本文選題：伴中央顳區(qū)棘波兒童良性癲癇　切入點：靜息態(tài)功能磁共振　出處：《川北醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：評估伴中央顳區(qū)棘波兒童良性癲癇（BECT）的認(rèn)知功能，采用靜息態(tài)功能磁共振（fMRI）成像技術(shù)，觀察BECT默認(rèn)模式腦網(wǎng)絡(luò)（DMN）特征及其功能連接的改變，初步探討B(tài)ECT認(rèn)知功能改變、DMN特征及認(rèn)知功能改變與fMRI功能連接之間的相關(guān)性，以期從腦網(wǎng)絡(luò)角度為BECT臨床診療及病理生理機(jī)制的探尋提供相關(guān)依據(jù)。 方法：收集27例符合診斷標(biāo)準(zhǔn)的患者為BECT組，以及18位健康志愿者為正常對照組，其中BECT組分為服藥組（n=13例）及未服藥組（n=14例）。采用中國修訂韋氏兒童智力量表（WISC），對所有兒童行智力測定，得出言語智商（VIQ）、操作智商（PIQ）及總智商（FSIQ）。采用SPSS13.0軟件包進(jìn)行統(tǒng)計分析，采用獨立樣本t檢驗及單因素方差分析的統(tǒng)計學(xué)方法，計量資料以x±s表示。所有被試在3.0T磁共振環(huán)境下采集靜息態(tài)fMRI數(shù)據(jù)，數(shù)據(jù)分析以后扣帶回（PCC）為種子點，采用基于感興趣區(qū)（ROI）功能連接的分析方法，觀察BECT的DMN特征及其功能連接的改變。最后以功能連接降低的腦區(qū)及ROI為種子點取其Z分?jǐn)?shù)值，分別與BECT組WISC評分結(jié)果行相關(guān)性分析。 結(jié)果：（一）WISC測試結(jié)果：1.BECT組兒童在常識、分類、算術(shù)、詞匯、理解、填圖、排列、積木、拼圖、編碼分測驗中得分明顯低于正常對照組兒童，差異有統(tǒng)計學(xué)意義（p0.01）；2.BECT組兒童VIQ、PIQ及FSIQ均低于正常對照組，差異有統(tǒng)計學(xué)意義（p0.01）；3.服藥組、未服藥組兒童VIQ、PIQ及FSIQ均低于正常對照組，差異有統(tǒng)計學(xué)意義（p0.01），但服藥組、未服藥組兒童VIQ、PIQ及FSIQ相比，差異無統(tǒng)計學(xué)意義（p0.05）。（二）fMRI數(shù)據(jù)方面，27例BECT組中5例被試因檢查時過度頭動而被淘汰，正常對照組3位因頭動過大被淘汰。fMRI功能連接研究結(jié)果：1.以PCC為種子點，利用基于ROI的DMN模式網(wǎng)絡(luò)分析所有被試，正相關(guān)區(qū)域主要位于前扣帶回，楔前葉，雙側(cè)角回，內(nèi)側(cè)前額葉皮層，額上回，顳下回皮層，小腦，尾狀核。負(fù)相關(guān)區(qū)域主要位于輔助運動區(qū)，中扣帶回，雙側(cè)頂下葉，腦島，額中葉，頂下小葉，雙側(cè)舌回，右側(cè)枕下葉，額下葉；2.比較DMN之間的差異顯示，與正常對照組相比，BECT組與PCC功能連接降低的腦區(qū)為右中扣帶回，楔前葉，即與種子區(qū)臨近的腦區(qū)有連接降低，BECT組與PCC功能連接增加的腦區(qū)為雙側(cè)額上回，右側(cè)額中回；3.在未服藥組、服藥組及正常對照組行兩兩之間的DMN網(wǎng)絡(luò)差異比較表明，與正常對照組相比，未服藥組與PCC功能連接降低的腦區(qū)為楔前葉，，右中扣帶回，即與種子區(qū)臨近的腦區(qū)有連接降低，與PCC功能連接增加的腦區(qū)為雙側(cè)額上回，右側(cè)額中回；與正常對照組相比，服藥組與PCC功能連接降低的腦區(qū)為楔前葉，左顳中回，與PCC功能連接增加的腦區(qū)為右側(cè)額上回，旁中央小葉；與服藥組相比，未服藥組功能連接降低的腦區(qū)為小腦后葉、右側(cè)尾狀核、楔前葉、中央后回、左側(cè)中央旁小葉，功能連接增強(qiáng)的腦區(qū)為額葉內(nèi)側(cè)回、左側(cè)中額葉。（三）基于ROI的DMN網(wǎng)絡(luò)內(nèi)部節(jié)點間功能連接分析結(jié)果顯示，BECT組相比于正常對照組，其DMN網(wǎng)絡(luò)連接更稠密。（四）認(rèn)知功能改變與fMRI功能連接之間的相關(guān)性分析結(jié)果：1.BECT組DMN中功能連接顯著降低的兩個腦區(qū)即楔前葉（Precuneus）、右側(cè)中扣帶回（R.MCC）的連接（Z分?jǐn)?shù)值）與BECT的VIQ、PIQ及FSIQ具有顯著正相關(guān)關(guān)系。2.基于ROI間的DMN功能連接與BECT組WISC評分行相關(guān)性分析，兩者總體呈負(fù)相關(guān)關(guān)系。 結(jié)論： 1. BECT患兒VIQ、PIQ及FSIQ降低，其存在一定程度的認(rèn)知功能損害。 2.服藥組與未服藥組VIQ、PIQ及FSIQ相比，差異無統(tǒng)計學(xué)意義（p0.05），推測其認(rèn)知功能損害可能是BECT的前兆癥狀或伴隨癥狀。 3.以PCC為種子點的功能連接分析方法能在BECT患者中獲得自發(fā)穩(wěn)定的低頻振蕩信號和DMN連接圖。 4. BECT組獲得的DMN腦區(qū)與既往研究的腦區(qū)基本一致，但BECT的DMN腦區(qū)范圍更廣，可能是由癲癇疾病間接地影響了兒童的生理發(fā)育周期，或系癲癇直接導(dǎo)致兒童大腦網(wǎng)絡(luò)連接異常，導(dǎo)致DMN重新分布。 5. BECT內(nèi)部功能連接改變可能造成DMN集成功能變化，其可能源自BECT兒童神經(jīng)發(fā)育異�；蛘叽竽X結(jié)構(gòu)功能方面的重組，從而導(dǎo)致其認(rèn)知功能損害。 6. BECT患兒的DMN內(nèi)部功能連接更加朝向一個規(guī)則化網(wǎng)絡(luò)發(fā)展，可能不利于患兒功能腦區(qū)的發(fā)育完善，引起大腦網(wǎng)絡(luò)調(diào)控紊亂，從而導(dǎo)致神經(jīng)心理行為學(xué)的異常。
[Abstract]:Objective: To evaluate with centrotemporal spikes in children with benign epilepsy (BECT) cognitive function by resting state functional magnetic resonance imaging (fMRI), observe the BECT default mode network (DMN) and its characteristics of brain functional connectivity changes, preliminary study of the cognitive function of BECT, the correlation between DMN features and the changes of cognitive function and fMRI function the connection between, in order to provide relevant basis to explore from the brain network angle of BECT clinical diagnosis and pathophysiological mechanisms.
Methods: a total of 27 cases of BECT group, and 18 healthy volunteers as normal control group, the BECT group was divided into treatment group (n=13 cases) and treatment group (n=14 cases). The China Wechsler Intelligence Scale for children (WISC), were determined for all children for intelligence, the verbal intelligence quotient (VIQ), operation (PIQ) and total IQ IQ (FSIQ). SPSS13.0 software was used for statistical analysis, using statistical methods analysis of variance independent sample t test and single factor, measurement data with x + s. All of the subjects in resting state fMRI data acquisition in 3.0T magnetic resonance environment. Data analysis after the cingulate (PCC) as the seed points, the region of interest (ROI) based on the analysis of functional connectivity, DMN features and functions of BECT. The change of the observation of connected brain areas decreased and ROI as seed points from the Z value, WISC and BECT group respectively. The results were analyzed by correlation.
Results: (1) WISC test results: 1.BECT group of children in the common sense, classification, arithmetic, vocabulary, comprehension, mapping, arrangement, building blocks, puzzles, encoding the test score is significantly lower than the normal control group, the difference was statistically significant (P0.01); 2.BECT group of children VIQ, PIQ and FSIQ were lower than the normal control group, the difference was statistically significant (P0.01); the 3. drug group, unmedicated group of children with VIQ, PIQ and FSIQ were lower than the normal control group, the difference was statistically significant (P0.01), but the medication group, unmedicated group of children with VIQ, compared with PIQ and FSIQ, the difference was not statistically significant (P0.05) (two) fMRI data. In 27 cases, there were 5 cases in group BECT were examined by excessive head motion was eliminated, the normal control group had 3 big head was eliminated.FMRI functional connectivity results: 1. using PCC as the seed point, use the DMN network model ROI analysis based on all subjects, is mainly located in the anterior region buckle Back, bilateral precuneus, angular gyrus, medial prefrontal cortex, superior frontal gyrus, inferior temporal gyrus, cerebellum, caudate nucleus. Negative correlation areas are mainly located in the supplementary motor area, middle cingulate gyrus, bilateral inferior parietal lobe, insula, frontal lobe, inferior parietal lobule, bilateral lingual gyrus, right occipital lobe, frontal leaves; show differences between 2. DMN, compared with the normal control group, BECT group and PCC brain areas is lower, right cingulate gyrus, precuneus, brain area near the area are connected with seed reduced, BECT group and PCC brain areas increased bilateral superior frontal gyrus, right frontal gyrus; 3. in the treatment group, treatment group and normal control group the difference between the 22 DMN network shows that compared with the normal control group, untreated group and PCC brain areas decreased as precuneus, right cingulate gyrus, namely brain regions near and seed regions connected to reduce increase, connected with the PCC function Brain regions of bilateral superior frontal gyrus, right middle frontal gyrus; compared with normal control group, drug group and PCC brain areas decreased as precuneus, left middle temporal gyrus, brain regions increased in connection with the PCC function as the right superior frontal gyrus, paracentral lobule; compared with the control group. The brain no medicine group decreased functional connectivity for the posterior lobe of cerebellum, right caudate nucleus, precuneus, posterior central gyrus, left paracentral lobule, brain functional connectivity for the medial frontal gyrus, left middle frontal lobe. (three) the internal nodes of the DMN network ROI function based on the connection analysis results showed that compared to the normal control group, BECT group, the DMN network connection is more densely populated. (four) correlation between the changes of cognitive function and fMRI function of connection between the results of the analysis: two areas of the brain function of 1.BECT in the DMN group significantly reduced the connection of the precuneus (Precuneus), right cingulate gyrus (R.MCC) connection (Z score) and BECT VIQ P. There was a significant positive correlation between IQ and FSIQ..2. based on ROI was associated with the correlation analysis of WISC scores in BECT group, and there was a negative correlation.
Conclusion:
1. BECT children with VIQ, PIQ and FSIQ decreased to a certain degree of cognitive impairment.
2., there was no significant difference in VIQ, PIQ and FSIQ between the two groups (P0.05), suggesting that their cognitive impairment may be a precursor or accompanying symptom of BECT.
3. the functional connection analysis method with PCC as the seed point can obtain spontaneous and stable low frequency oscillating signals and DMN connections in BECT patients.
4., the DMN area obtained from BECT group is basically the same as that of the previous study. However, the DMN brain area of BECT is wider. It may be indirectly affected by epilepsy, or directly lead to the abnormal connection of children brain network, resulting in the redistribution of DMN.
5., changes in internal functional connectivity of BECT may lead to changes in DMN integration function, which can be derived from BECT children's neurodevelopmental abnormalities or brain structural function reorganization, resulting in cognitive impairment.
6., the internal functional connectivity of DMN in children is more directed towards a regular network development. It may not be conducive to the development and improvement of functional brain regions in children, resulting in brain network regulation disorder, which leads to abnormal neuropsychological behavior. BECT

【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R742.1

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