本文選題：缺血性腦卒中 + 功能磁共振　； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的： 本研究采用皮層厚度、局部一致性(regional homogeneity，Reho)、分?jǐn)?shù)低頻振幅（fractional amplitude of frequency fluctuation，fALFF）以及靜息態(tài)功能連接（resting-states Functional Connectivity，rs-FC）的功能磁共振（functional magnetic resonance imaging，fMRI）的多模態(tài)分析方法，觀察早期缺血性腦卒中患者，運(yùn)動(dòng)相關(guān)腦區(qū)結(jié)構(gòu)和功能的變化情況，探討缺血性腦卒中后，患者運(yùn)動(dòng)功能損傷恢復(fù)的過(guò)程及機(jī)制。 方法： 選擇單側(cè)皮層下缺血性腦卒中患者20例（男12人，女8人），另外選取23例年齡、性別匹配的健康志愿者（男10人，女13人）作為正常對(duì)照組。采用Siemens Tim Trio3.0T磁共振成像系統(tǒng)（Siemens MedicalSystems,Erlangen,Germany）對(duì)所有被試者進(jìn)行常規(guī)T1WI（T1weightedimaging，T1加權(quán)成像）、T2W（IT2weighted imaging，T2加權(quán)成像）、FLAIR、3D解剖像及靜息態(tài)fMRI(resting states functional-magnetic resonanceimaging,rs-fMRI)掃描。運(yùn)用FreeSurfer V.5.1.0軟件進(jìn)行大腦皮層厚度計(jì)算。采用基于Matlab2011b運(yùn)行下的DPARSFA、REST軟件進(jìn)行靜息態(tài)的fMRI數(shù)據(jù)處理和分析。首先測(cè)量患側(cè)SMA區(qū)的ReHo值和fALFF值；其次定義8個(gè)運(yùn)動(dòng)相關(guān)腦區(qū)，雙側(cè)輔助運(yùn)動(dòng)區(qū)(supplement motor area，SMA)、雙側(cè)初級(jí)運(yùn)動(dòng)皮層（primary motor cortex，M1）雙側(cè)前運(yùn)動(dòng)區(qū)(premotor cortex，PM)、雙側(cè)扣帶運(yùn)動(dòng)區(qū)（cingulated motor areas，CMA）作為感興趣區(qū)（regional of intrest, ROI），進(jìn)行它們之間功能連接的分析；再次定義患側(cè)SMA區(qū)作為ROI，將它與全腦進(jìn)行功能連接的分析。最后采用一般線(xiàn)性模型對(duì)患側(cè)SMA區(qū)皮層厚度、ReHo值和fALFF值進(jìn)行統(tǒng)計(jì)學(xué)分析（將年齡和性別作為協(xié)變量）。運(yùn)用REST軟件中的雙樣本t檢驗(yàn)進(jìn)行患者與正常對(duì)照的組間功能連接模式差異的比較，并觀察有統(tǒng)計(jì)學(xué)意義的激活區(qū)的大小、所在位置、峰值以及坐標(biāo)等。 結(jié)果： 結(jié)果顯示患側(cè)半球SMA區(qū)較正常對(duì)照存在變薄區(qū)域(單體素閾值取p0.05,同時(shí)運(yùn)用FDR校正進(jìn)行cluster水平的校正，p 0.05)。測(cè)量患側(cè)SMA區(qū)ReHo值分析結(jié)果顯示,患者組患側(cè)SMA區(qū)的ReHo值較正常對(duì)照組增高(p 0.05)。患者組患側(cè)SMA區(qū)的fALFF值較正常對(duì)照組降低（p 0.05）�；紓�(cè)SMA區(qū)的功能連接分析結(jié)果顯示,患者組較正常對(duì)照連接增強(qiáng)的區(qū)域主要包括：患側(cè)M1區(qū)、健側(cè)SMA區(qū)等。功能連接減弱的區(qū)域主要包括：雙側(cè)小腦半球、健側(cè)PM區(qū)等（單體素閾值取p 0.05，同時(shí)運(yùn)用FDR校正進(jìn)行cluster水平的校正，p 0.05)。 結(jié)論: 1、缺血性腦卒中患者離病灶較遠(yuǎn)的患側(cè)SMA區(qū)皮層出現(xiàn)變薄區(qū)域,提示離病灶較遠(yuǎn)的區(qū)域出現(xiàn)了結(jié)構(gòu)的損傷，并且這種結(jié)構(gòu)的損傷從病變的較早時(shí)期就已經(jīng)開(kāi)始。 2、缺血性腦卒中患者患側(cè)SMA區(qū)fALFF值降低，提示該區(qū)域神經(jīng)元自發(fā)性活動(dòng)的降低；患側(cè)SMA區(qū)ReHo值升高，，提示該區(qū)域腦功能活動(dòng)的同步性增強(qiáng)。提示了，皮層下運(yùn)動(dòng)中樞損傷后，皮層的運(yùn)動(dòng)相關(guān)腦區(qū)信息傳遞與處理的效率提高，形成代償機(jī)制，以代償結(jié)構(gòu)損傷區(qū)域的功能，維持相應(yīng)的功能活動(dòng)。 3、缺血性腦卒中患者患側(cè)SMA區(qū)通過(guò)與雙側(cè)Ml區(qū)、PM區(qū)、CMA區(qū)和對(duì)側(cè)SMA區(qū)之間功能連接模式的改變，維持相應(yīng)的功能，這是損傷后的又一個(gè)有效的代償和皮層功能重組的機(jī)制。
[Abstract]:Purpose :

In this study , the changes of functional magnetic resonance imaging ( FALFF ) and resting - states functional Connectivity ( rs - FC ) in early ischemic stroke were investigated by the multi - modal analysis method of cortical thickness , regional coherence ( Reho ) , fractional amplitude of frequency fluctuation ( fALFF ) and resting - states functional Connectivity ( rs - FC ) .

Method :

Twenty patients ( 12 men and 8 women ) with ischemic stroke in one - sided cortex were selected and 23 healthy volunteers ( 10 men and 13 women ) matched with age and sex were selected as the normal control group . Using the Siemens Tim Trio3 . 0T magnetic resonance imaging system ( Siemens MedicalSystems , Erlangen , Germany ) , all subjects were subjected to conventional 1WI ( T1weighted imaging ) , T2W ( IT2weighted imaging , T2 - weighted imaging ) , FLAIR , 3D anatomical image and resting states functional - magnetic resonance anceimaging , rs - fmri scans .
Secondly , eight motion - related brain regions , two - sided auxiliary motor area ( SMA ) , primary motor cortex ( M1 ) , two - sided anterior motor cortex ( PM ) , double - sided anterior motor cortex ( PM ) , and cingulated motor areas ( CMA ) were defined as regions of interest ( ROI ) , and their functional connections were analyzed ;
In the end , the thickness , ReHo value and fALFF value of the affected SMA area were analyzed by using the general linear model ( age and sex as covariant ) . The difference of the functional connection patterns between the patients and the normal control group was compared by using the dual - sample t test in REST software , and the size , the location , the peak value and the coordinates of the active area with statistical significance were observed .

Results :

The results showed that the SMA area of the affected hemisphere was thinner than that of the normal control ( p < 0.05 ) . The results of ReHo value analysis of the SMA area in the affected area showed that the ReHo value of the SMA area in the patient group was higher than that of the normal control group ( p 0.05 ) . The fALFF value of the SMA area in the patient group was lower than that of the normal control group ( p 0.05 ) . The results of functional connection analysis showed that the area of the patients with higher functional connection was mainly composed of bilateral cerebellar hemisphere , healthy side PM region and so on ( single voxel threshold was p 0.05 , and the correction of cluster level was performed by using the correction of fdr correction , p 0.05 ) .

Conclusion :

1 . In patients with ischemic stroke , the area of SMA area on the affected side of the lesion was thinner , which suggested that the structure was damaged in the region farther away from the lesion , and the damage of this structure had started from the earlier period of the lesion .

2 . The value of fALFF decreased in the patients with ischemic stroke , suggesting that the spontaneous activity of neurons in the area decreased ;
The ReHo value in the affected area of the affected area is increased , which suggests that the regional cerebral function activity is enhanced . It is suggested that the transfer and processing efficiency of the movement - related brain area of the cortex after the injury of the motor cortex in the cortex is improved , the compensatory mechanism is formed , and the function of the damaged area of the compensatory structure is compensated , and the corresponding functional activity is maintained .

3 . The function of SMA in ischemic stroke patients was maintained by the change of functional linkage model between bilateral Ml area , PM area , CMA area and contralateral SMA area , which is another effective mechanism for compensatory and cortical function recombination after injury .

【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R445.2;R743.3

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本文編號(hào)：1810945