發(fā)布時間：2018-04-04 13:09

  本文選題：功能連接密度　切入點：腦網絡　出處：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:甲狀腺激素對于人類大腦維持正常的結構及功能起著至關重要的作用。甲狀腺激素減低患者常伴發(fā)抑郁、焦慮等神經精神癥狀,但對其機制尚不清楚。本實驗應用靜息態(tài)功能磁共振成像(rest functional magnetic resonance imaging,rs-fMRI)技術基于體素水平(voxel-wise)的功能連接密度(functional connectivity density,FCD)與基于種子點(region of interest,ROI)的全腦功能連接(functional connectivity,FC)相結合的方式來研究甲狀腺激素減低患者腦網絡的改變,并探討其與精神神經癥狀癥狀及甲狀腺激素水平的相關性。材料與方法:我們收集了自2014年6月至2016年8月在天津醫(yī)科大學總醫(yī)院核醫(yī)學科門診初診且未行治療的15例甲減患者(男性1例,女性14例)作為實驗組,另選取同期選入的年齡及性別匹配的健康志愿者15例(男性1例,女性14例)為對照組。臨床上采集每個被試的空腹靜脈血標本以測定其甲狀腺激素水平。并使用漢密爾頓焦慮量表(Hamilton Anxiety Scale,HAMA)來測定每個被試的焦慮程度,使用漢密爾頓抑郁量表(Hamilton Depression Scale,HAMD)來測定每個被試的抑郁程度。應用GE公司的3.0T核磁共振掃描儀(Discovery MR750,General Electric,Milwaukee,WI,USA)對所有被試進行常規(guī)軸位T1WI、T2WI掃描及靜息態(tài)fMRI掃描,經數據預處理后,使用Linux系統(tǒng)的內部腳本分別得到兩組人的全程功能連接密度(globle-FCD)、短程功能連接密度(short-FCD)及長程功能連接密度(long-FCD)圖像。然后采用REST(www.restfmri.net)軟件自帶的統(tǒng)計分析軟件對病例組與對照組全程功能連接密度(globle-FCD)、短程功能連接密度(short-FCD)及長程功能連接密度(long-FCD)三組數據分別進行雙樣本t檢驗(P0.001,AlphaSim校正),然后分析比較每兩組之間具體的差異水平。并以兩組間短程功能連接密度存在顯著差異的腦區(qū)作為感興趣區(qū),進行全腦功能連接分析,并比較兩組間差異。最后使用Pearson相關分析方法分別檢驗甲減組各個ROI的globle-FCD、short-FCD及l(fā)ong-FCD值與血清甲狀腺激素水平、HAMA以及HAMD量表評分的相關性。結果:(1)甲減組與正常對照組相比,在左側眶部額下回、左側眶部額中回、左側三角部額下回全程功能連接密度(globle-FCD)值更高(P0.001,AlphaSim校正)。(2)甲減組與正常對照組相比,在左側額中回、左側眶部額下回及左側眶部額中回短程功能連接密度(short-FCD)值顯著減低(P0.001,AlphaSim校正)。(3)甲減組與正常對照組相比,在左側額中回長程功能連接密度(long-FCD)值更高(P0.001,AlphaSim校正)。(4)左側額中回與左側三角部額下回、左側顳上回顳極、左側島葉、左側扣帶回中部、雙側輔助運動區(qū)及左側扣帶回前部功能連接增強(P0.001,AlphaSim校正)。(5)應用Pearson相關方法分別分析FCD值與血清FT3、FT4濃度及HAMA、HAMD得分的相關性。Pearson相關分析結果顯示:均未發(fā)現顯著相關性(P0.05)。結論:1.甲狀腺激素減低可引起左側額中回、左側眶部額下回及左側眶部額中回局部腦功能連接的異常,導致該區(qū)短程功能連接密度減低,提示可能與甲減患者伴發(fā)情緒抑郁及認知障礙等神經精神癥狀有關;2.甲狀腺激素降低可引起左側額中回長程功能連接異常,導致該區(qū)長程功能連接密度增高,提示可能與該腦區(qū)發(fā)揮代償機制,建立遠程連接彌補甲減患者認知及情緒障礙有關;3.甲狀腺激素減低可以引起左側眶部額下回、左側眶部額中回、左側三角部額下回全程功能連接密度增高,這說明全程功能連接密度主要受長程功能連接密度結果的影響,也就是代償機制大于額葉功能連接的局部破壞;4.左側額中回與默認網絡及雙側輔助運動區(qū)功能連接增強,提示可能甲減患者不自主運動增多而需要大腦控制網絡對其進行更強的控制作用有關。
[Abstract]:Objective: thyroid hormone to the human brain to maintain the normal structure and function plays a vital role. Thyroid hormone decreasing is common in patients with depression, anxiety and other neuropsychiatric symptoms, but the mechanism is not clear. The experimental application of resting state functional magnetic resonance imaging (rest functional magnetic resonance imaging, rs-fMRI) technology voxel level based on (voxel-wise) functional connectivity density (functional connectivity density, FCD) and based on the seed point (region of interest, ROI) of the whole brain functional connectivity (functional connectivity FC) to study the combination of the thyroid hormone changes in patients with impaired brain network, and explore its correlation with mental symptoms and thyroid hormone level. Materials and methods: We collected from June 2014 to August 2016 in the Department of nuclear medicine clinic of General Hospital Affiliated to Tianjin Medical University and not 15 cases of patients with hypothyroidism treatment (male 1 cases, female 14 cases) as the experimental group, 15 cases were selected in selected age and sex matched healthy volunteers (male 1 cases, female 14 cases) as the control group. The clinical subjects collected fasting venous blood samples to determine the thyroid gland hormone level and the use of Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA) to determine the anxiety level of each participant, using Hamilton Depression Scale (Hamilton Depression Scale, HAMD) to determine the degree of depression in each subjects. 3.0T nuclear magnetic resonance scanner using the GE (Discovery MR750, General Electric, Milwaukee WI, USA), all of the subjects were conventional axial T1WI, T2WI scan and resting state fMRI scan after data preprocessing, using Linux system internal scripts were obtained throughout the function of those in the two group (globle-FCD), short-range connection density function Connection density (short-FCD) and long term functional connectivity density (long-FCD) image. Then the REST (www.restfmri.net) software statistical analysis software for the case group and the control group throughout the functional connectivity density (globle-FCD) function, short-range connection density (short-FCD) and long term functional connectivity density (long-FCD) data of the three groups were double sample t test respectively (P0.001, AlphaSim, correction) and then compare the difference of each level between the two groups. And in between the two groups of short-range brain areas there are significant differences in density as regions of interest, for the whole brain functional connectivity analysis, and compare the differences between the two groups. Finally, using Pearson correlation analysis method respectively. Test each ROI hypothyroidism group globle-FCD, short-FCD and long-FCD values and serum thyroid hormone levels, HAMA and HAMD scale correlation. Results: (1) hypothyroidism group compared with normal control group, in The left orbital frontal gyrus, left orbital frontal gyrus, left inferior frontal triangle full functional connectivity density (globle-FCD) was higher (P0.001, AlphaSim correction). (2) hypothyroidism group compared with normal control group, the left middle frontal gyrus, left inferior frontal gyrus and left orbital orbital frontal gyrus short the functional connectivity density (short-FCD) values were significantly lower (P0.001, AlphaSim correction). (3) hypothyroidism group compared with normal control group, in the left frontal gyrus long-range functional connectivity density (long-FCD) was higher (P0.001, AlphaSim correction). (4) back to the left frontal gyrus and left frontal triangle in the left. Superior temporal gyrus temporal pole, left insula, left middle cingulate cortex, bilateral supplementary motor area and left anterior cingulate gyrus increased functional connectivity (P0.001, AlphaSim correction). (5) using Pearson method to analysis the FCD value and the concentration of serum FT3, FT4 and HAMA, the correlation results of.Pearson correlation analysis of HAMD score Display: found no significant correlation (P0.05). Conclusion: 1. thyroid hormone can cause impaired left middle frontal gyrus, abnormal return of brain function connected with the left orbital frontal gyrus and left orbital frontal, leads to the short-range functional connectivity density reduced, suggesting that patients with hypothyroidism with symptoms of depression and cognitive impairment and other neuropsychiatric related; 2. hypothyroidism can cause left middle frontal gyrus long-term functional connectivity abnormalities, leading to the long-range functional connectivity density increased, suggesting that may play a compensatory mechanism and the brain areas, establish a remote connection for cognitive and emotional disorder in patients with hypothyroidism; 3. thyroid hormone decreasing can cause left orbital volume the left orbital gyrus, middle frontal gyrus, left inferior frontal triangle full functional connectivity density increased, indicating that the whole function of connection density is mainly affected by the long-range functional connectivity density results, also The compensatory mechanism is greater than the local failure of frontal lobe functional connectivity. 4., the functional connectivity between the left frontal middle gyrus and the default network and bilateral supplementary motor areas is enhanced, suggesting that the involuntary movements of hypothyroidism patients are increasing, and the control network is required for their stronger control.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R581.2

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本文編號：1710088