本文選題：注意缺陷多動(dòng)障礙 + 靜息態(tài)功能核磁共振　； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探索經(jīng)系統(tǒng)哌醋甲酯治療的注意缺陷多動(dòng)障礙(Attention Deficit Hyperactivity Disorder,ADHD)患者在停藥6-8周后靜息態(tài)功能磁共振成像(Resting State Functional Magnetic Resonance Imaging,RS-fMRII)、認(rèn)知功能及臨床癥狀的變化情況及其影響因素,從而為臨床制定個(gè)體化治療方案、特別是選擇停藥時(shí)機(jī)提供參考。[方法]收集13例經(jīng)哌醋甲酯系統(tǒng)治療8周以上、治療有效、且符合DSM-Ⅳ診斷標(biāo)準(zhǔn)的ADHD患兒(服藥有效組)、以及12例與服藥有效組年齡、性別、智商、臨床癥狀嚴(yán)重程度相匹配的未服藥ADHD患者(未服藥對(duì)照組)的臨床資料,包括一般情況、臨床癥狀表現(xiàn)、認(rèn)知功能等。采用ADHD癥狀分級(jí)父母評(píng)量表(Attention Deficit Hyperactivity Disorder Rating Scale-IV Home Version, ARS)及 Conners 父母評(píng)癥狀量表(Conners Parent Symptom Questionnaire, PSQ)評(píng)估患者的臨房床癥狀,采用注意力持續(xù)操作測(cè)驗(yàn)、Rey復(fù)雜圖形、連線(xiàn)實(shí)驗(yàn)、Stroop色詞干擾測(cè)試等工具評(píng)估患者的認(rèn)知功能。采用飛利浦3. 0T磁共振機(jī)器采集未服藥對(duì)照組患者、服藥有效組患者服藥期及停藥期的RS-fMRI腦功能數(shù)據(jù)。所有核磁數(shù)據(jù)應(yīng)用基于Matlab平臺(tái)下的DPARSF、REST等軟件進(jìn)行數(shù)據(jù)處理及統(tǒng)計(jì)分析。采用局部一致性(Regional Homogeneity, ReHo)、功能連接的分析方法比較各個(gè)對(duì)比組間靜息態(tài)腦功能的情況,功能連接的感興趣區(qū)(Region of Interest,ROI)選取ReHo結(jié)果中團(tuán)塊最大的腦區(qū)右側(cè)前扣帶和旁扣帶腦回。將蒙特利爾神經(jīng)病學(xué)研究所(Montreal Neurological Institute,M I)標(biāo)準(zhǔn)三維腦模板疊加到所得到的全腦統(tǒng)計(jì)參數(shù)圖進(jìn)行顯示,對(duì)照AAL分區(qū)(Anatomical Automatic Labeling, AAL)標(biāo)記出具有統(tǒng)計(jì)學(xué)差異的團(tuán)塊所包含腦區(qū)及腦區(qū)的體素大小,并且記錄這些團(tuán)塊的峰值坐標(biāo)及峰值強(qiáng)度。采用配對(duì)T檢驗(yàn)統(tǒng)計(jì)方法,比較9例服藥有效組患者服藥期與停藥期臨床癥狀、認(rèn)知功能及腦功能的變化;比較12對(duì)未服藥對(duì)照組與服藥有效組服藥期臨床癥狀、認(rèn)知功能及腦功能的差異;比較8對(duì)未服藥對(duì)照組與服藥有效組停藥期臨床癥狀、認(rèn)知功能及腦功能的差異。[結(jié)果]1、服藥有效組共13人完成服藥期臨床資料及靜息態(tài)腦功能數(shù)據(jù)收集,其中男12人(92. 3%),女1人(7. 7%)。年齡最大13歲(2人),最小8歲(3人),平均年齡9. 77±1.69歲。IQ最高為106 (1人),最低為85 (1人),平均IQ94. 54±6. 06。其中9人完成停藥期的臨床資料及靜息態(tài)腦功能數(shù)據(jù)收集;納入與服藥有效組性別(同性別)、年齡(相差≤1歲)、IQ (相差≤15)、體重(相差≤5Kg)相匹配的ADHD患兒共12人;2、服藥有效組的ADHD患兒(n=9)停藥后ARS及PSQ總分上升(P均0. 05) ,其中高齡組(9歲)的ADHD患兒ADHD癥狀評(píng)估量表的增分較低齡組(≤9歲)的患兒低(P0. 05);服藥有效組的ADHD患兒停藥后在左側(cè)眶部額下回、左側(cè)眶部額中回、右側(cè)前扣帶和旁扣帶腦回、右側(cè)的背外側(cè)額上回、右側(cè)內(nèi)側(cè)額上回等腦區(qū)ReHo值變低,而在小腦腦區(qū)的ReHo值升高(P均0. 05);以右側(cè)前扣帶和旁扣帶腦回作為ROI,服藥有效組停藥后與ROI連接強(qiáng)度降低的腦區(qū)有左右側(cè)的眶部額上回及左側(cè)眶部額下回,與ROI連接強(qiáng)度增強(qiáng)的腦區(qū)有左右側(cè)的頂上回、右側(cè)顳中回、枕中回及小腦(P均0.05);3、與未服藥對(duì)照組相比,服藥有效組服藥期(12對(duì))PSQ總分、ARS總分、注意缺陷因子分、CPT錯(cuò)誤數(shù)T值均較低(P均0.05);服藥有效組服藥期在左側(cè)內(nèi)側(cè)額上回、右側(cè)前扣帶和旁扣帶腦回等腦區(qū)較未服藥對(duì)照組ReHo值高,在右側(cè)頂上回腦區(qū)較未服藥對(duì)照組ReHo值低(P均0. 05);4、與未服藥對(duì)照組相比,服藥有效組停藥期(8對(duì))PSQ總分低、Rey復(fù)雜圖形等級(jí)及Stroop色詞得分等級(jí)高(P均0.05);服藥有效組停藥期在左側(cè)額中回較未服藥對(duì)照組ReHo值高,而在小腦較未服藥對(duì)照組ReHo值低(P均0. 05)。[結(jié)論]經(jīng)哌醋甲酯系統(tǒng)治療有效的ADHD患者在停藥后臨床癥狀及靜息態(tài)腦功能均會(huì)出現(xiàn)不同程度的加重或衰退,率先出現(xiàn)衰退的腦區(qū)集中在前額葉及前扣帶回。但即便如此,停藥期患兒的臨床表現(xiàn)、認(rèn)知功能及腦功能依然要優(yōu)于未服藥患者;本研究?jī)H發(fā)現(xiàn)患者的年齡是停藥后臨床癥狀加重程度的影響因素,年齡9歲的ADHD患兒臨床癥狀的加重程度較年齡≤9歲的患兒輕。
[Abstract]:[Objective] to explore the changes of the resting state functional magnetic resonance imaging (Resting State Functional Magnetic Resonance Imaging, RS-fMRII) in patients with Attention Deficit Hyperactivity Disorder (ADHD) after 6-8 weeks of drug withdrawal, and the changes in the cognitive energy and clinical symptoms and the influencing factors. In order to establish an individualized treatment plan for clinical treatment, especially to choose the time of withdrawal, 13 cases of ADHD, which were treated effectively, were treated effectively, and were in line with DSM- IV diagnostic criteria (effective group), and 12 cases were matched with the age, sex, IQ, and clinical symptom severity of the effective group. Clinical data of patients with drug ADHD (untreated control group), including general conditions, clinical symptoms, cognitive functions, and so on. Using the ADHD symptom graded parents Rating Scale (Attention Deficit Hyperactivity Disorder Rating Scale-IV Home Version, ARS) and Conners parents rating scale Patients with atrial bed symptoms, using attention continuous operation test, Rey complex graph, connection test, Stroop color word interference test and other tools to evaluate the patient's cognitive function. Using PHILPS 3. 0T MRI machine to collect the patients in the control group, the effective group of patients in the period of taking medicine and the time of RS-fMRI brain function data. Data processing and statistical analysis are carried out based on DPARSF and REST software based on Matlab platform. Local consistency (Regional Homogeneity, ReHo), functional connection analysis method is used to compare the rest state brain function of each contrast group, and the region of interest of functional connection (Region of Interest, ROI) selects the largest mass in the ReHo result. The right anterior cingulate and paracerebral gyrus in the brain area. The Montreal Neurological Institute (M I) standard three-dimensional brain template was superimposed on the obtained statistical parameters of the whole brain, and the AAL partition (Anatomical Automatic Labeling, AAL) was used to mark the brain regions with statistical differences. And the size of voxel in the brain area and the peak value and peak intensity of these groups were recorded. The clinical symptoms, cognitive function and brain function of the 9 patients in the effective group were compared with the changes of the clinical symptoms, cognitive function and brain function of the 9 cases, compared with the 12 pairs of untreated control group and the effective group, and the cognitive function and brain. The difference in function, compared the clinical symptoms, cognitive function and brain function of the 8 untreated control group and the effective group, [results]1, 13 people in the effective group completed the clinical data and the resting state brain function data collection, including 12 men (92.3%), 1 women (7.7%), the oldest 13 years (2), and the smallest 8 years old (3), averages) The highest.IQ was 9.77 + 1.69 years old (1 people), the lowest was 85 (1), and the average IQ94. 54 + 6. 6 of them had completed the clinical data and the resting state brain function data collection in the stopping drug period; it was included in the ADHD children with the gender (the same sex), the age (the difference < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < 9.77); a total of ADHD children who were matched with IQ (difference < < < < < < < < 5Kg). The total score of ARS and PSQ in the effective group of ADHD children (n=9) increased (P 0.05). The increase score of the ADHD symptom assessment scale for ADHD children in the elderly group (9 years old) was lower (P0. 05) than those in the lower age group (< < 9 years of age); the effective group of ADHD children in the effective group stopped at the left orbital frontal gyrus, the left orbital frontal gyrus, right anterior cingulate and paracasal cingulate gyrus, right The ReHo value of the lateral frontal lateral frontal gyrus and the right medial upper frontal gyrus was lower, while the ReHo value in the cerebellar brain region increased (P 0.05), and the right anterior cingulate and paracerebral cingulate gyrus were used as ROI. The brain area of the effective group with the decrease of the intensity of the ROI connection had the left and right orbital frontal gyrus and the left orbital frontal gyrus, and the strength of the ROI connection was enhanced. The brain area had the upper and right lateral parietal gyrus, right temporal gyrus, occipital gyrus and cerebellum (P 0.05); 3, compared with the untreated control group, the effective group (12 pairs) of PSQ total, ARS total, attention deficit factor, and CPT error number T were lower (P 0.05); the effective group took the drug group in the left medial frontal gyrus, right anterior cingulate and paracerebral cingulate. Compared with those in the untreated control group, the value of ReHo was higher than that in the non drug control group (P 0.05) in the right top upper upper gyrus, and 4, 4. Compared with the untreated control group, the total score of PSQ in the effective group was lower than that in the control group (8 pairs), and the Rey complex figure grade and the Stroop color word score were higher (P 0.05), and the effective group was not given the left middle frontal gyrus in the effective group. The ReHo value of the drug control group was high, but the ReHo value of the cerebellum was lower than that in the control group (P 0.05). [Conclusion] the clinical symptoms and the resting state brain function of the effective ADHD patients treated with methylphenidate system were aggravated or declined in varying degrees after the withdrawal of the drug, and the first occurrence of the recession was concentrated in the prefrontal and anterior cingulate gyrus, but even so, The clinical manifestation, cognitive function and brain function of the children in the drug stop period are still better than those in the untreated patients. This study only found that the age of the patients was the influencing factor of the severity of the clinical symptoms after the drug withdrawal, and the severity of the clinical symptoms of ADHD children aged 9 years was lighter than those aged 9 years old.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R749.94

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