本文關鍵詞：基于靜息態(tài)功能磁共振對不同運動亞型帕金森病患者腦功能改變的研究　出處：《南京醫(yī)科大學》2017年博士論文　論文類型：學位論文

  更多相關文章： 帕金森病 靜止性震顫 姿勢不穩(wěn)步態(tài)障礙 靜息態(tài)功能磁共振 局部一致性 帕金森病 靜止性震顫 姿勢不穩(wěn)步態(tài)障礙 靜息態(tài)功能磁共振 度中心度 帕金森病 凍結步態(tài) 腳橋核 靜息態(tài)功能磁共振 局部一致性 功能連接

【摘要】：第一部分不同運動亞型帕金森病患者腦功能活動的改變:基于靜息態(tài)fMRI腦局部一致性的研究目的:探討不同運動亞型帕金森病(PD)患者靜息態(tài)功能磁共振的局部腦活動的改變及意義。方法:采集77例PD患者和29例健康對照者(HC)的靜息態(tài)功能磁共振數據,PD組根據統(tǒng)一帕金森病評定量表(UPDRS)相關評分分為震顫型(TD)43例和姿勢不穩(wěn)步態(tài)障礙型(PIGD)34例,采用局部一致性(ReHo)分析方法對所得數據進行分析,觀察不同亞型帕金森患者的腦功能活動變化,通過協方差分析(ANCOVA)和Post-Hoc t檢驗進行組間比較。結果:與HC相比,TD-PD患者右側額中回及額上回ReHo增強;左側顳葉、左側殼核、左側旁中央小葉、雙側丘腦、雙側楔狀葉及距狀裂周圍皮層、左側小腦ReHo減低;PIGD-PD患者右側額上回、額中回及扣帶回前部ReHo增強;左側殼核、左側蒼白球、左側顳葉、右側枕葉、雙側丘腦、雙側扣帶回中部、雙側輔助運動區(qū)ReHo減低;TD-PD與PIGD-PD相比,左側顳葉、左側小腦、雙側扣帶回中部ReHo增強;左側顳葉、左側旁中央小葉、雙側楔狀葉、右側額上回、右側扣帶回前部、右側小腦腳ReHo減低;Pearson相關分析發(fā)現,TD評分與右側內側額上回ReHo值呈正相關,與左側丘腦、左側殼核、右側丘腦、右側舌回ReHo值呈負相關;PIGD評分與右側內側額上回、右側扣帶回前部ReHo值呈正相關,與左側丘腦、左側殼核、左側顳下回、右側丘腦、右側舌回及右側枕下回ReHo值呈負相關。結論:不同亞型PD患者存在著特異性的腦功能活動改變,TD-PD患者腦功能活動局部改變體現了紋狀體-丘腦-皮層環(huán)路和小腦-丘腦-皮層環(huán)路的共同作用的結果,而PIGD-PD患者則主要體現了紋狀體-丘腦-皮層環(huán)路相關腦區(qū)和視覺網絡皮層的功能活動異常,這為進一步揭示不同運動亞型PD患者的神經病理機制、臨床診斷和針對性的治療提供新的思路。第二部分不同運動亞型帕金森病患者腦網絡節(jié)點功能連接屬性的改變:基于體素的靜息態(tài)fMRI度中心度的研究目的:研究不同運動亞型帕金森病患者靜息態(tài)功能磁共振的腦網絡節(jié)點功能連接屬性的變化特點及意義。方法:采集77例PD患者和29例健康對照者(HC)的靜息態(tài)功能磁共振數據,PD組根據統(tǒng)一帕金森病評定量表(UPDRS)相關評分分為震顫型(TD)43例和姿勢不穩(wěn)步態(tài)障礙型(PIGD)34例。采用度中心度(DC)分析方法對所得數據進行分析,觀察不同亞型帕金森患者的腦網絡節(jié)點功能連接屬性變化,通過協方差分析(ANCOVA)和Post-Hoc t檢驗進行組間比較。結果:與HC相比,TD-PD患者雙側丘腦、雙側尾狀核DC值升高;雙側梭狀回、雙側海馬、雙側海馬旁回、左側眶額回(左側眼眶部額下回、左側眶部額中回)、左側額上回、左側島葉、左側殼核、右側顳下回、右側額上回DC值減低;PIGD-PD與HC相比,右側頂上/下小葉、左側丘腦DC值升高;左側中央前/后回、左側旁中央小葉、左側枕中回、左側緣上回、雙側輔助運動區(qū)、雙側扣帶回DC值減低;TD-PD與PIGD-PD相比,雙側楔狀葉、左側楔前葉、雙側距狀裂及其周圍皮層、雙側輔助運動區(qū)、左側中央前回、左側旁中央小葉DC值升高;左側眶額回、左側額中回、左側背外側額上回DC值減低。Pearson相關分析發(fā)現,TD評分與左側殼核、左側梭狀回、左側海馬、左側海馬旁回DC值負相關,未見明顯正相關腦區(qū)。PIGD評分左側輔助運動區(qū)、左側顳中回DC值呈負相關,未見明顯正相關腦區(qū)。結論:兩種亞型PD患者均存在默認網絡相關腦區(qū)節(jié)點的DC減低,不同亞型PD患者靜息網絡節(jié)點功能連接屬性有著特異性的改變,TD-PD患者的網絡節(jié)點功能連接屬性改變主要表現在基底節(jié)、丘腦等神經環(huán)路相關腦區(qū),而PIGD-PD患者則主要體現運動網絡、視覺加工網絡等相關腦區(qū)。靜息態(tài)功能磁共振基于體素的度中心度功能連接分析方法為探索不同運動亞型PD患者的潛在發(fā)病機制提供了一種新的研究方法。第三部分凍結步態(tài)帕金森病患者腦功能活動及功能連接的改變:基于靜息態(tài)fMRI腦局部一致性和功能連接的研究目的:觀察凍結步態(tài)帕金森病患者靜息態(tài)功能磁共振腦活動局部一致性和功能連接的變化特點,并探索凍結步態(tài)產生的神經病理機制。方法:采集30例PD患者和16例健康對照者(HC)的靜息態(tài)功能磁共振數據,根據凍結步態(tài)量表評分(FOGQ)將PD組分為PD伴凍結步態(tài)患者(FOG(+)PD)14例和PD不伴凍結步態(tài)患者(FOG(-)PD)16例。采用局部一致性(ReHo)分析方法對所得數據進行分析,觀察伴有和不伴有凍結步態(tài)PD患者的腦功能活動變化;同時選擇腳橋核(PPN)為種子點,采用種子相關分析得到全腦中與腳橋核功能連接改變的區(qū)域。通過協方差分析(ANCOVA)和Post-Hoc t檢驗進行組間比較。結果:與HC相比,FOG(+)PD的左側顳下回、右側舌回、雙側梭狀回、右側枕下回、右側矩狀裂及其周圍皮層及右側小腦ReHo減弱;右側額中回、右側三角部額下回、右側島蓋部額下回、右側背外側額上回、右側中央前回及右側輔助運動區(qū)ReHo增強;與FOG(-)PD相比,FOG(+)PD的右側中央前回、右側額中回、右側額下回及右側輔助運動區(qū)ReHo增強,未發(fā)現ReHo減弱的區(qū)域。在功能連接方面,與正常對照組及帕金森病不伴凍結步態(tài)組相比,帕金森病伴凍結步態(tài)組與PPN功能連接異常的腦區(qū)主要分布在皮質-腦橋核-小腦通路(包括雙側小腦和腦橋)以及視覺相關顳葉皮層(包括右側顳中回和右側顳下回)。結論:帕金森病凍結步態(tài)患者存在異常的腦功能活動和功能連接,FOG(+)PD患者腦內局部一致性異常的腦區(qū)包括了小腦、額葉以及視覺網路相關皮層;同時通過觀察雙側PPN與全腦的功能連接,發(fā)現PD FOG(+)患者存在異常的PPN功能連接網絡,主要影響皮質-腦橋核-小腦通路和參與視覺信息處理相關皮層,提示了 FOG的產生可能涉及的潛在神經功能異常和損傷機制,有助于我們進一步探知FOG的神經病理機制。
[Abstract]:Part one: the changes of brain function in patients with different motion subtypes of Parkinson's disease: Based on the regional coherence of resting fMRI brain, objective: To explore the changes and significance of resting brain functional changes in resting state functional magnetic resonance imaging (MRF) in patients with different subtypes of Parkinson's disease (PD). Methods: collected 77 cases of PD patients and 29 healthy subjects (HC) of the resting state fMRI data, PD group according to the unified Parkinson's Disease Rating Scale (UPDRS) score divided into tremor type (TD) and 43 cases of postural instability gait disorder (PIGD) in 34 cases, using local consistency (ReHo) analysis method to analyze the data, observe the changes of brain activity in patients with different subtypes of Parkinson, through the analysis of covariance (ANCOVA) and Post-Hoc t test were compared between the two groups. Results: compared with HC, ReHo and TD-PD were back to the superior frontal gyrus, right middle frontal enhancement; left temporal lobe, left putamen, left paracentral lobule, bilateral thalamus, bilateral cuneus and calcarine cortex around the left cerebellum ReHo decreased; PIGD-PD patients with right superior frontal gyrus, middle frontal gyrus and anterior cingulate cortex ReHo enhancement on the left side; the left putamen, globus pallidus, left temporal lobe, right occipital lobe, bilateral thalamus, bilateral middle cingulate gyrus, bilateral supplementary motor area ReHo decreased; TD-PD compared with PIGD-PD, the left temporal lobe and left cerebellum, bilateral middle cingulate cortex ReHo enhancement; left lateral temporal lobe and left paracentral lobule, bilateral wedge the right lobe, right superior frontal gyrus, anterior cingulate gyrus, right cerebellar peduncle ReHo decreased; Pearson correlation analysis showed that TD score and right medial frontal gyrus ReHo values were positively correlated with the left thalamus, left putamen, right thalamus, right lingual The ReHo value was negatively correlated. PIGD score was positively correlated with ReHo value in the right medial superior frontal gyrus and right cingulate gyrus, and negatively correlated with ReHo value in left thalamus, left putamen, left inferior temporal gyrus, right thalamus, right lingual gyrus and right occipital gyrus. Conclusion: PD patients with different subtypes exist in specific brain activity changes, functional activities of patients with cerebral TD-PD local change reflects the interaction of striatal thalamo cortical loop and cerebellar thalamo cortical loop results, while the PIGD-PD patients mainly reflects the abnormal function of brain areas related to cerebral cortex - striatum - Qiu loop network and visual cortex, which further reveal the neural pathological mechanism, different subtypes of PD patients with clinical diagnosis and targeted therapy to provide new ideas. Subtypes of patients with Parkinson's disease brain network node function second different motion connection attribute changes: the purpose of voxel resting fMRI centrality based on the changes and clinical significance of brain functional network nodes of different exercise subtypes in patients with Parkinson disease in the resting state functional magnetic resonance linkage. Methods: resting state fMRI data of 77 PD patients and 29 healthy controls (HC) were collected. PD group was divided into tremor type (TD) 43 cases and postural instability gait type PIGD (34 cases) according to the unified Parkinson's Disease Rating Scale (UPDRS) score. The data were analyzed by the method of degree centrality (DC). The changes of functional connectivity of brain nodes in different subtypes of Parkinson patients were observed. The covariance analysis (ANCOVA) and Post-Hoc t test were used for comparison between groups. Results: compared with HC, TD-PD patients with bilateral thalamus, bilateral caudate nucleus, the DC value increased; bilateral fusiform gyrus, bilateral hippocampus, parahippocampal gyrus, left orbitofrontal gyrus (left orbital frontal gyrus, left orbital frontal gyrus), left superior frontal gyrus, left insula, left putamen, right lateral temporal gyrus, right superior frontal gyrus decreased DC; PIGD-PD compared with HC, right superior parietal lobule, left thalamus / DC value increased; the left front / rear central gyrus and left paracentral lobule, left occipital gyrus, left supramarginal gyrus, bilateral motor areas, bilateral cingulate DC value decreased TD-PD compared with PIGD-PD;, bilateral cuneus, left precuneus, bilateral calcarine and surrounding cortex, bilateral supplementary motor area, left precentral gyrus, left paracentral lobule DC value increased; the left orbitofrontal gyrus, gyrus, left dorsolateral frontal gyrus of left frontal DC values decreased. Pearson correlation analysis showed that TD score was negatively correlated with the DC value of left putamen, left fusiform gyrus, left hippocampus and left parahippocampal gyrus, and no significant positive brain region was found. The PIGD score was negatively correlated with the left temporal gyrus and the left temporal gyrus, and no significant positive brain region was found in the left auxiliary motor area and the left temporal gyrus. Conclusion: the default node network of brain areas related to the decreased DC there are two subtypes of PD patients, PD patients with different subtypes of resting functional connectivity network node has a specific attribute change function network node with TD-PD connection properties change mainly in the basal ganglia and thalamus nerve loop related brain regions, and PIGD-PD the patients mainly reflects the brain areas related to sports network, visual processing network etc.. Resting state functional magnetic resonance imaging based on voxel degree centrality functional connectivity analysis provides a new research method for exploring the potential pathogenesis of PD in different subtypes of sports. The third part change freezing of gait in patients with Parkinson's disease brain activity and functional connectivity in the resting state fMRI connection: the purpose of the local consistency and brain function based on the characteristics of observation: freezing of gait in patients with Parkinson's disease of resting state functional magnetic resonance brain activity in local consistency and functional connectivity, and explore the pathological mechanism of nerve freezing gait. Methods: resting state fMRI data of 30 PD patients and 16 healthy controls (HC) were collected. According to the frozen gait Rating Scale (FOGQ), the PD group was divided into PD and frozen gait patients (FOG (+) PD), 14 cases and PD without frozen gait patients (FOG (- PD)) 16 cases. Local consistency (ReHo) analysis was used to analyze the data and observe the changes of brain function in patients with or without frozen gait. At the same time, the foot bridge nucleus (PPN) was selected as seed point, and seed correlation analysis was used to get the whole PD.
【學位授予單位】：南京醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R445.2;R742.5

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