本文選題：精神分裂癥 + 局部一致性��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：第一部分不同亞型精神分裂癥患者靜息態(tài)腦功能對(duì)比研究目的:通過靜息態(tài)腦功能局部一致性的方法,研究陽性、陰性癥狀為主型精神分裂癥患者較對(duì)照組比較ReHo差異的區(qū)域,并探討差異腦區(qū)在精神分裂癥患者中的作用,為精神分裂癥的發(fā)病機(jī)制、分型等提供影像學(xué)依據(jù)。材料與方法:1.研究對(duì)象:依據(jù)《美國精神疾病診斷與統(tǒng)計(jì)學(xué)手冊-第5版》(DSM-V)精神分裂癥診斷標(biāo)準(zhǔn)收集患者,并根據(jù)PANSS量表將精神分裂癥患者分為陽性組(n=25)和陰性組(n=19),選擇年齡、性別及受教育程度較為匹配的正常人作為對(duì)照組(n=20)。2.數(shù)據(jù)采集:采用GE SignaHDXT3.0T超導(dǎo)型磁共振成像儀進(jìn)行腦功能成像數(shù)據(jù),掃描序列包括:常規(guī)磁共振序列(T1WI、T2WI及FLAIR)、3D高分辨結(jié)構(gòu)像以及靜息態(tài)掃描。3.數(shù)據(jù)預(yù)處理:于MATLAB(R2012a)軟件平臺(tái),采用靜息態(tài)磁共振處理軟件DPARSFA 2.3對(duì)所獲取的影像數(shù)據(jù)進(jìn)行預(yù)處理,ReHo方法數(shù)據(jù)預(yù)處理步驟包括:格式轉(zhuǎn)換、剔除前10時(shí)間點(diǎn)、時(shí)間層校正、頭動(dòng)校正、空間標(biāo)準(zhǔn)化、去線性漂移、濾波以及去除協(xié)變量、計(jì)算ReHo值以及平滑。頭動(dòng)校正剔除標(biāo)準(zhǔn)設(shè)置為x、y、z軸方向平動(dòng)大于2mm和轉(zhuǎn)動(dòng)2°。4.統(tǒng)計(jì)學(xué)分析:采用SPSS 20.0對(duì)臨床資料進(jìn)行統(tǒng)計(jì)學(xué)分析。使用REST軟件中One WayANOVA方法對(duì)三組ReHo指標(biāo)進(jìn)行比較,結(jié)果進(jìn)行AlphaSim校正(P0.01),提取單因素方差分析差異腦區(qū)中ReHo值進(jìn)行post hoc test(Bonferroni校正),得到陰性、陽性組與對(duì)照組組間比較的結(jié)果,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:精神分裂癥陰性、陽性組與對(duì)照組在年齡、性別、受教育年限上無明顯統(tǒng)計(jì)學(xué)差異。陽性組較對(duì)照組相比,右側(cè)額上回眶部及左側(cè)顳中回ReHo下降,左側(cè)枕下回、右側(cè)殼核和雙側(cè)舌回ReHo增高。而陰性組較對(duì)照組相比,左側(cè)小腦、顳下回及右側(cè)殼核ReHo增高,左側(cè)中央后回、右側(cè)額上回眶部ReHo減低。結(jié)論:陰性、陽性癥狀為主的精神分裂癥患者較對(duì)照組存在廣泛的局部一致性異常,包括額葉、顳葉、枕葉、基底節(jié)區(qū)及小腦等。陽性組、陰性組與對(duì)照組相比,ReHo差異的腦區(qū)不盡相同,考慮不同亞型精神分裂癥患者存在不同的神經(jīng)病理學(xué)差異。其中額葉、殼核功能的異常可能是兩種亞型共同的病理生理學(xué)改變;枕葉與患者陽性癥狀相關(guān),而小腦與陰性癥狀形成有關(guān);顳葉不同亞區(qū)、中央后回在精神分裂癥發(fā)病機(jī)制中的作用目前尚不明確。第二部分不同亞型精神分裂癥患者3D ASL灌注成像對(duì)比研究目的:SPECT、PET/CT方面研究表明精神分裂癥患者存在腦部血流灌注差異。本研究采用3D ASL技術(shù),無創(chuàng)性地研究陽性、陰性癥狀為主型精神分裂癥患者腦部血流灌注的改變,探討不同亞型精神分裂癥患者灌注特點(diǎn)以及差異腦區(qū)在精神分裂癥患者中的作用。方法:1.研究對(duì)象:依據(jù)《美國精神疾病診斷與統(tǒng)計(jì)學(xué)手冊-第5版》(DSM-V)精神分裂癥診斷標(biāo)準(zhǔn)收集患者,并根據(jù)PANSS量表將精神分裂癥患者分為陽性組(n=25)、陰性組(n=19),選擇年齡、性別及受教育程度較為匹配的正常人作為對(duì)照組(n=20)。2.數(shù)據(jù)采集:采用GESignaHDXT3.0T超導(dǎo)型磁共振成像儀進(jìn)行腦功能成像數(shù)據(jù)。掃描序列包括:常規(guī)磁共振序列(T1WI、T2WI及FLAIR)、3D高分辨結(jié)構(gòu)像以及三維動(dòng)脈自旋標(biāo)記成像(3D Arterial Spin Labeling,3D ASL)掃描。3.數(shù)據(jù)預(yù)處理:通過GE Signa HDXT 3.0T掃描儀自帶的Functool后處理工作站獲得被試的腦血流灌注圖。采用SPM 8軟件對(duì)CBF圖進(jìn)行基于體素的預(yù)處理,步驟包括格式轉(zhuǎn)換、配準(zhǔn)、分割、空間標(biāo)準(zhǔn)化以及平滑。4.統(tǒng)計(jì)學(xué)分析:采用SPSS 20.0對(duì)臨床資料進(jìn)行統(tǒng)計(jì)學(xué)分析。陰性、陽性組及對(duì)照組預(yù)處理之后的CBF圖采用SPM 8軟件中One Way ANOVA方法進(jìn)行分析(P0.05),提取clustersize56的體素作為mask,用于精神分裂癥亞組與對(duì)照組組間比較。兩兩之間比較采用兩樣本t檢驗(yàn),統(tǒng)計(jì)結(jié)果進(jìn)行AlphaSim校正(P0.05)。結(jié)果:精神分裂癥陰性、陽性組與對(duì)照組在年齡、性別、受教育年限上無統(tǒng)計(jì)學(xué)差異。陽性組較對(duì)照組相比,右側(cè)枕下回、枕中回及左側(cè)顳中回CBF顯著增高,而左側(cè)丘腦、雙側(cè)額上回CBF降低。陰性組左側(cè)顳中回、右側(cè)枕中回、枕下回及角回灌注增高,左側(cè)殼核、丘腦、楔前葉及右側(cè)尾狀核、補(bǔ)充運(yùn)動(dòng)區(qū)和雙側(cè)額上回CBF降低。結(jié)論:本實(shí)驗(yàn)發(fā)現(xiàn)ASL成像可應(yīng)用于精神分裂癥患者腦血流灌注檢測,結(jié)果也支持既往PET/CT、SPECT發(fā)現(xiàn)的精神分裂癥額葉、顳葉、枕葉以及基底節(jié)區(qū)等灌注的異常。此外,陰性、陽性組在血流灌注方面存在差異,推斷不同亞型精神分裂癥患者存在不同的病理生理學(xué)變化,不同區(qū)域的灌注改變可能與不同亞型精神分裂癥臨床表現(xiàn)相關(guān)。其中額葉、丘腦的血流灌注改變可能是兩組亞型共同的病理生理學(xué)改變;楔前葉、角回與陰性癥狀的發(fā)生關(guān)系密切;而補(bǔ)充運(yùn)動(dòng)區(qū)域的作用尚待進(jìn)一步證實(shí)。
[Abstract]:Part 1 Comparison of resting state brain function in different subtypes of schizophrenics Objective: To compare the region of ReHo difference between positive and negative symptomatic schizophrenics compared with the control group by the method of resting state of brain function, and to explore the role of different brain areas in schizophrenic patients and to be schizophrenic. The pathogenesis and classification of the disease provided the basis of imaging. Materials and methods: 1. subjects were collected according to the diagnostic criteria for schizophrenia in the American psychiatric diagnosis and statistics manual Fifth Edition (DSM-V), and the schizophrenic patients were divided into positive group (n=25) and negative group (n=19) according to the PANSS scale, and the age, sex and teaching were selected. The normal people with more matched level as the control group (n=20).2. data acquisition: using the GE SignaHDXT3.0T superconducting magnetic resonance imaging instrument for brain functional imaging data, the scanning sequence includes the conventional magnetic resonance sequence (T1WI, T2WI and FLAIR), the 3D high resolution structure image and the static state scanning.3. data preprocessing: the MATLAB (R2012a) software platform, The rest state magnetic resonance processing software DPARSFA 2.3 is used to preprocess the acquired image data. The ReHo method data preprocessing steps include the format conversion, the elimination of the first 10 time points, the time layer correction, the head motion correction, the space standardization, the de linear drift, the filtering and elimination of the covariance, the calculation of the ReHo value and the smoothness correction culling mark. X, y, Z axis translations were more than 2mm and 2 degrees.4. of rotation: SPSS 20 was used to analyze the clinical data. The One WayANOVA method was used in the REST software to compare the three groups of ReHo indexes, and the AlphaSim correction (P0.01) was carried out. Ferroni correction), the results of negative, positive and control groups were compared, and P0.05 thought the difference was statistically significant. Results: schizophrenia was negative. There was no significant difference between the positive group and the control group in age, sex, and the number of years of education. Compared with the control group, the right side of the upper frontal gyrus and the left temporal gyrus ReHo decreased. The lateral occipital gyrus, right putamen and bilateral lingual gyrus increased ReHo. Compared with the control group, the left cerebellum, the lower temporal gyrus and the right putamen increased ReHo, the left central posterior gyrus, and the right frontal gyrus orbital ReHo decreased. Conclusion: the negative, positive symptoms of schizophrenia patients have extensive local concordance abnormalities, including the frontal lobes, as compared with the control group. Temporal lobe, occipital lobe, basal ganglia and cerebellum. Positive group, negative group compared with control group, the difference of ReHo brain area was different, considering the different neuropathic differences in different subtype schizophrenic patients. The abnormalities of the frontal and putamen function may be the pathophysiological changes of the two subtypes, and the positive symptoms of the occipital lobe and the patients. Correlation, and the cerebellum is related to the formation of negative symptoms; the role of the posterior central temporal lobe in the pathogenesis of schizophrenia is not clear. Second the comparison of 3D ASL perfusion imaging in different subtypes of schizophrenic patients: SPECT, PET/CT studies show that the difference of cerebral blood perfusion in schizophrenic patients In this study, 3D ASL technique was used to study the changes in cerebral blood flow in schizophrenic patients with positive and negative symptoms, and to explore the perfusion characteristics of schizophrenic patients with different subtypes and the role of different brain regions in schizophrenic patients. Methods: 1. subjects: according to the diagnostic and statistical hands of American Psychiatric disorders. The diagnostic criteria of schizophrenia, Fifth Edition > (DSM-V) were collected, and the schizophrenic patients were divided into positive group (n=25) and negative group (n=19) according to the PANSS scale. The age, sex and the normal persons with more matched education were collected as the.2. number of the control group (n=20): the GESignaHDXT3.0T superconducting magnetic resonance imaging instrument was used to perform the brain work. The scanning sequence includes: the conventional magnetic resonance sequence (T1WI, T2WI and FLAIR), the 3D high resolution structure image, and the three-dimensional arterial spin labeling imaging (3D Arterial Spin Labeling, 3D ASL) scan.3. data preprocessing. SPM 8 software preprocessed the CBF map based on voxel, including format conversion, registration, segmentation, spatial standardization, and smooth.4. statistical analysis: SPSS 20 was used for statistical analysis of clinical data. Negative, positive and control groups were pretreated with SPM 8 One Way ANOVA method in SPM 8 software (P0.05). The voxel of clustersize56 was used as mask for the comparison between the subgroup of schizophrenia and the control group. The two sample t test was compared between 22 and the result was AlphaSim correction (P0.05). The result: the schizophrenia was negative. There was no statistical difference between the positive group and the control group in age, sex, and the number of years of education. On the right, the right occipital gyrus, the middle occipital gyrus and the left temporal gyrus CBF increased significantly, while the left thalamus and the bilateral frontal gyrus decreased CBF. The left lateral temporal gyrus, the right occipital gyrus, the lower occipital gyrus and the angular gyrus increased, the left putamen, the thalamus, the anterior lobe of the wedge and the right caudate nucleus, and the CBF decreased in the motor area and the bilateral frontal gyrus. Conclusion: this experiment found ASL into the motor area and bilateral frontal gyrus. Conclusion: this experiment found that the CBF decreased in the motor area and bilateral frontal gyrus. Conclusion: this experiment found ASL into the motor area and bilateral frontal gyrus. The results also supported abnormal perfusion in the frontal lobe, the temporal lobe, the occipital lobe and the basal ganglia found in the PET/CT, SPECT, and the positive groups were different in the blood flow perfusion, and the different pathophysiology of the patients with different subtype schizophrenia had different pathophysiology. Changes in the perfusion changes in different regions may be related to the clinical manifestations of different subtypes of schizophrenia. The changes in the perfusion of the frontal and thalamus may be the common pathophysiological changes in the two subtypes; the anterior lobe, the angular gyrus are closely related to the negative symptoms, and the role of the supplementary exercise area needs to be further confirmed.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R749.3

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