本文選題：輕度認(rèn)知障礙　切入點(diǎn)：有氧訓(xùn)練操　出處：《南京醫(yī)科大學(xué)》2017年博士論文

【摘要】：第一部分有氧訓(xùn)練對(duì)輕度認(rèn)知障礙患者干預(yù)作用的研究目的:通過(guò)靜息態(tài)fMRI研究,評(píng)估一套專門編制的中等強(qiáng)度有氧訓(xùn)練操對(duì)輕度認(rèn)知障礙(MCI)患者的干預(yù)作用。方法:本研究將38例MCI患者按照隨機(jī)數(shù)字表法隨機(jī)分為訓(xùn)練組(19例)和對(duì)照組(19例)。訓(xùn)練組接受3個(gè)月的有氧訓(xùn)練操,對(duì)照組僅接受健康宣教。兩組受試者在入組時(shí)及3個(gè)月干預(yù)結(jié)束時(shí)均接受認(rèn)知功能量表評(píng)分和靜息態(tài)功能磁共振(fMRI)評(píng)估。靜息態(tài)fMRI采用低頻振幅(ALFF)分析方法。結(jié)果:經(jīng)過(guò)3個(gè)月的有氧訓(xùn)練操干預(yù)后,訓(xùn)練組簡(jiǎn)易精神狀態(tài)評(píng)分(MMSE)、蒙特利爾認(rèn)知評(píng)估量表(MoCA)、韋氏邏輯記憶及符號(hào)數(shù)字模式測(cè)試評(píng)分與干預(yù)前基線水平相比差異有統(tǒng)計(jì)學(xué)意義(p0.05),同時(shí)訓(xùn)練組韋氏邏輯記憶評(píng)分變化值與對(duì)照組韋氏邏輯記憶評(píng)分變化值相比差異也有統(tǒng)計(jì)學(xué)意義(p0.05)。對(duì)照組3個(gè)月后所有認(rèn)知功能評(píng)分與基線水平相比差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。靜息態(tài)fMRI數(shù)據(jù)分析提示訓(xùn)練組3個(gè)月后的雙側(cè)額顳葉、內(nèi)嗅、前扣帶回及海馬旁皮層較訓(xùn)練前廣泛性ALFF值增高,而對(duì)照組3個(gè)月后的僅右側(cè)顳葉和后扣帶回皮層小范圍的ALFF值較前增高。結(jié)論:有氧訓(xùn)練操能有效提高M(jìn)CI患者的認(rèn)知功能。靜息態(tài)fMRI為MCI患者有氧訓(xùn)練的有效性評(píng)價(jià)提供了一種敏感可行的量化方法。第二部分有氧訓(xùn)練對(duì)阿爾茨海默病患者干預(yù)作用的研究目的:通過(guò)靜息態(tài)fMRI研究,評(píng)估一套專門編制的中等強(qiáng)度有氧訓(xùn)練操對(duì)輕度阿爾茨海默病(AD)患者的干預(yù)作用。方法:本研究將40例輕度AD患者按照隨機(jī)數(shù)字表法隨機(jī)分為訓(xùn)練組(20例)和對(duì)照組(20例)。訓(xùn)練組接受3個(gè)月的有氧訓(xùn)練操,對(duì)照組僅接受健康宣教。兩組受試者在入組時(shí)及3個(gè)月干預(yù)結(jié)束時(shí)均接受認(rèn)知功能量表評(píng)分和靜息態(tài)fMRI評(píng)估。靜息態(tài)fMRI采用低頻振幅(ALFF)分析方法。結(jié)果:經(jīng)過(guò)3個(gè)月的有氧訓(xùn)練操干預(yù)后,訓(xùn)練組MMSE量表、連線測(cè)試A與干預(yù)前基線水平相比差異有統(tǒng)計(jì)學(xué)意義(p0.05);對(duì)照組3個(gè)月后所有認(rèn)知功能評(píng)分與基線水平相比差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);兩組3個(gè)月與基線水平的變化值也均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。靜息態(tài)tMRI數(shù)據(jù)分析提示訓(xùn)練組3個(gè)月后的左側(cè)額葉、左前扣帶回、右側(cè)頂葉及右側(cè)中央前后回皮層ALFF值較訓(xùn)練前顯著增高;對(duì)照組3個(gè)月后的雙側(cè)小腦、左側(cè)顳葉、右側(cè)額葉及右前扣帶回皮層ALFF值較入組時(shí)減低。結(jié)論:有氧訓(xùn)練操能適度地提高輕度AD患者的認(rèn)知功能。靜息態(tài)fMRI為輕度AD患者有氧訓(xùn)練的有效性評(píng)價(jià)提供了一種敏感可行的量化方法。第三部分基于靜息態(tài)fMRI的有氧訓(xùn)練在阿爾茨海默病患者中的初步機(jī)制研究目的:通過(guò)靜息態(tài)fMRI研究,探討有氧訓(xùn)練操對(duì)阿爾茨海默病患者的干預(yù)作用機(jī)制。方法:本研究將選取的17例AD患者隨機(jī)分為訓(xùn)練組(9例)和對(duì)照組(8例)。訓(xùn)練組接受3個(gè)月的有氧訓(xùn)練操,對(duì)照組僅接受健康宣教。同時(shí)獲取兩組患者在入組時(shí)和3個(gè)月后的fMRI數(shù)據(jù),分別進(jìn)行低頻振幅(ALFF)分析和腦功能網(wǎng)絡(luò)分析。結(jié)果:訓(xùn)練組3個(gè)月后的雙側(cè)前額葉、前扣帶回皮層ALFF值及腦網(wǎng)絡(luò)介數(shù)中心度(BC)值較訓(xùn)練前增高,且3個(gè)月后訓(xùn)練組的BC值較對(duì)照組增高,差異有統(tǒng)計(jì)學(xué)意義(p0.05);進(jìn)一步根據(jù)網(wǎng)絡(luò)的核心節(jié)點(diǎn)分布情況發(fā)現(xiàn),訓(xùn)練后網(wǎng)絡(luò)的核心節(jié)點(diǎn)呈現(xiàn)出雙側(cè)分布,有異于訓(xùn)練前的偏側(cè)分布。結(jié)論:有氧訓(xùn)練可有效增強(qiáng)關(guān)鍵腦區(qū)自發(fā)活動(dòng)水平及全腦信息傳遞效率,促進(jìn)腦網(wǎng)絡(luò)結(jié)構(gòu)重組及對(duì)側(cè)大腦半球代償,進(jìn)而有助于AD患者認(rèn)知功能的恢復(fù)。
[Abstract]:The first part of study on the effect of aerobic exercise intervention in patients with mild cognitive impairment: by resting state fMRI study, a special assessment of moderate intensity aerobic exercise on Preparation of mild cognitive impairment (MCI) intervention patients. Methods: in this study, 38 cases of MCI patients according to randomly divided into the training group (19 cases) and control group (19 cases). The training group received 3 months of aerobic exercise, the control group received health education. The two groups of subjects at baseline and 3 months at the end of the intervention received cognitive function scores and resting state functional magnetic resonance (fMRI). Evaluation of resting state fMRI by low frequency amplitude (ALFF) analysis method. Results: after 3 months of aerobic exercise intervention training group, the mini mental state score (MMSE), Montreal cognitive assessment scale (MoCA), Wechsler Memory and logic symbols in digital mode test scores before and after intervention There are significant differences compared to the baseline level (P0.05), at the same time training group Wechsler logical memory score changes value and group Wechsler logical memory score changes the control value compared to the difference was statistically significant (P0.05). The control group after 3 months all the cognitive function scores from baseline compared differences were not statistically significant (P0.05) analysis. That training group after 3 months of bilateral frontotemporal and entorhinal resting state fMRI data, anterior cingulate and parahippocampal cortex compared with that before the training, wide ALFF value increased, while the control group after 3 months only right temporal lobe and the posterior cingulate cortex, small range of ALFF value higher than before. Conclusion: aerobic exercise training can improve the cognitive function of MCI patients. The resting fMRI for MCI patients is effective evaluation of aerobic training provides a quantitative sensitive and reliable method. The second part of aerobic training on the role of intervention in patients with Alzheimer's disease Objective: To study the resting state fMRI, a special assessment of moderate intensity aerobic exercise on the preparation of mild Blzheimer's disease (AD) intervention patients. Methods: 40 cases of mild AD patients were randomly divided into training group (20 cases) and control group (20 cases). The training group received 3 months of aerobic exercise, the control group received health education. The two groups of subjects at baseline and 3 months at the end of the intervention received cognitive function scores and resting state fMRI assessment. The resting state fMRI by low frequency amplitude (ALFF) analysis method. Results: after 3 months of aerobic exercise intervention training group, MMSE scale, A connection test before and after the intervention at baseline compared to the difference was statistically significant (P0.05); the control group after 3 months of all cognitive scores compared with the baseline levels showed no significant difference (P0.05); the two group of 3 months with the baseline water The change values were not statistically significant (P0.05). The analysis showed that the left frontal training group after 3 months of resting state tMRI data, left anterior cingulate gyrus, right parietal lobe and right back after the central cortex ALFF was significantly increased compared with before training; the control group 3 months after bilateral cerebellum, left temporal lobe, right frontal lobe and right anterior cingulate cortex ALFF value decreased in the group. Conclusion: aerobic exercise can moderately improve cognitive function in patients with mild AD. The resting state fMRI of mild AD patients, evaluation of the effectiveness of aerobic training provides a quantitative sensitive and reliable method. The third part based on resting state fMRI objective to study the preliminary mechanism in patients with Alzheimer's disease through aerobic training: a resting state fMRI study, to explore the mechanism of aerobic training exercise intervention on patients with Alzheimer's disease. Methods: This study selected 17 cases of AD patients were randomly divided into training group ( 9 cases) and control group (8 cases). The training group received 3 months of aerobic exercise, the control group received health education. At the same time to obtain fMRI data at baseline and after 3 months of the two groups of patients, respectively, low-frequency amplitude (ALFF) analysis and analysis of brain functional network. Results: the training group after 3 months of bilateral prefrontal, anterior cingulate cortex and brain ALFF value network betweenness centrality (BC) value and the value increased compared with before training, the training group BC was higher than those in control group after 3 months, the difference was statistically significant (P0.05); according to the distribution of the core nodes of the network. Now, after training the core node of the network showed bilateral distribution, different from the side before the training distribution. Conclusion: aerobic training can effectively enhance the level of spontaneous activity of key brain region and whole brain information transmission efficiency, network structure and to promote brain hemisphere compensatory, and thus contribute to the cognitive function in patients with AD Recovery.

【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;R749.16

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