本文選題：顳葉癲癇 + 警覺功能�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的結(jié)合行為學(xué)測(cè)試,運(yùn)用聯(lián)合任務(wù)態(tài)功能磁共振(f MRI)和基于體素的形態(tài)學(xué)研究(VBM)的方法,探討顳葉癲癇患者警覺功能及腦結(jié)構(gòu)的損害特點(diǎn)及其關(guān)系。方法顳葉癲癇患者(癲癇組)21例,正常人(健康對(duì)照組)19例,均予行為學(xué)練習(xí)和測(cè)試,并進(jìn)行警覺功能的任務(wù)態(tài)f MRI和3D結(jié)構(gòu)像的掃描。行為學(xué)數(shù)據(jù)采用數(shù)據(jù)采用SPSS16.0軟件統(tǒng)計(jì)分析,磁共振數(shù)據(jù)采用SPM8、Rest1.8軟件統(tǒng)計(jì)分析。結(jié)果1、注意網(wǎng)絡(luò)測(cè)試中TLE組雙重暗示平均反應(yīng)時(shí)間(638.03±78.81ms)顯著長于健康對(duì)照組(584.26±88.33 ms),差異有統(tǒng)計(jì)學(xué)意義(t=2.035,P0.05),而警覺網(wǎng)絡(luò)效應(yīng)反應(yīng)時(shí)間(RT)兩組并無差異(t=0.011,P0.05)。2、任務(wù)態(tài)f MRI中警覺網(wǎng)絡(luò)組內(nèi)及組間分析:(1)健康對(duì)照組警覺效應(yīng)激活腦區(qū)主要為右頂葉、右額葉、雙側(cè)顳葉,雙側(cè)枕葉、小腦等腦區(qū)激活(P0.05)。(2)TLE患者組其主要激活腦區(qū)為雙側(cè)的顳葉、右額葉、左枕葉,但總體激活的強(qiáng)度和范圍較對(duì)照組小,且小腦、頂葉未見明顯激活(P0.05)(3)組間分析兩樣本t檢驗(yàn):TLE患者組較健康對(duì)照組在右頂葉(頂下小葉)、右枕葉、小腦、左顳葉的激活明顯下降(P0.05,Alphasim校正,體素152)3、VBM組間分析結(jié)果顯示TLE患者組較健康對(duì)照組在右島葉、右顳葉、右側(cè)嗅皮層以及左顳葉、左側(cè)楔前葉、距狀回等腦區(qū)灰質(zhì)體積明顯減少。(P0.05,Alphasim校正,體素228)4、右側(cè)頂下小葉與警覺網(wǎng)絡(luò)效應(yīng)RT呈中等程度負(fù)相關(guān)關(guān)系(r=-0.449,p0.05),其余腦區(qū)相關(guān)分析未見有統(tǒng)計(jì)學(xué)意義。結(jié)論1、顳葉癲癇患者警覺網(wǎng)絡(luò)腦區(qū)的激活明顯下降,具有右側(cè)偏性,可能是TLE患者警覺功能下降的基礎(chǔ)。2、右頂葉(頂下小葉)是警覺腦功能網(wǎng)絡(luò)中的一個(gè)重要節(jié)點(diǎn)。3、TLE患者灰質(zhì)減少的腦區(qū)主要集中在內(nèi)側(cè)顳葉的海馬旁回,以及顳葉以外的右額葉嗅皮層、左枕葉的距狀回、左楔葉等。4、警覺激活下降的區(qū)域主要為內(nèi)側(cè)顳葉以遠(yuǎn)端的頂枕葉為主,而VBM下降的區(qū)域以顳葉及其鄰近的額葉為主。二者大部分不重疊。
[Abstract]:Objective to investigate the characteristics and relationship between alertness and brain structure in patients with temporal lobe epilepsy by means of combined task state functional magnetic resonance imaging (fMRI) and voxel based morphologic study (VBM). Methods Twenty one patients with temporal lobe epilepsy (epileptic group) and 19 normal subjects (healthy control group) were examined with behavioral exercises and tests, and the task-based fMRI and 3D structural images of alertness were performed. The behavioral data were analyzed by SPSS 16.0 software, and the magnetic resonance data by SPM8 / Rest1.8 software. Results 1. The average response time (638.03 鹵78.81ms) of the TLE group was significantly longer than that of the healthy control group (584.26 鹵88.33 ms), while the alert network response time (RT) was not different between the two groups (t 0.011 P 0.05). Intra-group and inter-group analysis: (1) the right parietal lobe was the main brain area activated by alerting effect in healthy control group. In the right frontal lobe, bilateral temporal lobe, bilateral occipital lobe, and cerebellar area activation (P0.05). (2), the main activation areas were bilateral temporal lobe, right frontal lobe, left occipital lobe, but the overall activation intensity and range were smaller than those in the control group. There was no significant activation in the parietal lobe (P0.05) (3) the activation of the right parietal lobe, the right occipital lobe, the cerebellum and the left temporal lobe was significantly decreased (P0.05 Alphasim correction) in the TLE group compared with the healthy control group. The volume of gray matter in the right insular lobe, the right temporal lobe, the right olfactory cortex and the left temporal lobe, the left anterior cuneate lobe and the talar gyrus were significantly decreased in the TLE group than in the healthy control group. The correlation between right inferior parietal lobule and alert network effect RT was negatively correlated (r = -0.449, p 0.05). No significant correlation was found in other brain regions. Conclusion 1. The activation of the alert network area in patients with temporal lobe epilepsy was significantly decreased, and the right side of the brain was deviated. The right parietal lobe (inferior parietal lobule) is an important node in the alerting brain function network. The decreased gray matter of TLE patients is mainly concentrated in the parahippocampal gyrus of the medial temporal lobe. Besides, the olfactory cortex of the right frontal lobe, the talus gyrus of the left occipital lobe, the left cuneiform lobe, etc. 4. The medial temporal lobe with the distal parietal occipital lobe, the medial temporal lobe with the medial temporal lobe, and the region with VBM decreased mainly in the temporal lobe and its adjacent frontal lobe. Most of the two do not overlap.
【學(xué)位授予單位】：廣西醫(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;R742.1

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