【摘要】：目的:應(yīng)用靜息態(tài)功能磁共振(resting-state functional magnetic resonance imaging,rs-f MRI)成像的低頻振幅(Amplitude of Low-Frequency Fluctuation,ALFF)及功能連接(functional connectivity,FC)的方法對(duì)重型顱腦損傷昏迷患者進(jìn)行損傷評(píng)估及預(yù)測(cè)其預(yù)后。方法:用靜息態(tài)功能磁共振對(duì)21例重型顱腦損傷昏迷(s TBI)患者的病例組和21例受教育程度、年齡、性別均相匹配的正常對(duì)照組進(jìn)行成像檢查,通過(guò)軟件對(duì)數(shù)據(jù)進(jìn)行處理及分析,使我們能夠得到健康對(duì)照組及重型顱腦損傷昏迷患者的大腦的激活圖,采用單樣本t檢驗(yàn)分別分析后扣帶回(PCC)在重型顱腦損傷昏迷患者和正常對(duì)照組的各自組內(nèi)的功能連接,從而得到病例組及正常對(duì)照組的后扣帶回(PCC)同全腦的連接圖,我們只選擇正連接的激活圖,然后取兩圖的并集做一個(gè)默認(rèn)腦網(wǎng)絡(luò)的蒙版(MASK)。再采用雙樣本t檢驗(yàn)在蒙版(MASK)內(nèi)比較健康對(duì)照組和病例組之間腦區(qū)的低頻振幅(ALFF)的差異。根據(jù)重型顱腦損傷性昏迷患者的預(yù)后情況將病例組分為清醒組及昏迷組,同樣采用雙樣本t檢驗(yàn)在蒙版(MASK)內(nèi)比較清醒組和昏迷組之間腦區(qū)的功能連接及低頻振幅(ALFF)的差異。最后將重型顱腦損傷昏迷病人后扣帶回(PCC)區(qū)域內(nèi)的平均低頻振幅(m ALFF)的值同格拉斯哥昏迷評(píng)分做相關(guān)性分析。結(jié)果:重型顱腦損傷性昏迷患者與正常對(duì)照組在基于MASK內(nèi)相比,重型顱腦損傷性昏迷患者的背外側(cè)額上回、前額葉內(nèi)側(cè)區(qū)、左側(cè)額中回、前扣帶回、左側(cè)顳回、后扣帶回、楔前葉、楔葉、右枕中回、右枕下回、右頂上回區(qū)域的低頻振幅(ALFF)值明顯降低。病例組中的清醒組與昏迷組在基于MASK內(nèi)相比,在清醒組的額上回內(nèi)側(cè)區(qū)、左側(cè)顳回、前扣帶回、楔前葉、后扣帶回、頂葉區(qū)域的功能連接明顯增強(qiáng)。而在其右側(cè)額回、右側(cè)顳回、右側(cè)頂下回區(qū)域的低頻振幅(ALFF)明顯增高。病例組的后扣帶回(PCC)的平均低頻振幅(m ALFF)同重型顱腦損傷性昏迷患者的GCS評(píng)分的高低呈明顯正相關(guān)r=0.798,P0.0001。結(jié)論:在靜息態(tài)下重型顱腦損傷昏迷(s TBI)患者的默認(rèn)腦網(wǎng)絡(luò)仍然存在,但其范圍卻減小,重型顱腦損傷昏迷(s TBI)患者在靜息態(tài)下與健康對(duì)照組相比多個(gè)腦區(qū)的低頻振幅(ALFF)明顯降低,說(shuō)明了重型顱腦損傷的患者昏迷的原因不只是某個(gè)特定腦區(qū)自發(fā)活動(dòng)的異常,而是整個(gè)默認(rèn)腦網(wǎng)絡(luò)的腦區(qū)整體自發(fā)活動(dòng)的降低。在病例組中昏迷組相比清醒組的多個(gè)腦區(qū)的功能連接明顯增高,而其余多個(gè)腦區(qū)低頻振幅明顯增高。從而揭示了大腦默認(rèn)網(wǎng)絡(luò)的腦區(qū)功能連接及自發(fā)活動(dòng)的增高與其預(yù)后關(guān)系密切。病例組后扣帶回(PCC)的平均ALFF值同重型顱腦損傷性昏迷患者的GCS評(píng)分呈明顯正相關(guān),揭示了后扣帶回自發(fā)活動(dòng)的強(qiáng)弱與患者昏迷程度的高低密切相關(guān),但與患者的預(yù)后關(guān)系不太密切。
[Abstract]:Objective: to evaluate the low frequency amplitude (Amplitude of Low-Frequency Fluctuation,ALFF and functional junction (functional connectivity,FC) of resting functional magnetic resonance (resting-state functional magnetic resonance imaging,rs-f MRI) imaging in severe craniocerebral injury coma patients and predict their prognosis. Methods: resting functional magnetic resonance imaging was performed in 21 patients with severe craniocerebral injury coma (s TBI) and 21 normal controls with matched education, age and sex. The data were processed and analyzed by software. So that we can get the activation map of the brain in the healthy control group and the comatose patients with severe craniocerebral injury. The functional connections of the posterior cingulate gyrus (PCC) in the comatose patients with severe craniocerebral injury and the normal control group were analyzed by single sample t-test. So we can get the connection diagram of the posterior cingulate gyrus (PCC) and the whole brain of the case group and the normal control group. We only select the active map of the positive connection, and then take the combination of the two images to make a mask (MASK). Of the default brain network. The difference of low frequency amplitude (ALFF) between healthy control group and case group was compared by double sample t test in masked (MASK). According to the prognosis of severe craniocerebral injury coma patients, the patients were divided into conscious group and coma group. The difference of functional connection and low frequency amplitude (ALFF) between awake group and coma group was also compared by double sample t test in masked (MASK). Finally, the correlation between the mean low frequency amplitude (m ALFF) of the posterior cingulate gyrus (PCC) and the Glasgow coma score in the coma patients with severe craniocerebral injury was analyzed. Results: the patients with severe craniocerebral injury coma were compared with the control group based on MASK. The superior dorsolateral frontal gyrus, medial prefrontal lobe, left middle frontal gyrus, anterior cingulate gyrus, left temporal gyrus, posterior cingulate gyrus were found in severe craniocerebral injury coma patients. The low frequency amplitude (ALFF) of anterior cuneate lobe, cuneiform lobe, right occipital middle gyrus, right inferior occipital gyrus and right superior parietal gyrus decreased significantly. The functional connections in the medial area of superior frontal gyrus, left temporal gyrus, anterior cingulate gyrus, anterior cuneate lobe, posterior cingulate gyrus and parietal lobe were significantly enhanced in the conscious group compared with the coma group based on MASK. The low frequency amplitude of (ALFF) in the right frontal gyrus, right temporal gyrus and right inferior parietal gyrus was significantly increased. The mean low frequency amplitude (m ALFF) of posterior cingulate gyrus (PCC) in the case group was positively correlated with the GCS score of severe craniocerebral injury coma patients (P 0.0001). Conclusion: the default brain network still exists in (s TBI) patients with severe craniocerebral injury, but its range is reduced. The low frequency amplitude (ALFF) of (s TBI) patients with severe craniocerebral injury was significantly lower than that of the healthy control group, indicating that the reason of coma in severe brain injury patients was not only the abnormality of spontaneous activity in a particular brain area. It is a decrease in the overall spontaneous activity of the entire default brain network. In the case group, the functional connections of multiple brain regions in the coma group were significantly higher than those in the awake group, while the low frequency amplitudes in the other multiple brain regions were significantly increased. Therefore, it is revealed that the increase of functional connections and spontaneous activities of the brain's default network is closely related to its prognosis. The average ALFF value of posterior cingulate gyrus (PCC) was positively correlated with the GCS score of severe craniocerebral injury coma patients, which revealed that the intensity of spontaneous activity of posterior cingulate gyrus was closely related to the degree of coma. However, it is not closely related to the prognosis of the patients.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.15

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