本文關鍵詞：感覺傳入對帕金森病患者TMS運動誘發(fā)電位的影響　出處：《安徽醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 帕金森病 配對關聯(lián)刺激 運動誘發(fā)電位 感覺運動整合

【摘要】：目的 研究早期和中晚期帕金森病(PD)患者運動皮層興奮性以及感覺運動整合功能變化情況,早期和中晚期PD患者感覺運動整合功能是否存在差異。方法 研究對象為PD患者16例,分為早期PD組(PD-E,n=10)、中晚期PD組(PD-L,n=6)和正常對照組(n=10)。采用經(jīng)顱磁刺激(TMS)刺激運動皮層,在對側拇短展肌運動誘發(fā)電位(MEP),記錄靜息運動閾值(RMT)、靜息期(SP)、強度反應曲線比較三組背景運動皮層興奮性。運用配對關聯(lián)刺激(PAS)技術觀察外周正中神經(jīng)感覺傳入對TMS誘發(fā)的拇短展肌MEP幅度影響,分析感覺運動整合功能變化。將正中神經(jīng)電刺激與對側運動皮層TMS組成PAS作為條件刺激(PAS間隔16ms、20m、24ms、28ms、100ms及200ms),將單一TMS刺激作為非條件刺激。分別記錄不同刺激間隔條件刺激和非條件刺激拇短展肌MEP,以條件刺激MEP幅度與非條件刺激MEP幅度比值(MEP')表示外周感覺傳入對MEP幅度影響。結果 PD-E組及PD-L組RMT均低于正常對照組且差異具有統(tǒng)計學意義(P0.05),PD-E組與PD-L組兩組之間RMT無顯著差異(P0.05);PD-L組靜息期顯著小于正常對照組(P0.05),PD-E組MEP靜息期與正常對照組比較差異不具有統(tǒng)計學意義(P0.05)。三組強度反應曲線均表現(xiàn)為MEP波幅隨刺激強度遞增而遞增,TMS刺激強度自130%RMT增長至150%RMT時,PD-L組MEP波幅均小于PD-E組及正常對照組且差異具有統(tǒng)計學意義(P均0.05)。PAS實驗顯示三組MEP’隨著PAS的ISI值不同而變化(MEP’1或1),提示外周感覺傳入對大腦皮層運動區(qū)興奮性具有抑制或易化效應。當ISI為24ms、200ms時,PD-L組PAS對運動皮層興奮性的影響不同與正常對照組及PD-E組。ISI為24ms時,正常對照組PAS對MEP波幅無明顯影響(MEP’:0.98±0.40),在PD-E組呈現(xiàn)輕度抑制效應(MEP’:0.75±0.44),PD-L組則呈現(xiàn)易化效應(MEP’:1.71±0.67),PD-L組MEP’與正常對照組及PD-E組比較具有顯著差異(P均0.05),提示ISI為24ms時晚期PD患者外周感覺傳入對運動皮層抑制效應減弱并發(fā)生反轉。ISI為200ms時,正常對照組和PD-E組PAS對MEP波幅呈現(xiàn)易化效應(MEP’分別為1.37±0.66、1.35±0.64),PD-L組則呈現(xiàn)抑制效應(MEP’:0.84±0.35),但MEP’三組間無統(tǒng)計學差異(P0.05)。PD-E組與正常對照組PAS對MEP波幅的影響類似,各ISI對應MEP’無統(tǒng)計學差異。結論外周感覺信息傳入隨潛伏期不同對運動皮層有易化或抑制效應,早期PD患者與正常人比較差異不顯著,中晚期PD患者24ms短潛伏期傳入抑制效應反轉為興奮效應,提示其感覺運動整合功能與正常人及早期PD相比存在差異。結論 配對關聯(lián)刺激隨刺激間隔不同對誘發(fā)運動電位波幅有易化或抑制效應,早期PD患者外周感覺傳入對運動皮層興奮性的影響與正常人比較差異不顯著,中晚期PD患者24ms短潛伏期傳入抑制效應減弱并反轉為興奮效應,提示其感覺運動整合功能存在紊亂。
[Abstract]:Objective to study the changes of motor cortex excitability and sensorimotor integration function in patients with early and advanced Parkinson's disease (PD). Methods 16 patients with PD were divided into early PD group and early PD group. The motor cortex was stimulated by transcranial magnetic stimulation (TMS) and the contralateral abductor pollicis brevis motor evoked potential (MEP). The resting exercise threshold value (RMTT) was recorded, and the rest period (SPV) was recorded. The intensity response curve was used to compare the excitability of the background motor cortex in the three groups. The effects of peripheral median nerve sensory afferent on the MEP amplitude of abductor pollicis brevis induced by TMS were observed by paired associated stimulation (pass) technique. The changes of sensorimotor integration function were analyzed. PAS was made up of median nerve electrical stimulation and contralateral motor cortex TMS as conditioned stimulation of pas interval of 16 Ms ~ 20 m ~ (24) Ms ~ (28 Ms). 100ms and 200ms respectively, single TMS stimulation was used as unconditioned stimulus. MEP of abductor pollicis brevis was recorded under different stimulus interval and unconditioned stimulation. Using the ratio of conditioned MEP amplitude to unconditioned stimulus MEP amplitude to determine the ratio of MEP amplitude to MEP amplitude. Results the RMT of PD-E group and PD-L group were lower than that of normal control group (P 0.05). There was no significant difference in RMT between PD-E group and PD-L group (P 0.05). The rest period of PD-L group was significantly lower than that of normal control group (P0.05). There was no significant difference in the resting period of MEP between the PD-E group and the normal control group (P 0.05). The intensity response curves of the three groups showed that the amplitude of MEP increased with the increase of the stimulus intensity. The intensity of TMS increased from 130 RMT to 150 RMTs. The amplitude of MEP in PD-L group was lower than that in PD-E group and normal control group (P < 0.05). Pas experiment showed that three groups of MEP 'varied with the ISI value of PAS. The results suggest that peripheral sensory afferents can inhibit or facilitate the excitability of the motor area of the cerebral cortex when the ISI is 24ms / 200ms. The effects of PAS on the excitability of motor cortex in PD-L group were different from those in normal control group and PD-E group (.ISI = 24 Ms). There was no significant effect of PAS on the amplitude of MEP in the normal control group, but there was a slight inhibitory effect in the PD-E group (0. 75 鹵0. 44). In PD-L group, there were significant differences between MEP 'and normal control group and PD-E group (P < 0.05). It was suggested that the inhibitory effect of peripheral sensory afferent on motor cortex was attenuated in late PD patients when ISI was 24ms and the inversion occurred at 200ms. The facilitation effect of PAS on the amplitude of MEP in normal control group and PD-E group was 1.37 鹵0.666 鹵1.35 鹵0.64, respectively. In PD-L group, the inhibitory effect was 0.84 鹵0.35). However, there was no statistical difference among the three groups. The effect of PAS on the amplitude of MEP was similar in P0.05U. PD-E group and normal control group. Conclusion Peripheral sensory information afferent has facilitation or inhibition effect on motor cortex with different incubation period, but there is no significant difference between early PD patients and normal people. The afferent inhibitory effect of 24ms short latency was reversed to excitatory effect in patients with advanced PD. Conclusion pairing associated stimuli can facilitate or inhibit the amplitude of evoked motor potential with different stimulus intervals. The effect of peripheral sensory afferent on the excitability of motor cortex in early PD patients was not significantly different from that in normal controls. The inhibitory effect of 24 Ms short latency afferent afferent in middle and late stage PD patients was weakened and reversed to excitatory effect. The results suggest that the sensory and motor integration function is in disorder.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.5

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