發(fā)布時間：2018-03-04 06:17

  本文選題：阿爾茨海默病　切入點：磁共振成像　出處：《吉林大學(xué)》2012年博士論文　論文類型：學(xué)位論文

【摘要】：老年性認(rèn)知障礙是困擾老年人的常見性疾病，目前我國老年人口數(shù)已占總?cè)丝跀?shù)的10.15%，隨著國家老齡化的不斷深入，老年性認(rèn)知障礙的發(fā)病人數(shù)將會逐年增加，估計到2050年，我國老年人口將增加到4億，而癡呆患者將超過2000萬，因此，防治老年性的發(fā)生刻不容緩，對于這方面的研究也應(yīng)該有長足的進(jìn)步，本研究即圍繞這一中心展開一系列研究。 目的：比較阿爾茨海默病(AD)與健康老年人、輕度認(rèn)知障礙(MCI)患者的顱腦影像學(xué)改變，尋求一種AD的影像學(xué)診斷依據(jù)；探討白質(zhì)纖維束在輕度認(rèn)知障礙（MCI）和阿爾茨海默病（AD）中的改變，為MCI和早期AD的診斷提供理論基礎(chǔ)；比較阿爾茨海默病(AD)與健康老年人、輕度認(rèn)知障礙(MCI)患者的代謝物濃度變化，以探求AD患者的腦部代謝的病理性改變。方法：選取12例MCI患者、18例AD患者及20例健康的志愿者，進(jìn)行常規(guī)MR冠狀位1mm薄層掃描，利用西門子工作站進(jìn)行三維重建，分別進(jìn)行哈氏值(HI)，，腦室指數(shù)(VI)，前角指數(shù)(FHI)，三腦室寬(TVW)，皮層腦溝寬度(CSW)，外側(cè)裂寬度（LFW）等線性指標(biāo)的測量和海馬體積的測量；行常規(guī)MR和DTI序列掃描，分別對其進(jìn)行白質(zhì)評級和感興趣區(qū)域（上縱束、下縱束、鉤束、胼胝體壓部、胼胝體膝部、內(nèi)囊前肢、內(nèi)囊膝部、內(nèi)囊后肢、扣帶回前部、扣帶回后部）FA和ADC值的測量并統(tǒng)計分析；行常規(guī)MR掃描和MRS掃描，利用西門子工作站進(jìn)行后處理，并對其測量的各種數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析。結(jié)果：線性測量指標(biāo)HI, FHI, TVW,LFW均具有顯著的統(tǒng)計學(xué)意義(P0.05)，海馬標(biāo)準(zhǔn)化體積存在組間差異(P0.05)，且大于一定年齡后，海馬體積隨年齡增加而不斷減小(P0.05)、兩性間海馬體積不具有顯著性差異(P0.05)，MCI組和AD組的海馬體積具有側(cè)別差異(P0.05)；白質(zhì)損傷評級與年齡變化具有相關(guān)性，MCI與AD之間的白質(zhì)評級有顯著性差異（P0.05），DTI序列掃描，三組之間的上縱束、下縱束、扣帶回后部、胼胝體膝部FA值均存在組間差異（P0.01），白質(zhì)評級與上縱束、下縱束的FA值存在相關(guān)性（P0.05），與上縱束、胼胝體膝部、內(nèi)囊前肢ADC值存在相關(guān)性（P0.05）；三組代謝物比值的組間差異均不受側(cè)別、性別、年齡的影響(P0.05)，三組受試對象中丘腦NAA/Cr表現(xiàn)為明顯的組間差異(P0.05)，其他感興趣區(qū)域的代謝物比值均不存在顯著性差異(P0.05)。結(jié)論：顱腦的影像學(xué)改變在診斷AD中具有明顯的特異性，線性指標(biāo)和海馬體積的聯(lián)合診斷可有效提高AD的診斷率。MCI病人和早期AD病人的白質(zhì)出現(xiàn)了明顯的損傷性改變，因而利用上縱束、下縱束、扣帶回后部、胼胝體膝部的FA值作為白質(zhì)損傷的指標(biāo)來輔助診斷AD具有重要的臨床價值。白質(zhì)評級中MCI組與AD組存在顯著性差異，因而可作為判斷MCI轉(zhuǎn)歸的依據(jù)指標(biāo)。大腦的MRS掃描在AD的診斷中具有一定的價值，通過對一些代謝物比值的測定，可以為臨床診斷提供參考。
[Abstract]:Senile cognitive impairment is a common disease that puzzles the elderly. At present, the elderly population in our country has accounted for 10.15% of the total population. With the deepening of aging in our country, the incidence of senile cognitive impairment will increase year by year. It is estimated that by 2050, the number of senile cognitive disorders will increase year by year. The elderly population in China will increase to 400 million, while the dementia patients will exceed 20 million. Therefore, it is urgent to prevent and cure the occurrence of senile disease. The research in this field should also make great progress. Objective: to compare the craniocerebral imaging changes between Alzheimer's disease (AD) and healthy elderly patients with mild cognitive impairment (MCI) and to find a diagnostic basis for AD. To investigate the changes of white matter fiber bundle in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD), and to provide a theoretical basis for the diagnosis of MCI and early AD. In order to explore the pathological changes of brain metabolism in patients with mild cognitive impairment (MCI), 18 AD patients with MCI and 20 healthy volunteers were selected for conventional coronal 1 mm thin slice Mr scanning. Three dimensional reconstruction was carried out by Siemens workstation. The linear indexes such as Hihler's value, ventricular index (VI), anterior angle index (FHI), third ventricle width (TVWN), cortical sulcus width (CSW), lateral fissure width (LFW), and hippocampal volume were measured. Routine Mr and DTI sequences were performed to evaluate the white matter and area of interest (superior longitudinal bundle, inferior longitudinal bundle, hook bundle, splenium callosum, genu of corpus callosum, anterior limb of internal capsule, knee of internal capsule, posterior limb of internal capsule, anterior part of cingulate gyrus). The FA and ADC values of posterior cingulate gyrus were measured and statistically analyzed, conventional Mr scan and MRS scan were performed, and the postprocessing was performed by Siemens workstation. Results: the linear measurement indexes HIH, FHI, TVWN LFW all had significant statistical significance (P 0.05). There was a significant difference in the standardized volume of hippocampus between groups and was larger than that after a certain age. The hippocampal volume decreases with age. There is no significant difference in hippocampal volume between the two sexes. The hippocampal volume in P0.05 MCI group and AD group is different from that in AD group (P0.05), and there is a correlation between white matter damage rating and age change. There was significant difference in quality rating (P 0.05 / DTI scan). The FA values of upper longitudinal bundle, lower longitudinal bundle, posterior cingulate gyrus, genu of corpus callosum were significantly different among the three groups (P 0.01). There was a correlation between the white matter rating and the upper longitudinal bundle and the FA value of the lower longitudinal bundle (P 0.05), and with the superior longitudinal bundle, the genu of corpus callosum, and the knee of corpus callosum. There was a correlation between the ADC values of the anterior limb of the internal capsule and the ratio of metabolites in the three groups, and there was no difference in the ratio of metabolites between the three groups. The NAA/Cr of thalamus in the three groups was significantly different among the three groups, but there was no significant difference in the ratio of metabolites in other regions of interest. Conclusion: the imaging changes of brain have obvious specificity in the diagnosis of AD. The combination of linear index and hippocampal volume can effectively improve the diagnostic rate of AD. The white matter of patients with MCI and early AD patients has obvious damage changes, so the upper longitudinal bundle, the lower longitudinal bundle, the posterior cingulate gyrus, and the posterior cingulate gyrus can be used. The FA value of the genu of corpus callosum as a marker of white matter injury has important clinical value in the diagnosis of AD. There is a significant difference between the MCI group and AD group in the white matter rating. The brain MRS scan has certain value in the diagnosis of AD. By measuring the ratio of some metabolites, it can provide a reference for clinical diagnosis.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R445.2;R749.1

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