本文關(guān)鍵詞：基于靜息態(tài)功能磁共振對(duì)不同運(yùn)動(dòng)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(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 帕金森病 靜止性震顫 姿勢(shì)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(shì)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(jié)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(yùn)動(dòng)亞型帕金森病患者腦功能活動(dòng)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(yùn)動(dòng)亞型帕金森病(PD)患者靜息態(tài)功能磁共振的局部腦活動(dòng)的改變及意義。方法:采集77例PD患者和29例健康對(duì)照者(HC)的靜息態(tài)功能磁共振數(shù)據(jù),PD組根據(jù)統(tǒng)一帕金森病評(píng)定量表(UPDRS)相關(guān)評(píng)分分為震顫型(TD)43例和姿勢(shì)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(duì)所得數(shù)據(jù)進(jìn)行分析,觀察不同亞型帕金森患者的腦功能活動(dòng)變化,通過(guò)協(xié)方差分析(ANCOVA)和Post-Hoc t檢驗(yàn)進(jìn)行組間比較。結(jié)果:與HC相比,TD-PD患者右側(cè)額中回及額上回ReHo增強(qiáng);左側(cè)顳葉、左側(cè)殼核、左側(cè)旁中央小葉、雙側(cè)丘腦、雙側(cè)楔狀葉及距狀裂周圍皮層、左側(cè)小腦ReHo減低;PIGD-PD患者右側(cè)額上回、額中回及扣帶回前部ReHo增強(qiáng);左側(cè)殼核、左側(cè)蒼白球、左側(cè)顳葉、右側(cè)枕葉、雙側(cè)丘腦、雙側(cè)扣帶回中部、雙側(cè)輔助運(yùn)動(dòng)區(qū)ReHo減低;TD-PD與PIGD-PD相比,左側(cè)顳葉、左側(cè)小腦、雙側(cè)扣帶回中部ReHo增強(qiáng);左側(cè)顳葉、左側(cè)旁中央小葉、雙側(cè)楔狀葉、右側(cè)額上回、右側(cè)扣帶回前部、右側(cè)小腦腳ReHo減低;Pearson相關(guān)分析發(fā)現(xiàn),TD評(píng)分與右側(cè)內(nèi)側(cè)額上回ReHo值呈正相關(guān),與左側(cè)丘腦、左側(cè)殼核、右側(cè)丘腦、右側(cè)舌回ReHo值呈負(fù)相關(guān);PIGD評(píng)分與右側(cè)內(nèi)側(cè)額上回、右側(cè)扣帶回前部ReHo值呈正相關(guān),與左側(cè)丘腦、左側(cè)殼核、左側(cè)顳下回、右側(cè)丘腦、右側(cè)舌回及右側(cè)枕下回ReHo值呈負(fù)相關(guān)。結(jié)論:不同亞型PD患者存在著特異性的腦功能活動(dòng)改變,TD-PD患者腦功能活動(dòng)局部改變體現(xiàn)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(jié)果,而PIGD-PD患者則主要體現(xiàn)了紋狀體-丘腦-皮層環(huán)路相關(guān)腦區(qū)和視覺(jué)網(wǎng)絡(luò)皮層的功能活動(dòng)異常,這為進(jìn)一步揭示不同運(yùn)動(dòng)亞型PD患者的神經(jīng)病理機(jī)制、臨床診斷和針對(duì)性的治療提供新的思路。第二部分不同運(yùn)動(dòng)亞型帕金森病患者腦網(wǎng)絡(luò)節(jié)點(diǎn)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(yùn)動(dòng)亞型帕金森病患者靜息態(tài)功能磁共振的腦網(wǎng)絡(luò)節(jié)點(diǎn)功能連接屬性的變化特點(diǎn)及意義。方法:采集77例PD患者和29例健康對(duì)照者(HC)的靜息態(tài)功能磁共振數(shù)據(jù),PD組根據(jù)統(tǒng)一帕金森病評(píng)定量表(UPDRS)相關(guān)評(píng)分分為震顫型(TD)43例和姿勢(shì)不穩(wěn)步態(tài)障礙型(PIGD)34例。采用度中心度(DC)分析方法對(duì)所得數(shù)據(jù)進(jìn)行分析,觀察不同亞型帕金森患者的腦網(wǎng)絡(luò)節(jié)點(diǎn)功能連接屬性變化,通過(guò)協(xié)方差分析(ANCOVA)和Post-Hoc t檢驗(yàn)進(jìn)行組間比較。結(jié)果:與HC相比,TD-PD患者雙側(cè)丘腦、雙側(cè)尾狀核DC值升高;雙側(cè)梭狀回、雙側(cè)海馬、雙側(cè)海馬旁回、左側(cè)眶額回(左側(cè)眼眶部額下回、左側(cè)眶部額中回)、左側(cè)額上回、左側(cè)島葉、左側(cè)殼核、右側(cè)顳下回、右側(cè)額上回DC值減低;PIGD-PD與HC相比,右側(cè)頂上/下小葉、左側(cè)丘腦DC值升高;左側(cè)中央前/后回、左側(cè)旁中央小葉、左側(cè)枕中回、左側(cè)緣上回、雙側(cè)輔助運(yùn)動(dòng)區(qū)、雙側(cè)扣帶回DC值減低;TD-PD與PIGD-PD相比,雙側(cè)楔狀葉、左側(cè)楔前葉、雙側(cè)距狀裂及其周圍皮層、雙側(cè)輔助運(yùn)動(dòng)區(qū)、左側(cè)中央前回、左側(cè)旁中央小葉DC值升高;左側(cè)眶額回、左側(cè)額中回、左側(cè)背外側(cè)額上回DC值減低。Pearson相關(guān)分析發(fā)現(xiàn),TD評(píng)分與左側(cè)殼核、左側(cè)梭狀回、左側(cè)海馬、左側(cè)海馬旁回DC值負(fù)相關(guān),未見(jiàn)明顯正相關(guān)腦區(qū)。PIGD評(píng)分左側(cè)輔助運(yùn)動(dòng)區(qū)、左側(cè)顳中回DC值呈負(fù)相關(guān),未見(jiàn)明顯正相關(guān)腦區(qū)。結(jié)論:兩種亞型PD患者均存在默認(rèn)網(wǎng)絡(luò)相關(guān)腦區(qū)節(jié)點(diǎn)的DC減低,不同亞型PD患者靜息網(wǎng)絡(luò)節(jié)點(diǎn)功能連接屬性有著特異性的改變,TD-PD患者的網(wǎng)絡(luò)節(jié)點(diǎn)功能連接屬性改變主要表現(xiàn)在基底節(jié)、丘腦等神經(jīng)環(huán)路相關(guān)腦區(qū),而PIGD-PD患者則主要體現(xiàn)運(yùn)動(dòng)網(wǎng)絡(luò)、視覺(jué)加工網(wǎng)絡(luò)等相關(guān)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(yùn)動(dòng)亞型PD患者的潛在發(fā)病機(jī)制提供了一種新的研究方法。第三部分凍結(jié)步態(tài)帕金森病患者腦功能活動(dòng)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(jié)步態(tài)帕金森病患者靜息態(tài)功能磁共振腦活動(dòng)局部一致性和功能連接的變化特點(diǎn),并探索凍結(jié)步態(tài)產(chǎn)生的神經(jīng)病理機(jī)制。方法:采集30例PD患者和16例健康對(duì)照者(HC)的靜息態(tài)功能磁共振數(shù)據(jù),根據(jù)凍結(jié)步態(tài)量表評(píng)分(FOGQ)將PD組分為PD伴凍結(jié)步態(tài)患者(FOG(+)PD)14例和PD不伴凍結(jié)步態(tài)患者(FOG(-)PD)16例。采用局部一致性(ReHo)分析方法對(duì)所得數(shù)據(jù)進(jìn)行分析,觀察伴有和不伴有凍結(jié)步態(tài)PD患者的腦功能活動(dòng)變化;同時(shí)選擇腳橋核(PPN)為種子點(diǎn),采用種子相關(guān)分析得到全腦中與腳橋核功能連接改變的區(qū)域。通過(guò)協(xié)方差分析(ANCOVA)和Post-Hoc t檢驗(yàn)進(jìn)行組間比較。結(jié)果:與HC相比,FOG(+)PD的左側(cè)顳下回、右側(cè)舌回、雙側(cè)梭狀回、右側(cè)枕下回、右側(cè)矩狀裂及其周圍皮層及右側(cè)小腦ReHo減弱;右側(cè)額中回、右側(cè)三角部額下回、右側(cè)島蓋部額下回、右側(cè)背外側(cè)額上回、右側(cè)中央前回及右側(cè)輔助運(yùn)動(dòng)區(qū)ReHo增強(qiáng);與FOG(-)PD相比,FOG(+)PD的右側(cè)中央前回、右側(cè)額中回、右側(cè)額下回及右側(cè)輔助運(yùn)動(dòng)區(qū)ReHo增強(qiáng),未發(fā)現(xiàn)ReHo減弱的區(qū)域。在功能連接方面,與正常對(duì)照組及帕金森病不伴凍結(jié)步態(tài)組相比,帕金森病伴凍結(jié)步態(tài)組與PPN功能連接異常的腦區(qū)主要分布在皮質(zhì)-腦橋核-小腦通路(包括雙側(cè)小腦和腦橋)以及視覺(jué)相關(guān)顳葉皮層(包括右側(cè)顳中回和右側(cè)顳下回)。結(jié)論:帕金森病凍結(jié)步態(tài)患者存在異常的腦功能活動(dòng)和功能連接,FOG(+)PD患者腦內(nèi)局部一致性異常的腦區(qū)包括了小腦、額葉以及視覺(jué)網(wǎng)路相關(guān)皮層;同時(shí)通過(guò)觀察雙側(cè)PPN與全腦的功能連接,發(fā)現(xiàn)PD FOG(+)患者存在異常的PPN功能連接網(wǎng)絡(luò),主要影響皮質(zhì)-腦橋核-小腦通路和參與視覺(jué)信息處理相關(guān)皮層,提示了 FOG的產(chǎn)生可能涉及的潛在神經(jīng)功能異常和損傷機(jī)制,有助于我們進(jìn)一步探知FOG的神經(jīng)病理機(jī)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(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R742.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 徐翠萍;莊平;李勇杰;;帕金森病臨床分型的研究進(jìn)展[J];中華神經(jīng)外科雜志;2016年11期

2 王輝;陳楠;李坤成;段祥攻;;度中心度方法對(duì)基底節(jié)區(qū)腦梗死患者人腦功能連接組的研究[J];磁共振成像;2016年10期

3 卞育婕;王瑩雪;周玉奇;崔逸爽;周國(guó)龍;魏子峰;張宇新;王茜;;帕金森病震顫?rùn)C(jī)制腦部網(wǎng)絡(luò)模型研究進(jìn)展[J];中國(guó)綜合臨床;2016年08期

4 魏彩霞;鄧霞;潘治斌;徐仁O5;;功能磁共振在帕金森病運(yùn)動(dòng)癥狀診斷中的應(yīng)用[J];中國(guó)老年學(xué)雜志;2015年21期

5 許媛媛;劉衛(wèi)國(guó);;靜息態(tài)功能磁共振成像在帕金森病中應(yīng)用的研究進(jìn)展[J];中華腦科疾病與康復(fù)雜志(電子版);2015年04期

6 候亞男;張佳榮;陳彪;吳濤;;帕金森病不同運(yùn)動(dòng)分型患者局部腦活動(dòng)的功能磁共振觀察[J];中華醫(yī)學(xué)雜志;2015年07期

7 彭帥;陳敏;李春媚;馬欣昕;婁寶輝;羅曉捷;王蕊;蘇聞;;帕金森病靜息態(tài)腦功能MRI研究[J];磁共振成像;2014年05期

8 武成華;范國(guó)光;張雷;;帕金森病的小腦功能連接與解剖連接的影像學(xué)研究現(xiàn)況與進(jìn)展[J];中華臨床醫(yī)師雜志(電子版);2013年12期

9 劉虎;范國(guó)光;徐克;商秀麗;何志義;;帕金森病患者靜息態(tài)下腦活動(dòng)的局部一致性[J];中國(guó)醫(yī)學(xué)影像技術(shù);2011年10期

10 劉波;陳俊;劉峴;龍玉;陳志光;李寧娜;;帕金森病靜息態(tài)腦默認(rèn)狀態(tài)網(wǎng)絡(luò)的觀察[J];中國(guó)醫(yī)學(xué)影像技術(shù);2009年07期

，

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