發(fā)布時(shí)間：2018-06-13 20:07

  本文選題：兒童生長激素缺乏癥 + 智商��； 參考：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文

【摘要】：目的：兒童生長激素缺乏癥是由于垂體前葉合成分泌生長激素過少引起的身材矮小、生長速度減慢的內(nèi)分泌疾病。針對(duì)該患者群體可能存在的認(rèn)知能力受損的熱點(diǎn)問題,本文通過多模態(tài)腦核磁共振成像技術(shù)研究其腦結(jié)構(gòu)及功能的改變,分析腦結(jié)構(gòu)、功能與其認(rèn)知能力和生長激素/胰島素樣生長因子-1之間的相關(guān)關(guān)系。方法：北京協(xié)和醫(yī)院內(nèi)分泌科矮小門診自2013年至今招募學(xué)齡期診斷為完全性生長激素缺乏癥患者作為病例組,骨齡偏小同時(shí)生長激素/胰島素樣生長因子-1及生長速度正常的兒童作為對(duì)照組,使用韋氏兒童智力量表評(píng)估智力,采集腦核磁共振T1加權(quán)像、彌散張量成像及靜息態(tài)腦功能像數(shù)據(jù),結(jié)合激素水平進(jìn)行統(tǒng)計(jì)分析。結(jié)果：病例組(n=11)與對(duì)照組(n=10)兒童年齡(10.36±0.61歲vs 9.21±0.54歲)、性別(男性被試百分比81.8%vs 70.0%)及父母經(jīng)濟(jì)受教育情況相匹配�；純涸谥巧炭偡�、語言理解、知覺推理、工作記憶及加工速度分測(cè)試方面均顯著低于對(duì)照組(p0.05)。病例組在雙側(cè)皮質(zhì)脊髓束的平均彌散率較對(duì)照組顯著升高(p0.01)。相關(guān)分析(檢驗(yàn)水平p0.05)發(fā)現(xiàn),血清IGF-1水平與智商、工作記憶及加工速度指數(shù)存在顯著正相關(guān)；IGF-1水平與左側(cè)丘腦、蒼白球,右側(cè)殼核體積呈顯著正相關(guān),與包括非優(yōu)勢(shì)半球枕中回、枕下回、楔葉等多個(gè)腦區(qū)皮層厚度呈負(fù)相關(guān)；與位于右側(cè)皮質(zhì)脊髓束、上縱束腦區(qū)的各向異性分?jǐn)?shù)呈負(fù)相關(guān)；與左側(cè)海馬、海馬旁回腦區(qū)局部一致性,雙側(cè)中央前回、中央后回及中央旁小葉腦區(qū)低頻振幅及局部一致性呈顯著負(fù)相關(guān),其中后者腦區(qū)的低頻振幅水平完全介導(dǎo)了血清IGF-1水平與工作記憶指數(shù)的相關(guān)關(guān)系。結(jié)論：兒童生長激素缺乏癥患者在言語理解、知覺推理、工作記憶和加工速度維度的認(rèn)知能力均存在輕微降低,其中智商總分、工作記憶和加工速度指數(shù)與IGF-1水平呈正相關(guān)。丘腦等皮質(zhì)下核團(tuán),枕葉中下回等皮質(zhì)厚度,皮質(zhì)脊髓束的彌散特性,海馬、海馬旁回、中央前回、中央后回、中央旁小葉等腦區(qū)的腦活動(dòng)異�？赡苁莾和疓HD患者的腦部表現(xiàn)。上述發(fā)現(xiàn)對(duì)于GH/IGF-1的作用部位和疾病認(rèn)知異常的可能機(jī)制提供了實(shí)驗(yàn)依據(jù)。
[Abstract]:Objective: growth hormone deficiency in children is an endocrine disease of short stature and slow growth caused by low synthesis and secretion of growth hormone in anterior pituitary. In view of the hot issues of cognitive impairment in this patient group, the changes of brain structure and function were studied by multimodal MRI, and the brain structure was analyzed. The correlation between function and cognitive ability and growth hormone / insulin-like growth factor-1. Methods: school age patients with complete growth hormone deficiency were recruited from the dwarf outpatient department of Endocrinology Department of Peking Union Hospital from 2013 to present as case group. Children with small bone age and normal growth rate of growth hormone / insulin-like growth factor 1 were used as control group. Intelligence was assessed by Wechsler Intelligence scale and brain MRI T 1 weighted images were collected. Diffusion Zhang Liang imaging and resting brain function imaging data were analyzed with hormone level. Results: the age of the children in the case group was 10.36 鹵0.61 years old vs 9.21 鹵0.54 years old. The sex (the percentage of male subjects 81.8%vs 70.0) and the economic education of parents were matched with those of the control group (10. 36 鹵0. 61 years old vs 9. 21 鹵0. 54 years old). The scores of intelligence quotient, language understanding, perceptual reasoning, working memory and processing speed were significantly lower than those of the control group (P 0.05). The average diffusion rate of bilateral cortical spinal tract in the case group was significantly higher than that in the control group (P 0.01). Correlation analysis (p0.05) showed that there was a significant positive correlation between serum IGF-1 level and intelligence quotient (IQ), working memory and processing speed index. The level of IGF-1 was positively correlated with the volume of left thalamus, globus pallidus and right putamen nucleus. There was a negative correlation between the cortical thickness of the middle occipital gyrus, the inferior occipital gyrus and the wedge lobe, the anisotropy fraction of the upper longitudinal tract and the left hippocampus. The low frequency amplitude and local consistency of bilateral precentral gyrus, posterior central gyrus and paracentral lobular area were negatively correlated. The low frequency amplitude level of the latter completely mediates the correlation between the serum IGF-1 level and the working memory index. Conclusion: the cognitive ability of children with growth hormone deficiency in speech comprehension, perceptual reasoning, working memory and processing speed was slightly decreased. The total IQ score, working memory and processing speed index were positively correlated with IGF-1 level. The abnormal brain activity in hypocortical nucleus of thalamus, inferior middle occipital gyrus, diffusion characteristic of corticospinal tract, parahippocampal gyrus, precentral gyrus, posterior central gyrus and paracentral lobules may be the brain manifestations of children with GHD. These findings provide experimental evidence for the site of GHP IGF-1 and the possible mechanisms of disease cognitive abnormalities.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R725.8

【參考文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 李康;兒童期起病的成人生長激素缺乏癥患者的記憶功能靜息態(tài)功能核磁共振以及腦結(jié)構(gòu)的影像學(xué)研究[D];北京協(xié)和醫(yī)學(xué)院;2013年

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本文編號(hào)：2015254