本文選題：精神分裂癥 + 兒童青少年�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景精神分裂癥是一種高遺傳度、高異質(zhì)性的大腦功能紊亂性疾病。臨床以其精神活動與所處的環(huán)境不相協(xié)調(diào)為特征,有慢性化和衰退傾向,病情波動難于預(yù)測,許多癥狀如自殺、被害妄想、命令性幻聽等的出現(xiàn)嚴(yán)重影響患者自身、家人與社會的安全,甚至給人民生命和國家財(cái)產(chǎn)造成巨大損失。兒童青少年精神分裂癥(childhood and adolescence schizophrenia)起病于18歲前,與成年起病的患者比較,神經(jīng)發(fā)育異常更明顯,臨床癥狀更不典型,治療效果及預(yù)后更差。越來越多的研究發(fā)現(xiàn)精神分裂癥患者存在腦結(jié)構(gòu)異常,包括腦室擴(kuò)大、皮層及皮層下萎縮。本課題組在既往研究中發(fā)現(xiàn)首發(fā)兒童青少年精神分裂癥患者顯示類似的異常。關(guān)于兒童青少年精神分裂癥腦功能相關(guān)研究較少,本研究擬通過磁共振成像技術(shù)(Magnetic Resonance Imaging,MRI)從結(jié)構(gòu)和功能兩個方面進(jìn)行檢測,為兒童青少年精神分裂癥病理生理學(xué)機(jī)制的探索提供線索。目的通過分析首發(fā)兒童青少年精神分裂癥患者的腦區(qū)白質(zhì)和灰質(zhì)體積改變及靜息態(tài)腦功能成像特點(diǎn),為兒童青少年精神分裂癥病理生理學(xué)機(jī)制的探索提供線索。方法1.研究對象:本研究將選取45例符合《美國精神障礙診斷與統(tǒng)計(jì)手冊第四版》(Diagnostic and Statistical Manual of Mental Disorder-IV,DSM-IV)診斷標(biāo)準(zhǔn)的首發(fā)兒童青少年精神分裂癥患者作為病例組,并嚴(yán)格按照性別、年齡、民族和教育程度等配對原則選擇39例正常對照者作為健康組。2.結(jié)構(gòu)影像數(shù)據(jù)的處理及分析:其程序依次為格式重建、空間標(biāo)準(zhǔn)化、圖像分割、計(jì)算腦體積、平滑等,最后對平滑后的灰、白質(zhì)體積進(jìn)行統(tǒng)計(jì)分析。應(yīng)用的軟件是Matlab(The Math Works,Inc.,Natick,Massachusetts)平臺下,基于SPM8(Statistical Parametric Mapping,http://www.fil.ion.ucl.ac.uk/spm)軟件下的子工具包VBM8(voxel-based morphometry.dbm.neuro.uni-jena.de/vbm/)及REST(RS-fMRI Data Analysis Toolkit,http://www.restfmri.net)軟件包。3.腦功能成像及分析:采用3.0T功能磁共振成像系統(tǒng)對所有研究對象進(jìn)行血氧水平依賴性的靜息態(tài)功能磁共振成像(blood oxygenation level dependent resting-state functional Magnetic Resonance Imaging,BOLD-fMRI)檢查,對所獲取的影像學(xué)數(shù)據(jù)運(yùn)用DPARSF軟件進(jìn)行預(yù)處理后,對符合標(biāo)準(zhǔn)的入組對象運(yùn)用REST(Resting-State fMRI Data Analysis Toolkit)軟件進(jìn)行分析,得出低頻振幅(Amplitude of Low-Frequency Fluctuation,ALFF)改變有統(tǒng)計(jì)學(xué)意義的腦區(qū)。以低頻振幅值改變的腦區(qū)作為種子點(diǎn),運(yùn)用REST軟件進(jìn)行腦功能連接分析,得出種子點(diǎn)與全腦功能連接有統(tǒng)計(jì)學(xué)意義的腦區(qū)。結(jié)果1.病例組與健康組之間腦結(jié)構(gòu)比較⑴兩組之間腦白質(zhì)體積比較:和健康組相比,病例組的大腦在左側(cè)額葉、右側(cè)邊緣葉、左側(cè)扣帶回部位的白質(zhì)體積顯著降低,MNI坐標(biāo)分別為:x=-27、18、-21,y=12、-9、-18,z=21、39、45;體素分別為:116、411、76;t=-4.4132、-5.0232、-5.2164;Alphasim矯正,矯正后P0.05。⑵兩組之間腦灰質(zhì)體積比較:和健康組相比,病例組的大腦在右側(cè)腦島、左側(cè)額下回、左側(cè)邊緣葉部位的灰質(zhì)體積顯著降低,MNI坐標(biāo)分別為:x=36、54、0,y=21、18、45,z=3、9、27;體素分別為:42、37、83;t=-5.303、-5.3016、-6.211;Alphasim矯正,矯正后P0.05。2.病例組與健康組之間低頻振幅分析及功能連接結(jié)果⑴低頻振幅分析:和健康組相比,病例組大腦在左側(cè)舌回、左側(cè)顳葉、額葉等部位低頻振幅顯著降低,MNI坐標(biāo)分別為:x=0、-54、0,y=-63、-21、-27,z=9、0、69;體素分別為:225、84、143;t=-4.8201、-4.3652、-4.7325;Alphasim矯正,矯正后P0.05。⑵功能連接分析:將低頻振幅降低的腦區(qū)作為種子點(diǎn)與全腦進(jìn)行靜息態(tài)功能連接分析。當(dāng)左側(cè)舌回(MNI坐標(biāo)x=0,y=-63,z=9)作為種子點(diǎn)時,病例組顯示右顳上回、左顳上回、右腦島、左額葉、右頂葉與種子點(diǎn)的連接顯著低于健康組,MNI坐標(biāo)分別為:x=66、-51、63、-33、-6,y=-36、-21、-18、-21、-33,z=12、3、9、54、72;體素分別為:123、196、164、158、190;t=-4.586、-4.448、-4.1543、-5.0523、-4.8143;FDR矯正P0.05。當(dāng)左側(cè)顳葉(MNI坐標(biāo)x=-54,y=-21,z=0)作為種子點(diǎn)時,病例組顯示右枕葉、右額內(nèi)側(cè)回、左頂葉、左額葉、右額上回與種子點(diǎn)的連接顯著低于健康組,MNI坐標(biāo)分別為:x=12、6、-39、-45、12,y=-36、54、-18、-18、6,z=78、-3、12、60、66;體素分別為:8589、622、346、464、157;t=-6.2086、-4.6238、-5.0948、-4.8746、-4.5463;FDR矯正P0.05。當(dāng)額葉(MNI坐標(biāo)x=0,y=-27,z=69)作為種子點(diǎn)時,病例組顯示左顳葉、右額中回、左頂葉、右額上回、右扣帶回與種子點(diǎn)的連接顯著低于健康組,MNI坐標(biāo)分別為:x=18、39、-54、24、6,y=-51、45、-21、30、-21,z=9、-18、36、45、45;體素分別為:12536、99、510、77、104;t=-5.1981、-4.8179、-3.5712、-4.1543、-3.4971;FDR矯正P0.05。結(jié)論1.首發(fā)兒童青少年精神分裂癥患者腦灰質(zhì)及白質(zhì)體積均有顯著降低。2.首發(fā)兒童青少年精神分裂癥患者在靜息狀態(tài)下存在多個腦區(qū)的功能連接異常。
[Abstract]:Background schizophrenia is a highly hereditary, highly heterogeneous brain disorder. It is characterized by the lack of coordination between the mental activity and the environment. It has a tendency of chronicity and decline, and the fluctuation of the disease is difficult to predict. Many symptoms such as suicide, delusion, and hallucination have serious influence on the patient, family and family. Social security, even to the people's life and national property caused great loss. Children and adolescent schizophrenia (childhood and adolescence schizophrenia) before the age of 18 years old, compared with adult patients, the neurodevelopmental abnormalities are more obvious, the clinical symptoms are more untypical, the treatment effect and worse prognosis. More and more research found Patients with schizophrenia have abnormal brain structure, including ventricular enlargement, cortical and subcortical atrophy. In our previous study, we found that the onset of schizophrenia in the first children and adolescents showed similar abnormalities. The brain function related to schizophrenia in children and adolescents was less. This study was designed by magnetic resonance imaging (Magnetic Resonance Imaging, MRI), from two aspects of structure and function, provides clues for the pathophysiological mechanism of children and adolescents with schizophrenia. Objective to analyze the changes of white matter and gray matter volume and the resting state brain functional imaging in the brain area of the first children with schizophrenia. The pathophysiological mechanism of cleft disease provides clues. Method 1. subjects: This study will select 45 juvenile schizophrenia patients who are in line with the diagnostic and Statistical Manual of Diagnostic and Statistical Manual of Mental Disorder-IV, DSM-IV). According to the matching principle of sex, age, nationality and education level, 39 normal controls were selected as the data processing and analysis of.2. structure in the health group. The program was in turn in format reconstruction, space standardization, image segmentation, calculation of brain volume, smoothing and so on. Finally, the volume of white matter after smoothing was statistically analyzed. The application software was Matla B (The Math Works, Inc., Natick, Massachusetts) platform based on SPM8 (Statistical Parametric Mapping, http://www.fil.ion.ucl.ac.uk/spm) software package And analysis: the 3.0T functional magnetic resonance imaging system was used to perform resting state functional magnetic resonance imaging (blood oxygenation level dependent resting-state functional Magnetic Resonance Imaging, BOLD-fMRI) for all research subjects, and the obtained imaging data were pretreated with DPARSF software. The REST (Resting-State fMRI Data Analysis Toolkit) software was used to analyze the standard group. The low frequency amplitude (Amplitude of Low-Frequency Fluctuation, ALFF) changed the statistically significant brain area. The brain region, which was changed by the low frequency amplitude value, was used as the seed point, and the brain function connection was analyzed by using the REST software. Compared with the healthy group, the cerebral structure of the 1. cases group and the healthy group was compared with the healthy group. Compared with the health group, the white mass accumulation in the left frontal lobe, the right marginal lobe and the left cingulate gyrus decreased significantly compared with the healthy group, and the MNI coordinates were x=-27,18, -21, y=12, respectively. -9, -18, z=21,39,45; 116411,76; t=-4.4132, -5.0232, -5.2164; Alphasim corrected, and after correction of the volume of gray matter between the two groups of P0.05. 2: compared with the health group, the brain of the case group decreased significantly in the right insula, the left inferior frontal gyrus, and the left margin of the lobe, and the MNI coordinates were x=36,54,0, y=21,18,45, respectively. 3,9,27; voxels were 42,37,83; t=-5.303, -5.3016, -6.211; Alphasim correction. Low frequency amplitude analysis and functional connection results (1) analysis of low frequency amplitude between the P0.05.2. case group and the healthy group after correction: compared with the health group, the low frequency amplitude of the left lingual gyrus, the left temporal lobe, the frontal lobe and other parts of the case group decreased significantly, and the MNI coordinates were x, respectively: X =0, -54,0, y=-63, -21, -27, z=9,0,69; the voxels were 225,84143; t=-4.8201, -4.3652, -4.7325; Alphasim correction, and after corrective P0.05. 2 functional connection analysis: the brain area of low frequency amplitude reduced as seed point and whole brain resting state function connection analysis. Case group showed when the left tongue gyrus was used as seed point. Right temporal gyrus, left temporal gyrus, right brain Island, left frontal lobe and right parietal lobe were significantly lower than those of the healthy group. The MNI coordinates were x=66, -51,63, -33, -6, y=-36, -21, -18, -21, -33, z=12,3,9,54,72, respectively. 1, z=0) as the seed point, the case group showed that the right occipital lobe, right medial frontal gyrus, left parietal lobe, left frontal lobe, right upper frontal gyrus and seed points were significantly lower than those of the healthy group, and the MNI coordinates were x=12,6, -39, -45,12, y=-36,54, -18, -18,6, z=78, -3,12,60,66, respectively: 8589622346464157; t=-6.2086, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238 When the frontal lobe (MNI coordinates x=0, y=-27, z=69) was used as seed point, the case group showed that the left temporal lobe, right middle frontal gyrus, left parietal lobe, right upper frontal gyrus, right cingulate gyrus and seed point were significantly lower than those of the healthy group, and the MNI coordinates were x=18,39, -54,24,6, y=-51,45, -21,30, -21, z=9, MNI, respectively. .8179, -3.5712, -4.1543, -3.4971, and P0.05. correction of P0.05. conclusion 1. the cerebral gray matter and white matter volume of children with schizophrenia in the first episode of children and adolescents significantly decreased the function connection of multiple brain areas in the resting state of children with schizophrenia in the resting state.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R749.3

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