(fā)現(xiàn)帕金森病伴嗅覺障礙組左側顳上回(STG)與右側中央前回(MPG)、右側枕中回(MOG)的rs FC減低(P0.05,cluster size139voxels)。結論1.帕金森病伴嗅覺障礙患者嗅球體積明顯減小,嗅球體積定量分析有助于帕金森病嗅覺障礙的評估,為臨床診斷提供幫助。2.帕金森病伴嗅覺障礙患者較正常人存在腦內嗅覺相關區(qū)域的結構和功能異常,主要表現(xiàn)為灰質體積萎縮和功能連接減弱。
[Abstract]:Background and objective: Parkinson's disease is a common neurodegenerative disease, more common in the elderly, the average age is about 60 years old. The main clinical manifestations include resting tremor, bradykinesia and myotonia, while patients with olfactory dysfunction, sleep disorders and cognitive impairment in patients with no other non motor symptoms. Parkinson's disease cure and reversion, patients with advanced easy to lose independent ability, a serious burden to family and society. It is the most common clinical early olfactory dysfunction in patients with Parkinson's disease. One of the non motor symptoms of olfactory magnetic resonance imaging study in patients with Parkinson's disease may contribute to the early clinical diagnosis, differential diagnosis and explore the pathogenesis, clinical and the diagnostic value of significance. The researchers used magnetic resonance imaging technology in recent years, found Parkinson's disease with olfactory dysfunction The brain structure and brain function change. This study uses high resolution magnetic resonance imaging, voxel based morphometry (VBM) and functional connectivity (FC) analysis method combining the study of Parkinson disease with the olfactory bulb, changes in brain gray matter structure and brain function. Materials and methods of this data were collected from 56 cases of Parkinson disease with olfactory dysfunction patients and 43 age and sex matched normal controls. Using Prisma 3 T magnetic resonance scanner. All of the subjects were high resolution magnetic resonance imaging (T2-spc-cor) sequence, 3D-T1WI like structure (T1-mprage) sequence and resting state functional magnetic resonance imaging (rs-fMRI) sequences. Scanning as much as possible to fix the head of the inspector is, at the same time have their eyes closed, stay awake, relax, the body still.1. in the T2-spc-cor sequence image layer manually outline the olfactory bulb outline, each level within the area multiplied by the layer of olfactory bulb The thickness can be obtained by adding the olfactory bulb volume were measured 3 times the average.2. Matlab platform using SPM8 software based on 3D-T1WI structure as the preprocessing: segmentation and registration, spatial normalization, resampling and spatial smoothing.3. using the rs-fMRI data DPARSFA and SPM8 software. The postprocessing selects two groups of brain gray matter volume the differences in brain regions as ROI, then.4. was employed to analyze the resting state functional connectivity analysis and whole brain: the use of SPSS 19 software, olfactory bulb volume of the patients and the control group of two independent samples t test. Correlation analysis using Spearman correlation of olfactory bulb volume results and clinical indicators were analyzed by two independent. Sample t test using SPM8 software were compared between cases and group differences in brain gray matter volume and resting state functional connectivity control. The process of statistical analysis to test the level of a =0.05, when P0.05, that difference There was statistical significance. Results of the 1. patients with Parkinson's disease olfactory disorder group left, right and average olfactory bulb volume, compared with the normal control group was significantly decreased, the difference was statistically significant (t = -3.804, -4.945, -4.593, P 0.05); and the clinical course, H-Y grade, UPDRS score were not found the relationship (P 0.05); positively correlated with olfactory test scores (P0.05.2.) compared with the normal control group, Parkinson disease with olfactory disorder group bilateral superior temporal gyrus (STG) gray matter volume (GMV) decreased significantly (P0.05, cluster size1004voxels).3. double lateral temporal gyrus (STG) as a region of interest (ROI) analysis on the connection of the resting state functional whole brain voxel level, found Parkinson's disease with olfactory dysfunction group (STG) and the left superior temporal gyrus, right precentral gyrus (MPG), right middle occipital gyrus (MOG) of RS FC (P0.05 cluster size139voxels) decreased. Conclusion 1. with Parkinson's disease patients with olfactory disorder of olfactory bulb The volume of olfactory bulb volume decreased significantly, the quantitative evaluation is helpful to olfactory dysfunction of Parkinson's disease, Parkinson's disease with.2. to help patients with olfactory disorders than normal people are the structure and function of brain olfactory related regional abnormalities for clinical diagnosis, mainly for the volume of gray matter atrophy and decreased functional connectivity.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.5;R445.2
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本文編號：1424734