本文選題：多發(fā)性硬化　切入點(diǎn)：丘腦　出處：《貴州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:利用DTI、MRS、3D-T1WI技術(shù)評(píng)價(jià)復(fù)發(fā)緩解型多發(fā)性硬化丘腦微觀(guān)結(jié)構(gòu)及體積變化,并探討DTI參數(shù)、MRS參數(shù)及體積與臨床神經(jīng)功能障礙之間的相關(guān)性。方法:依據(jù)McDonald2010診斷標(biāo)準(zhǔn)納入本院2015年1月-2016年5月臨床確診復(fù)發(fā)緩解型多發(fā)性硬化(relapsing remitting multiple sclerosis,RRMS)患者33例組成RRMS組,對(duì)照組為健康志愿者33例,其性別、年齡與RRMS組相匹配。在RRMS患者進(jìn)行MRI掃描前,由兩名神經(jīng)內(nèi)科醫(yī)生對(duì)其進(jìn)行擴(kuò)展殘疾量表(expanded disability status scale,EDSS)評(píng)分�；颊呓M及對(duì)照組均使用PHILIPS Achieva 3.0T X-Series超導(dǎo)型磁共振成像系統(tǒng)掃描獲取DTI數(shù)據(jù)、左側(cè)丘腦單體素MRS數(shù)據(jù)、右側(cè)丘腦單體素MRS數(shù)據(jù)、3D-T1WI數(shù)據(jù)。將DTI數(shù)據(jù)經(jīng)過(guò)dcm2niigui軟件轉(zhuǎn)換,使用PANDA軟件處理DTI圖像,包括渦流及頭動(dòng)校正等步驟,利用最小二乘法擬合張量模型對(duì)所處理的數(shù)據(jù)進(jìn)行計(jì)算,從而獲得FA、MD、AD、RD值,以雙側(cè)丘腦為模板提取FA、MD、AD、RD值,使用獨(dú)立樣本t檢驗(yàn)分析RRMS患者左側(cè)丘腦及右側(cè)丘腦的DTI參數(shù)與對(duì)照組的差異,將RRMS患者雙側(cè)丘腦DTI參數(shù)與EDSS評(píng)分進(jìn)行Person相關(guān)分析。使用LC-model軟件對(duì)左側(cè)丘腦及右側(cè)丘腦單體素MRS數(shù)據(jù)進(jìn)行分析得出NAA、Ins、Glu定量濃度值,使用獨(dú)立樣本t檢驗(yàn)分析RRMS患者左側(cè)丘腦及右側(cè)丘腦NAA、Ins、Glu定量濃度值與對(duì)照組的差異,將RRMS患者左側(cè)丘腦及右側(cè)丘腦NAA、Ins、Glu濃度與EDSS評(píng)分進(jìn)行Person相關(guān)分析。對(duì)3D-T1WI全腦結(jié)構(gòu)圖像進(jìn)行預(yù)處理(包括標(biāo)準(zhǔn)化、分割、平滑等),所得圖像的數(shù)據(jù)利用SPM自帶的統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)分析,使用雙側(cè)丘腦模板再次提取得出丘腦體積,計(jì)算出左、右丘腦體積與腦實(shí)質(zhì)體積的比值Vl、Vr,使用獨(dú)立t檢驗(yàn)分析RRMS患者Vl、Vr與對(duì)照組的差異,將RRMS患者Vl、Vr與EDSS評(píng)分進(jìn)行Person相關(guān)分析。結(jié)果:1、與對(duì)照組比較,RRMS患者左側(cè)丘腦及右側(cè)丘腦的FA值均降低(p0.05),RRMS患者左側(cè)丘腦及右側(cè)丘腦MD、AD、RD值升高(p0.05);RRMS患者左側(cè)丘腦及右側(cè)丘腦FA、MD、AD、RD值與EDSS評(píng)分之間均無(wú)相關(guān)性(p0.05)。2、與對(duì)照組比較,RRMS患者左側(cè)丘腦及右側(cè)丘腦的NAA定量濃度值降低(p0.05),RRMS患者左側(cè)丘腦Ins定量濃度值升高(p0.05),RRMS患者右側(cè)丘腦Ins定量濃度值差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),RRMS患者左側(cè)丘腦及右側(cè)丘腦Glu定量濃度值差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);RRMS患者左側(cè)丘腦及右側(cè)丘腦NAA定量濃度值與EDSS評(píng)分呈負(fù)相關(guān)(左側(cè)丘腦r=-0.669,p0.05;右側(cè)丘腦r=-708,p0.05),RRMS患者左側(cè)丘腦Ins定量濃度值與EDSS評(píng)分之間呈負(fù)相關(guān)(r=-0.708,p0.05),RRMS患者右側(cè)丘腦Ins、雙側(cè)丘腦Glu定量濃度值與EDSS評(píng)分無(wú)相關(guān)性(p0.05)。3、與對(duì)照組比較,RRMS患者左側(cè)丘腦體積、右側(cè)丘腦體積差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),RRMS患者左側(cè)丘腦及右側(cè)丘腦體積與EDSS評(píng)分無(wú)相關(guān)性(p0.05)結(jié)論:1、RRMS患者丘腦存在微觀(guān)結(jié)構(gòu)的改變。2、RRMS患者丘腦NAA濃度值的降低和Ins濃度值的升高可能是監(jiān)測(cè)RRMS患者神經(jīng)功能狀況的指標(biāo)。3、RRMS患者丘腦體積不能作為監(jiān)測(cè)RRMS患者神經(jīng)功能狀況的指標(biāo)。
[Abstract]:Objective: using DTI, MRS, 3D-T1WI evaluation of relapsing remitting multiple sclerosis thalamic microstructure and volume changes, and to explore the correlation between DTI parameters, MRS parameters and volume and neurological dysfunction. Methods: according to the diagnostic criteria of McDonald2010 in our hospital in January 2015 -2016 year in May the clinical diagnosis of relapsing remitting multiple sclerosis (relapsing remitting multiple sclerosis, RRMS) in 33 cases of group RRMS, control group of 33 healthy volunteers, their gender, age matched with RRMS group. MRI scan was performed in two RRMS patients before, by God by physicians to be expanded disability scale (expanded disability status scale, EDSS) score group. And the control group of patients using the PHILIPS Achieva 3.0T X-Series superconducting magnetic resonance imaging scanning system to obtain DTI data, the left thalamus single voxel MRS data, right thalamus, single voxel MRS data, 3 D-T1WI data. DTI data by dcm2niigui software, using PANDA software DTI image processing, including eddy current and head correction steps of the data was calculated by using the least squares fitting tensor model, obtained FA, MD, AD, RD value in bilateral thalamus as template extracted from FA, MD, AD. The value of RD, using independent samples t test analysis of RRMS patients with left thalamus and right thalamus DTI parameters and control group differences, RRMS patients with bilateral thalamus DTI parameters and EDSS score Person correlation analysis was conducted using LC-model software. On the left thalamus and right thalamus, single voxel MRS data analysis of NAA, Ins, Glu quantitative the concentration value, using independent samples t test analysis of RRMS patients with left thalamus and right thalamus, NAA, Ins, Glu concentration and quantitative differences in the control group, RRMS patients left thalamus and right thalamus, NAA, Ins, Glu concentration and EDSS score for P Erson analysis of whole brain structural images of 3D-T1WI pretreatment (including standardization, segmentation, smoothing, etc.) the image data were analyzed using statistical software SPM with the use of template to extract the bilateral thalamus thalamus, calculate the ratio of Vl, left, right thalamus and brain volume Vr, the independent t test was used to analysis the differences of Vr and RRMS in patients with Vl, control group, RRMS were Vl, Vr and EDSS were tested with Person correlation analysis. Results: 1, compared with the control group, RRMS patients with left thalamus and right thalamus FA values were lower in patients with RRMS (P0.05), left thalamus and right thalamus MD, AD, RD increased (P0.05); RRMS patients with left thalamus and right thalamus, FA, MD, AD, between RD and EDSS score showed no correlation (.2, P0.05) compared with the control group, NAA quantitative RRMS concentration in patients with left thalamus and right thalamus decreased (P0.05), with RRMS Who left thalamus Ins quantitative concentration increased (P0.05), RRMS patients with right thalamic Ins quantitative concentration values showed no significant difference (P0.05), RRMS patients with left thalamus and right thalamus Glu quantitative concentration showed no significant difference (P0.05); RRMS patients with left thalamus and right thalamus NAA quantitative concentration was negatively correlated with EDSS score (r=-0.669 P0.05; the left thalamus, right thalamus, r=-708, P0.05), there was a negative correlation between RRMS patients with left thalamus Ins quantitative concentration and EDSS score (r=-0.708, P0.05), RRMS patients with right thalamic Ins, bilateral thalamus Glu quantitative concentration had no correlation with EDSS score (.3, P0.05) compared with the control group, patients with RRMS the left thalamus, there was no significant difference of the volume of the right thalamus (P0.05), there was no correlation between RRMS patients with left thalamus and right thalamus and EDSS score (P0.05) conclusion: 1 RRMS patients with thalamic exist microstructure changes in.2, RR The decrease of NAA concentration and the increase of Ins concentration in MS patients may be an index to monitor the neurological function of RRMS patients..3 can not be used as an index for monitoring the neurological function of RRMS patients.

【學(xué)位授予單位】：貴州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R744.51;R445.2

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