發(fā)布時(shí)間：2018-05-21 16:04

  本文選題：灰質(zhì)體積 + 病灶側(cè)別��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:雖然有一些關(guān)于中風(fēng)后灰質(zhì)體積變化的神經(jīng)影像學(xué)研究,但是關(guān)于中風(fēng)后病灶側(cè)別和運(yùn)動(dòng)恢復(fù)程度對(duì)灰質(zhì)體積的影響還不清楚。本研究根據(jù)梗死病灶側(cè)別和運(yùn)動(dòng)功能恢復(fù)程度對(duì)右利手的慢性期皮層下缺血性腦梗死患者進(jìn)行分組,從而探究病灶側(cè)別和運(yùn)動(dòng)恢復(fù)程度對(duì)中風(fēng)后灰質(zhì)體積的影響。另外,雖然有研究報(bào)道了中風(fēng)患者短時(shí)記憶功能的損害,但是關(guān)于中風(fēng)后短時(shí)記憶損害的機(jī)制仍是不清楚的。本研究通過評(píng)估病灶本身和遠(yuǎn)隔腦區(qū)灰質(zhì)體積的減少與短時(shí)記憶評(píng)分的關(guān)系來(lái)探究短時(shí)記憶損害的神經(jīng)機(jī)制。資料與方法:選取慢性期皮層下腦梗死患者97例(男72,女25),這些患者均伴有不同程度的運(yùn)動(dòng)功能恢復(fù),并且都是病灶位于內(nèi)囊及其周圍結(jié)構(gòu)的單發(fā)病灶者。同時(shí)選取了79名(男50,女29)年齡、性別相匹配的健康志愿者作為對(duì)照組。采用3.0T磁共振掃描儀進(jìn)行3D高分辨率T1WI解剖像掃描。首先,基于病灶側(cè)別的不同,將慢性皮層下中風(fēng)患者分成兩組,即左側(cè)病灶組和右側(cè)病灶組。然后,根據(jù)運(yùn)動(dòng)恢復(fù)程度的不同,分別將左側(cè)病灶組和右側(cè)病灶組的中風(fēng)患者分為完全恢復(fù)和部分恢復(fù)亞組。對(duì)左側(cè)病灶組和右側(cè)病灶組分別進(jìn)行分析:采用一般線性模型對(duì)完全恢復(fù)、部分恢復(fù)和正常對(duì)照組這三組之間體素水平的灰質(zhì)體積進(jìn)行比較,同時(shí)控制年齡、性別和掃描設(shè)備的影響;然后提取出有差異腦區(qū)的灰質(zhì)體積進(jìn)行事后(post-hoc)分析來(lái)確定完全恢復(fù)和部分恢復(fù)的皮層下中風(fēng)患者相對(duì)于正常對(duì)照組的灰質(zhì)體積的變化是否相同;最后利用偏相關(guān)分析觀察哪些腦區(qū)的灰質(zhì)體積與部分恢復(fù)的中風(fēng)患者的運(yùn)動(dòng)功能評(píng)分相關(guān)。另外,我們采用基于體素的病灶-癥狀圖譜來(lái)探究病灶本身與短時(shí)記憶功能之間的關(guān)系。然后基于體素水平對(duì)中風(fēng)病人和健康對(duì)照組的灰質(zhì)體積進(jìn)行比較,觀察哪些腦區(qū)的灰質(zhì)體積是減少的,同時(shí)控制年齡、性別和掃描設(shè)備的影響,其中左右側(cè)病灶組分別與正常對(duì)照組進(jìn)行比較;最后利用偏相關(guān)分析觀察這些灰質(zhì)體積減少的腦區(qū)與短時(shí)記憶評(píng)分的相關(guān)性。結(jié)果:1.與正常對(duì)照組相比,左側(cè)病灶組的右側(cè)中央旁小葉和右側(cè)枕中回的灰質(zhì)體積是增加的;右側(cè)病灶組的雙側(cè)中央旁小葉、雙側(cè)輔助運(yùn)動(dòng)區(qū)和右側(cè)枕中回的灰質(zhì)體積是增加的。2.與正常對(duì)照組相比,只有右側(cè)病灶組的右側(cè)中央前回的灰質(zhì)體積是減少的。3.完全恢復(fù)和部分恢復(fù)的慢性皮層下腦梗死患者灰質(zhì)體積增加的程度是沒有顯著統(tǒng)計(jì)學(xué)差異的。4.梗死病灶位置和體積與短時(shí)記憶評(píng)分沒有相關(guān)性。5.左側(cè)病灶組患者的左側(cè)感覺運(yùn)動(dòng)皮層、左側(cè)島葉皮層、左側(cè)顳中回、左側(cè)枕中回、左側(cè)額下回的三角部和右側(cè)額中回的灰質(zhì)體積較正常對(duì)照組減少;右側(cè)病灶組患者的右側(cè)感覺運(yùn)動(dòng)皮層、右側(cè)島葉皮層、右側(cè)顳中回、右側(cè)眶額皮層、右側(cè)背側(cè)后扣帶和左側(cè)額上回的灰質(zhì)體積較正常對(duì)照組減少。6.在左側(cè)病灶組中,右側(cè)額中回和左側(cè)額下回的灰質(zhì)體積與短時(shí)記憶評(píng)分正相關(guān);在右側(cè)病灶組中,右側(cè)背側(cè)后扣帶皮層的灰質(zhì)體積與短時(shí)記憶評(píng)分正相關(guān)。小結(jié):1.慢性期皮層下缺血性中風(fēng)患者灰質(zhì)體積增加的腦區(qū)比灰質(zhì)體積減少的腦區(qū)更廣泛,提示慢性期皮層下缺血性中風(fēng)患者中結(jié)構(gòu)可塑性的存在。2.慢性期皮層下缺血性中風(fēng)患者右側(cè)病灶組灰質(zhì)體積增加的腦區(qū)較左側(cè)病灶組灰質(zhì)體積增加的腦區(qū)更廣泛,提示病灶側(cè)別對(duì)右利手的慢性期皮層下缺血性中風(fēng)患者的灰質(zhì)體積是有影響的。3.慢性期皮層下缺血性中風(fēng)患者灰質(zhì)體積的增加在完全恢復(fù)和部分恢復(fù)的患者中表現(xiàn)相似,提示慢性期皮層下缺血性中風(fēng)患者的結(jié)構(gòu)重塑不是影響患者運(yùn)動(dòng)功能恢復(fù)程度的關(guān)鍵因素。4.慢性皮層下中風(fēng)患者短時(shí)記憶功能的損害與病灶遠(yuǎn)隔腦區(qū)的繼發(fā)損害有關(guān),而與病灶的位置和大小沒有顯著的相關(guān)性,說明遠(yuǎn)隔腦區(qū)的繼發(fā)損害在短時(shí)記憶功能受損過程中的重要作用,而且左右側(cè)病灶組中與短時(shí)記憶功能相關(guān)的腦區(qū)不同,因此之后關(guān)于中風(fēng)后認(rèn)知功能的研究應(yīng)該考慮到病灶側(cè)別的影響。結(jié)論皮層下缺血性中風(fēng)患者的慢性階段存在廣泛的結(jié)構(gòu)重塑,其中病灶側(cè)別對(duì)結(jié)構(gòu)重塑是有影響的,而運(yùn)動(dòng)功能恢復(fù)程度與灰質(zhì)體積的重塑沒有顯著的相關(guān)性。另外,慢性皮層下中風(fēng)患者短時(shí)記憶功能的損害與病灶遠(yuǎn)隔腦區(qū)的繼發(fā)損害有關(guān),而與病灶的位置和大小沒有顯著的相關(guān)性,而且左右側(cè)病灶組中與短時(shí)記憶功能相關(guān)的腦區(qū)不同,因此之后關(guān)于中風(fēng)后認(rèn)知功能的研究應(yīng)該考慮到病灶側(cè)別對(duì)研究結(jié)果的影響。
[Abstract]:Objective: Although there are some neuroimaging studies on the changes in the volume of gray matter after stroke, the effect of the lesion side and motion recovery on the volume of gray matter after stroke is not clear. In addition, the mechanism of short-term memory impairment after apoplexy is still unclear. However, the mechanism of short-term memory impairment after apoplexy is still unclear. This study evaluated the decrease and short-term volume of gray matter in the lesion itself and in the distant brain region. Data and methods: 97 patients with subcortical cerebral infarction (male 72, female 25) were selected with different degrees of motor function recovery, and all of them were single focal lesions located in the internal capsule and its surrounding structure, and 79 (men 50, 29) age were selected. 3.0T magnetic resonance scanner (3.0T) was used as a control group for 3D high resolution anatomical image scan. First, the patients with chronic subcortical apoplexy were divided into two groups, the left focus group and the right lesion group based on the difference of the lesion side. Then, the left focus group was divided into the left focus group according to the degree of movement recovery. The patients with apoplexy in the right lesion group were divided into complete recovery and partial recovery subgroups. The left focus group and the right lesion group were analyzed respectively: the general linear model was used to complete the complete recovery, the partial recovery and the normal control group were compared with the volume of the voxel levels between the three groups, and the age, sex and scanning equipment were controlled. The volume of gray matter in the different brain regions was then analyzed to determine whether the volume of gray matter in the subcortical stroke patients with complete recovery and partial recovery was the same as that in the normal control group; finally, the gray matter volume of the brain regions and the partial recovery of stroke patients were observed by partial correlation analysis. In addition, we used a voxel based focus - symptom map to explore the relationship between the focus itself and the short-term memory function. Then based on the voxel level, the volume of gray matter in the stroke patients and the healthy control group was compared, and the gray matter volume of the brain regions was reduced and the age, sex, and scan were controlled. The relationship between the left and right side focus groups was compared with the normal control group, and the correlation analysis was used to observe the correlation between the brain area and the short-term memory score of the gray matter volume reduction. Results: 1. compared with the normal control group, the gray matter volume of the right central paraleal lobule and right occipital gyrus was increased in the left focus group; The volume of gray matter in the bilateral central paraceal lobule, bilateral auxiliary motor area and right occipital gyrus was increased by.2. in the lesion group than in the normal control group. The gray matter volume of the right anterior central gyrus in the right lesion group was less than that of the reduced.3., and the increase in the volume of gray matter in the patients with chronic subcortical infarction was not significant. There was no correlation between the location and volume of.4. infarcts with statistical difference and short-term memory score. The left sensory motor cortex, left insula cortex, left temporal cortex, left temporal gyrus, left occipcipital gyrus, and the gray matter volume in the left inferior frontal gyrus and right middle frontal gyrus were less than that of the normal control group; the right focus group patients were found to have no correlation with the short-term memory score. The right sensory motor cortex, right insula cortex, right medial temporal gyrus, right orbital frontal cortex, right dorsal posterior cingulate and left superior frontal gyrus decreased.6. in the left focus group. The volume of gray matter in the right middle frontal gyrus and left inferior frontal gyrus was positively correlated with the short-term memory score; in the right lesion group, the right dorsal side was in the posterior side. A positive correlation between the gray matter volume of the cingulate cortex and the short-term memory score. Summary: 1. the increased gray matter volume in the patients with chronic subcortical ischemic stroke is more extensive than the gray matter volume, suggesting the existence of structural plasticity in the chronic subcortical ischemic stroke patients with.2. slow subcortical ischemic stroke on the right side of the patient. The increase of gray matter volume in the brain region is more extensive than that in the left focus group, suggesting that the volume of gray matter in patients with chronic subcortical ischemic stroke in the right hand side is an impact on the increase of gray matter volume in patients with.3. chronic subcortical ischemic stroke in patients with complete recovery and partial recovery. Similar, suggesting that structural remodeling in patients with subcortical ischemic stroke is not a key factor affecting the degree of motor function recovery in patients with.4., the impairment of short-term memory function in patients with chronic subcortical stroke is related to the secondary lesion of the distant brain area, but it has no significant correlation with the location and size of the lesion, indicating the distant brain region. Secondary damage is an important role in the impairment of short-term memory function, and the brain area related to short-term memory function in the left and right lesions group is different. Therefore, the study of cognitive function after stroke should take into consideration the effect of the lesion side. Conclusion the chronic stage of subcortical ischemic patients has extensive structural weight. There is no significant correlation between the degree of motor function recovery and the reshaping of the mass of gray matter. In addition, the impairment of short-term memory function in patients with subcortical stroke is related to the secondary lesion of the distant brain area, but there is no significant correlation with the location and size of the lesion. In the right lesion group, the brain regions associated with short-term memory function are different, so the subsequent study of cognitive function after stroke should take into account the effect of the focus side on the results of the study.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R743.33

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本文編號(hào)：1919867