本文選題：遺忘型輕度認(rèn)知障礙　切入點(diǎn)：靜息態(tài)功能磁共振　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景隨著社會(huì)經(jīng)濟(jì)、醫(yī)療技術(shù)的發(fā)展和教育水平的提高,人口老齡化進(jìn)程在逐漸提速,人類的平均壽命在延長(zhǎng)。阿爾茨海默病(Alzheimer's Disease,AD)是一種患病率隨著年齡的增長(zhǎng)而升高的進(jìn)展性神經(jīng)退行性病變,具有不可逆性,是引起老年殘疾的重要因素之一,并給家庭和社會(huì)帶來沉重的負(fù)擔(dān)。然而,目前的治療方法并不能延緩AD的病情進(jìn)展。遺忘型輕度認(rèn)知障礙(amnestic mild cognitive impairment,aMCI)是AD的前驅(qū)階段,早期的識(shí)別和治療對(duì)防止AD的發(fā)生有重要的意義。多項(xiàng)臨床研究表明,重復(fù)經(jīng)顱磁刺激(repetitive transcranial stimulation,rTMS)和認(rèn)知相關(guān)穴位磁療可改善aMCI患者的認(rèn)知功能,但這兩種方法的作用機(jī)制尚不明確。因此,本研究基于靜息態(tài)功能磁共振成像(functional magnetic resonance imaging,fMRI)技術(shù)觀察rTMS和認(rèn)知相關(guān)穴位的磁穴療法對(duì)aMCI患者腦功能的影響,探討它們對(duì)認(rèn)知功能的中樞性作用機(jī)制,為其臨床應(yīng)用提供理論依據(jù)。研究目的1.明確中樞性的rTMS對(duì)aMCI患者腦功能的作用,探討rTMS對(duì)認(rèn)知功能的中樞作用機(jī)制。2.明確周圍性的磁穴療法對(duì)aMCI患者腦功能的作用,探討磁穴療法對(duì)認(rèn)知功能的中樞作用機(jī)制。研究方法實(shí)驗(yàn)一招募aMCI患者10例,對(duì)所有患者進(jìn)行重復(fù)經(jīng)顱磁刺激治療,刺激部位為左背外側(cè)前額葉腦區(qū),刺激頻率10Hz,刺激強(qiáng)度為80%RMT,刺激時(shí)間2s,間歇期8s,如此重復(fù)20次。每周5次,共8周。治療前后均對(duì)所有患者進(jìn)行蒙特利爾認(rèn)知評(píng)估量表(Montreal cognitive assessment scale,MoCA)、韋氏數(shù)字符號(hào)測(cè)試、韋氏數(shù)字廣度測(cè)試認(rèn)知功能評(píng)估,和fMRI掃描,并采集和分析認(rèn)知功評(píng)估結(jié)果和靜息態(tài)fMRI的ReHo值及ALFF值。實(shí)驗(yàn)二招募aMCI患者32例,將患者隨機(jī)分配為治療組(16例)和對(duì)照組(16例),對(duì)所有患者進(jìn)行磁穴療法:將磁貼貼敷在體穴和耳穴上。治療組選取“調(diào)神益智”組穴:體穴:神門、內(nèi)關(guān)、豐隆、太溪、太沖;耳穴:心、腎、肝、腦;對(duì)照組選取陽(yáng)明經(jīng)的穴位:體穴:合谷、外關(guān)、曲池、足三里、下巨墟;耳穴:大腸、上肢、肩、臀。均3天更換新貼,4周為一療程,共8周。治療前后均對(duì)所有患者進(jìn)行蒙特利爾認(rèn)知評(píng)估量表(Montreal cognitive assessment scale,MoCA)、韋氏數(shù)字符號(hào)測(cè)試、韋氏數(shù)字廣度測(cè)試認(rèn)知功能評(píng)估,和fMRI掃描,并采集、分析認(rèn)知功評(píng)估結(jié)果和靜息態(tài)fMRI的ReHo值及ALFF值。研究結(jié)果1 rTMS對(duì)aMCI患者認(rèn)知功能的影響患者M(jìn)oCA、韋氏數(shù)字長(zhǎng)度測(cè)試、韋氏數(shù)字符號(hào)測(cè)試的積分都較治療前提高,且治療前后的積分差異有高度統(tǒng)計(jì)學(xué)意義(P0.01)。在MoCA的多個(gè)認(rèn)知域中主要表現(xiàn)為視空間與執(zhí)行功能、語(yǔ)言和延遲回憶的改善(P0.05)2 rTMS對(duì)aMCI患者靜息態(tài)fMRI的ReHo和ALFF值的影響rTMS引起aMCI患者ReHo值顯著增強(qiáng)的腦區(qū)集中在:額顳頂葉的多個(gè)亞回、左側(cè)額上回、額下回、顳上回、島葉、海馬旁回、楔前葉、右側(cè)扣帶回;引起ReHo值顯著降低的腦區(qū)集中在:左側(cè)枕中回、緣上回、頂上小葉。引起ALFF值顯著增強(qiáng)的腦區(qū)集中在:左側(cè)額顳葉的多個(gè)亞回、右側(cè)額下回、顳上回、左側(cè)楔前葉;引起ALFF值顯著降低的腦區(qū)集中在:右側(cè)額上回、內(nèi)側(cè)額葉和左側(cè)顳中回。3磁穴療法對(duì)aMCI患者認(rèn)知功能的影響治療組患者M(jìn)oCA、數(shù)字廣度及數(shù)字符號(hào)測(cè)試的積分均提高,與治療前對(duì)比差異有高度統(tǒng)計(jì)學(xué)意義(P0.01),而對(duì)照組患者只有MoCA和數(shù)字符號(hào)與治療前對(duì)比差異有高度統(tǒng)計(jì)學(xué)意義(P0.01);治療組與對(duì)照組間的差異亦有統(tǒng)計(jì)學(xué)意義(P0.05)。在MoCA包含的多個(gè)認(rèn)知域中主要表現(xiàn)為視空間結(jié)構(gòu)功能、執(zhí)行功能及延遲回憶的改善,尤其是延遲回憶,其余認(rèn)知領(lǐng)域改變不大。4磁穴療法對(duì)aMCI患者靜息態(tài)fMRI的ReHo值和ALFF值的影響4.1治療組磁穴療法對(duì)aMCI患者靜息態(tài)fMRI的ReHo值和ALFF值的影響治療組磁穴療法引起aMCI患者ReHo值顯著增強(qiáng)的腦區(qū)集中在:左側(cè)內(nèi)側(cè)額葉、額下回、島葉、杏仁核、中央后回和右側(cè)頂下小葉、扣帶回;引起ReHo顯著降低的腦區(qū)集中在:右側(cè)顳中回、左側(cè)枕中回、左側(cè)緣上回。引起ALFF值顯著增強(qiáng)的腦區(qū)集中在:右側(cè)顳上回、楔前葉、舌回、梭狀回、枕中回;引起ALFF值顯著降低的腦區(qū)集中在:左側(cè)顳上回、右側(cè)角回。4.2對(duì)照組磁穴療法對(duì)aMCI患者靜息態(tài)fMRI的ReHo值和ALFF值的影響對(duì)照組磁穴療法引起aMCI患者ReHo值顯著增強(qiáng)的腦區(qū)集中在:右側(cè)額中回、顳中回、中央前回,左側(cè)額上回、額下回、額極區(qū)、顳上回;引起ReHo值顯著降低的腦區(qū)集中在:右側(cè)舌回。引起ALFF值顯著增強(qiáng)腦區(qū)集中在:右側(cè)內(nèi)側(cè)額葉、顳上回、枕下回、中央前回,左側(cè)舌回、中央后回及緣上回。ALFF值顯著降低的腦區(qū)集中在:右側(cè)后外側(cè)前額葉、左側(cè)額中回、右側(cè)頂下小葉。4.3治療組和對(duì)照組磁穴療法對(duì)aMCI患者靜息態(tài)fMRI的ReHo值和ALFF值的比較與對(duì)照組相比,治療組磁穴療法引起aMCI患者ReHo值顯著增強(qiáng)的腦區(qū)集中在:右側(cè)額上回、顳中回、頂下小葉,左側(cè)海馬旁回、枕上回;ReHo值顯著降低的腦區(qū)集中在:左側(cè)頂上小葉、右側(cè)內(nèi)側(cè)額葉、中央前回。引起ALFF顯著增強(qiáng)的腦區(qū)集中在:左側(cè)額上回、枕上回、楔前葉、右側(cè)顳中回;引起ALFF值顯著降低的腦區(qū)集中在:左側(cè)顳上回、右側(cè)頂下小葉、角回。結(jié)論1 rTMS可增強(qiáng)aMCI患者靜息態(tài)fMRI認(rèn)知相關(guān)腦區(qū)的自發(fā)活動(dòng)和使神經(jīng)元間的活動(dòng)更趨于同步化,并可改善認(rèn)知功能;2磁穴療法可增強(qiáng)aMCI患者靜息態(tài)fMRI認(rèn)知相關(guān)腦區(qū)的自發(fā)活動(dòng)和使神經(jīng)元間的活動(dòng)更趨于同步化,并可改善認(rèn)知功能;且“調(diào)神益智”組穴的磁穴療法效果顯著優(yōu)于陽(yáng)明經(jīng)穴位的。
[Abstract]:With the social and economic background, the development of medical technology and raise the level of education, the aging of the population in the process of gradually accelerated, the life expectancy of human beings in the extension of Alzheimer's disease (Alzheimer's. Disease, AD) is a kind of prevalence with age increased in the progression of neurodegenerative disease, is irreversible, is one of the important factors causing disability, and bring heavy burden to family and society. However, the current treatment methods and can delay the progression of AD disease. Amnestic mild cognitive impairment (amnestic mild cognitive impairment, aMCI) is the precursor of AD, early identification and treatment is important to prevent AD. Number of clinical studies have shown that repetitive transcranial magnetic stimulation (repetitive transcranial, stimulation, rTMS) and cognitive related acupoint therapy can improve cognitive functions in aMCI patients, but the two The mechanism method is not clear. Therefore, this study based on resting state functional magnetic resonance imaging (functional magnetic resonance imaging, fMRI) effect of magnetic acupoint therapy technique to observe the related points of rTMS and cognitive brain function in patients with aMCI, explore their cognitive function in central mechanism, provide theoretical basis for its clinical application Objective: 1.. Effect of rTMS on the central clear brain function in patients with aMCI, to investigate the effect of magnetic acupoint therapy of.2. in the central role of rTMS on cognitive function of aMCI patients to clear around the brain function, investigate the central mechanism of magnetic acupoint therapy on cognitive function. Experimental study on a recruitment of 10 patients with aMCI, treatment of repetitive transcranial magnetic stimulation in all patients, the stimulation site for the left dorsolateral prefrontal cortex, stimulation frequency 10Hz, stimulus intensity was 80%RMT, stimulation time 2s, interval 8s, so heavy 澶，

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