本文選題：缺血性腦卒中　切入點(diǎn)：BOLD-fMRI　出處：《成都體育學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:采用測量患者患側(cè)M1區(qū)皮層厚度、fALFF值、ReHo值及功能連接等多模態(tài)分析法,研究rTMS對亞急性期腦梗死患者M(jìn)1區(qū)在治療前后結(jié)構(gòu)和功能的變化,探討rTMS對患者大腦皮質(zhì)功能的重塑過程,以期為臨床提供可靠的治療依據(jù)。研究方法:選取30例初次患病腦梗死患者(病灶單一,病程10-20天),隨機(jī)平均分為對照組(采用神經(jīng)內(nèi)科藥物治療和一般康復(fù)治療)和實(shí)驗(yàn)組(在對照組治療基礎(chǔ)上增加rTMS治療)。兩組均于入院當(dāng)日和一個(gè)療程后(治療4周后),進(jìn)行BOLD-fMRI靜息態(tài)掃描和UE-FMA評(píng)分。其次,運(yùn)用Freesurfer V.5.1.0軟件逐個(gè)測量被試者患側(cè)M1區(qū)皮層厚度。再次,使用Matlab2009a自帶的DPARSFA、REST插件進(jìn)行靜息態(tài)fMRI數(shù)據(jù)處理,計(jì)算出全部被試者患側(cè)M1區(qū)ReHo值和fALFF值。第四,在治療后實(shí)驗(yàn)組與對照組M1區(qū)皮層厚度存在差異的腦區(qū),選取該腦區(qū)峰值點(diǎn)MNI坐標(biāo)為種子點(diǎn),以半徑為5mm球形區(qū)域作為ROI,與全腦其他體素進(jìn)行靜息態(tài)功能連接分析。最終,將所有被試者性別、年齡、受教育程度作為協(xié)變量,運(yùn)用REST對兩組被試者治療前后Re Ho值、fALFF值以及FC結(jié)果進(jìn)行配對t檢驗(yàn)和雙樣本t檢驗(yàn),分析組間和組內(nèi)結(jié)果差異,以及UE-FMA評(píng)分和Re Ho值的相關(guān)性。研究結(jié)果顯示:通過治療,兩組患者M(jìn)1區(qū)皮層厚度均存在增厚的變化,實(shí)驗(yàn)組增厚較明顯(p0.05);治療后,兩組患者RIO區(qū)的ReHo值均較前降低,而實(shí)驗(yàn)組降低較對照組明顯(P0.05);該區(qū)兩組患者fALFF值治療后較治療前增高,實(shí)驗(yàn)組增高明顯(P0.05)。RIO與全腦功能連接結(jié)果顯示,對照組治療前后ROI與全腦功能連接差異結(jié)果在患側(cè)顳中回、顳下回、額上回及額中回等存在連接增強(qiáng),健側(cè)枕下回、扣帶回后部等出現(xiàn)連接減弱;實(shí)驗(yàn)組治療后與治療前ROI與全腦功能連接差異結(jié)果顯示患側(cè)顳中回、顳下回出現(xiàn)功能連接增強(qiáng),患側(cè)中央前回、患側(cè)中央后回及雙側(cè)輔助運(yùn)動(dòng)區(qū)存在功能連接減弱表現(xiàn);對比實(shí)驗(yàn)組與對照組治療前后差異表明,在小腦及枕葉存在大面積連接減弱的區(qū)域。(p0.05,同時(shí)運(yùn)用FDR校正進(jìn)行cluster水平的校正,p0.05)。ReHo與UE-FMA評(píng)分相關(guān)分析結(jié)果顯示:患者患側(cè)Re Ho值與UE-FMA評(píng)分呈現(xiàn)正相關(guān)。研究結(jié)論:(1)通過治療,實(shí)驗(yàn)組和對照組患者患側(cè)M1區(qū)皮層厚度較前均有增厚表現(xiàn)、Re Ho值較前均降低、fALFF值較前均增高,而實(shí)驗(yàn)組較對照組變化幅度較大。這些結(jié)果以及功能連接的結(jié)果均證實(shí)了隨著治療介入大腦開始從代償向自我修復(fù)轉(zhuǎn)變,同時(shí)說明rTMS對腦部結(jié)構(gòu)重塑的起促進(jìn)作用。(2)患者患側(cè)ReHo值與UE-FMA評(píng)分呈現(xiàn)正相關(guān),說明基于ReHo的靜息態(tài)fMRI技術(shù)能夠有效評(píng)價(jià)rTMS的治療效果,動(dòng)態(tài)觀察以及預(yù)測患者的恢復(fù)情況。(3)采用結(jié)構(gòu)與功能相結(jié)合的分析方法觀察腦梗死患者M(jìn)1區(qū)變化,是探討rTMS對于改善患者上肢運(yùn)動(dòng)功能恢復(fù)機(jī)制的有效手段。
[Abstract]:Objective: to study the changes of the structure and function of M1 area in patients with subacute cerebral infarction before and after treatment by measuring the cortical thickness of the affected M1 area and the functional junction and other multimodal analysis methods. To investigate the remodeling process of cerebral cortex function in patients with rTMS in order to provide a reliable basis for clinical treatment. Methods: 30 patients with primary cerebral infarction (single focus) were selected. The course of the disease was 10-20 days and was randomly divided into two groups: the control group (treated with neuromedical therapy and general rehabilitation) and the experimental group (the treatment group was treated with rTMS on the basis of the control group). Both groups were treated on the day of admission and after one course of treatment (treatment). After 4 weeks, BOLD-fMRI rest scanning and UE-FMA score were performed. Secondly, Freesurfer V.5.1.0 software was used to measure the cortical thickness of M1 area of the affected side of the subjects one by one. Thirdly, the rest fMRI data were processed by using the rest plug-in of Matlab2009a's own DPARSFAP, and the ReHo and fALFF values of M1 region of all the subjects were calculated. 4th. After treatment, the cerebral regions with different cortical thickness in M1 region of the experimental group and the control group were selected as seed points, and the spherical area with a radius of 5 mm was used as the seed point, and the rest functional connection analysis was carried out with other voxels in the whole brain. The sex, age and education level of all subjects were used as covariables. Re Ho and FC results were matched t test and double sample t test before and after treatment with REST. The difference of results between groups and within groups was analyzed. The correlativity of UE-FMA score and ReHo value. The results showed that the cortical thickness of M1 area was thickened in both groups, the thickening of experimental group was more obvious (p 0.05), the ReHo value of RIO area in both groups was lower than that in the former group after treatment. The fALFF value of the two groups was higher than that of before treatment, and that of the experimental group was significantly higher than that of the control group. The results of functional connection between ROI and the whole brain in the experimental group showed that the difference between the ROI and the whole brain function before and after treatment was in the middle temporal gyrus of the affected side. The connection of inferior temporal gyrus, superior frontal gyrus and middle frontal gyrus was enhanced, the connection of contralateral inferior occipital gyrus and posterior cingulate gyrus was weakened. The functional junctions in the infratemporal gyrus, precentral gyrus of the affected side, postcentral gyrus of the affected side and bilateral auxiliary motor area were enhanced, and the differences between the experimental group and the control group before and after treatment were compared. In the cerebellum and occipital lobe, there is a large area of weakened junction. The FDR correction was used to correct the cluster level. The correlation analysis between ReHo and UE-FMA score showed that there was a positive correlation between the ReHo value of the affected side of the patient and the UE-FMA score. Conclusion: 1) through treatment, there is a positive correlation between the ReHo value of the affected side of the patient and the UE-FMA score. The cortical thickness of M1 region in the experimental group and the control group was thicker than that of the former. The re Ho value decreased and the fALFF value increased compared with the former. These results, as well as the results of functional junctions, confirmed that the brain began to shift from compensation to self-repair as treatment intervened. At the same time, it was suggested that the ReHo value of the affected side was positively correlated with the UE-FMA score in the patients with rTMS, and that the resting fMRI technique based on ReHo could effectively evaluate the therapeutic effect of rTMS. Dynamic observation and prediction of recovery in patients with cerebral infarction using structural and functional analysis method to observe the changes of M1 area in patients with cerebral infarction is an effective means to explore the mechanism of rTMS in improving the recovery of upper limb motor function in patients with cerebral infarction.
【學(xué)位授予單位】：成都體育學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R743.33

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