本文選題：視神經(jīng)脊髓炎 + 視覺皮層亞區(qū)�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:視神經(jīng)脊髓炎(neuromyelitis optica,NMO)的靜息態(tài)功能磁共振及結(jié)構(gòu)磁共振成像的研究發(fā)現(xiàn)視覺皮層存在顯著的結(jié)構(gòu)和功能的損害,但是精確到視覺亞區(qū)水平的結(jié)構(gòu)和功能變化及其與NMO患者臨床特征之間的關(guān)系目前尚不明確。本實驗招募較大樣本量的NMO患者,聯(lián)合腦灰質(zhì)體積(grey matter volume,GMV)分析及靜息態(tài)功能連接(resting-state functional connectivity,rs FC)分析,旨在探究NMO患者視覺皮層亞區(qū)水平結(jié)構(gòu)和功能連接改變特征及評價其對患者臨床殘疾程度的預(yù)測價值。材料與方法:本次實驗招募了符合Wingerchuk診斷標(biāo)準(zhǔn)的37名NMO患者(32名女性和5名男性)及42名健康志愿者(37名女性和5名男性),兩組受試者之間的年齡、性別、教育年限相匹配,使用GE Discovery MR750 3.0T磁共振掃描儀對所有受試者分別進(jìn)行了3D高分辨率T1WI結(jié)構(gòu)像和靜息態(tài)功能磁共振成像掃描,并對每位NMO患者用擴(kuò)展殘疾狀態(tài)量表(expanded disability status scale,EDSS)進(jìn)行臨床殘疾程度評分。1.用基于Matlab的軟件DPARSFA(Data Processing Assistant for Resting-State f MRI Advanced Edition)、SPM8(Statistical Parametric Mapping)及其插件VBM8分別對功能像和結(jié)構(gòu)像進(jìn)行預(yù)處理。2.定義左右大腦半球各10個視覺亞區(qū),計算各亞區(qū)的全腦rs FC及其GMV。3.控制年齡、性別及教育年限,研究NMO患者視覺皮層亞區(qū)GMV及rs FC的改變,同時用一般線性模型方法將GMV作為協(xié)變量去除來研究GMV的變化對rs FC的結(jié)果是否有影響。4.分別將存在顯著組間差異腦區(qū)的GMV和rs FC值提取出來,與EDSS評分進(jìn)行偏相關(guān)分析,年齡、性別、教育年限作為協(xié)變量,統(tǒng)計閾值為p0.05,并經(jīng)過多重比較校正。結(jié)果:1.與正常對照相比,NMO患者在雙側(cè)V1、V2、V3d、VP和LO及左側(cè)V3A區(qū)均有GMV減低。在經(jīng)典的視覺通路上,相對低級別的視覺亞區(qū)相比于相對高級別的視覺亞區(qū)GMV的減低更嚴(yán)重。2.不論是否回歸GMV,NMO患者在雙側(cè)LO和V4v及左側(cè)V2區(qū)都表現(xiàn)出rs FC的減低。3.在NMO患者中,雙側(cè)V1和LO及左側(cè)V2和V3d區(qū)的GMV都與臨床殘疾程度明顯呈負(fù)相關(guān)且相關(guān)的程度與相應(yīng)亞區(qū)在視覺通路的等級明顯相關(guān)。結(jié)論:1.在NMO患者中,相對低級別的視覺亞區(qū)表現(xiàn)出更嚴(yán)重的結(jié)構(gòu)損害;2.結(jié)構(gòu)損害不是視覺亞區(qū)rs FC改變的唯一影響因素;3.相對低級別視覺亞區(qū)的GMV減低對臨床殘疾程度具有最高的預(yù)測價值。
[Abstract]:Objective: the study of resting functional magnetic resonance (fMRI) and structural magnetic resonance imaging (SMR) of neuromyelitis optica (NMOA) revealed significant structural and functional damage in the visual cortex. However, the changes of structure and function at the visual subarea level and their relationship with the clinical features of NMO patients are unclear. In this study, we recruited a large sample of NMO patients, combined with grey matter volume analysis and resting-state functional connectivity rsFCanalysis. The purpose of this study was to investigate the changes of the horizontal structure and functional connections of visual cortex in patients with NMO and to evaluate their predictive value in clinical disability. Materials and methods: 37 NMO patients (32 females and 5 males) and 42 healthy volunteers (37 females and 5 males) who met the Wingerchuk diagnostic criteria were recruited in this study. The age, sex, education years of the two groups were matched. GE Discovery MR750 3.0T magnetic resonance scanner was used to perform 3D high-resolution T1WI structure image and resting functional magnetic resonance imaging respectively, and each NMO patient was evaluated with expanded disability status scale EDSS. The software DPARSFA(Data Processing Assistant for Resting-State f MRI Advanced mapping (SPM8 Statistical Parametric Mapping) and its plug-in VBM8 are used to preprocess the functional image and the structure image respectively. 2. Ten visual subregions of the left and right hemispheres were defined, and the whole brain RsFC and GMV.3 were calculated. The changes of GMV and RsFC in visual cortex of NMO patients were studied by controlling age, sex and years of education, and GMV was removed as a covariable by general linear model to study whether the changes of GMV had an effect on the results of RsFC. 4. The values of GMV and RsFC in brain regions with significant differences were extracted, and the partial correlation analysis was carried out with EDSS scores. Age, sex and years of education were used as covariables, the statistical threshold was p0.05, and was corrected by multiple comparisons. The result is 1: 1. Compared with the normal controls, the GMV was decreased in both V1V2V2V3dU and Lo and the left V3A region in the patients with NMO. In the classical visual pathway, the decrease of GMV in the relatively low level visual subregion is more serious than that in the relatively high level visual subregion. RsFC decreased in both Lo and V4v and left V2 regions in patients with NMO with or without GMVV regression. In patients with NMO, the GMV of bilateral V1 and Lo and left V2 and V3D were negatively correlated with the degree of clinical disability, and the degree of correlation was significantly correlated with the grade of the corresponding subregion in the visual pathway. Conclusion 1. In patients with NMO, the relatively lower visual subareas showed more severe structural damage. Structural damage is not the only factor affecting the changes of RsFC in the visual subarea. The reduction of GMV in the lower visual subarea has the highest predictive value for clinical disability.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R744.52

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