本文選題：發(fā)育遲緩 + 嬰幼兒��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究目的:通過靜息態(tài)血氧水平依賴腦功能成像(blood oxygenation level dependent functional magnetic imaging,BOLD-fMRI)和磁共振擴(kuò)散張量成像(diffusion tensor imaging,DTI)技術(shù)觀察無明確病因的發(fā)育遲緩(global developmental delay,GDD)嬰幼兒靜息狀態(tài)下局部腦區(qū)神經(jīng)活動改變和腦白質(zhì)微細(xì)結(jié)構(gòu)改變,探討嬰幼兒發(fā)育遲緩的腦損傷模式,為早期診斷嬰幼兒發(fā)育遲緩提供影像學(xué)指標(biāo)。材料與方法:我們選用22例Bayley嬰幼兒發(fā)育量表評分低于69分的發(fā)育遲緩嬰幼兒作為病例組。同時選擇14例年齡、性別等與之無明顯統(tǒng)計學(xué)差異的發(fā)育正常嬰幼兒作為對照組。病例組和對照組嬰幼兒均接受磁共振檢查,包括常規(guī)磁共振掃描序列(橫軸位T1WI、T2WI、FLAIR),靜息態(tài)BOLD-fMRI掃描序列及DTI掃描序列,掃描范圍包括全部大腦,排除在常規(guī)磁共振掃描序列中有異常影像學(xué)表現(xiàn)的嬰幼兒。應(yīng)用局部一致性(regional homogeneity,ReHo)和低頻振幅(amplitude of low frequency fluctuation,ALFF)分析 GDD 嬰幼兒組和發(fā)育正常嬰幼兒組的RS-fMRI數(shù)據(jù),評估GDD嬰幼兒靜息狀態(tài)下局部腦區(qū)神經(jīng)活動改變情況。采用基于纖維束示蹤的空間統(tǒng)計分析(tract-based spatial statistics,TBSS)方法分析GDD嬰幼兒組和足月發(fā)育正常嬰幼兒組的DTI數(shù)據(jù),比較分析GDD嬰幼兒與發(fā)育正常嬰幼兒全腦白質(zhì)的各向異性分?jǐn)?shù)(fractional anisotropy,FA)值和平均擴(kuò)散率(mean diffusivity,MD)值的變化特點,尋找有顯著性差異的腦白質(zhì)纖維。結(jié)果:相對于發(fā)育正常嬰幼兒組,GDD嬰幼兒組ALFF值減小腦區(qū)包括左側(cè)顳中回和右側(cè)扣帶回;ALFF值增加腦區(qū)為楔前葉。與發(fā)育正常嬰幼兒組相比,GDD嬰幼兒組腦前額葉ReHo值減低;ReHo值增加的腦區(qū)為右側(cè)大腦半球額上回。與發(fā)育正常嬰幼兒組相比,GDD嬰幼兒組多個腦區(qū)纖維束FA值顯著減小,主要包括雙側(cè)放射冠區(qū),右側(cè)內(nèi)囊前肢,右側(cè)矢狀層、額上皮層及梭狀回附近,左側(cè)穹窿、上縱束、內(nèi)囊晶狀體后側(cè)及小腦腳上部等部位的纖維束;右側(cè)上縱束FA值增加。對比發(fā)育正常嬰幼兒組,發(fā)育遲緩嬰幼兒白質(zhì)纖維束MD值增高的腦區(qū)包括:左側(cè)小腦、小腦腳中部和小腦蚓部,右側(cè)梭狀回和內(nèi)側(cè)丘腦;左側(cè)楔葉部位的白質(zhì)纖維束MD值減小。結(jié)論:與發(fā)育正常嬰幼兒相比,發(fā)育遲緩嬰幼兒的局部大腦皮層功能和腦白質(zhì)纖維束微結(jié)構(gòu)有其特殊性,這種特殊性可能與該病的病理基礎(chǔ)有關(guān)。研究嬰幼兒發(fā)育遲緩的功能神經(jīng)影像學(xué)改變,有助于了解其發(fā)病機(jī)制,從而為其提供早期診斷的影像學(xué)指標(biāo)。
[Abstract]:Objective: to observe the regional brain regions in infants with global developmental delay-GDDs without definite etiology by resting blood oxygenation level dependent functional magnetic imaging1 (BOLD-f MRI) and diffusion Zhang Liang diffusion tensor imaging (DTI) techniques. Changes in nerve activity and microstructures in the white matter, To explore the model of brain injury in infants with developmental retardation, and to provide imaging index for early diagnosis of infant stunting. Materials and methods: 22 cases of stunted infants with Bayley score below 69 were selected as the case group. At the same time, 14 normal infants with age and sex were selected as control group. All infants and infants in the case group and the control group underwent MRI examination, including conventional MRI sequences (axial T1WIT T2WIFLAIRI, resting BOLD-fMRI scan sequence and DTI scan sequence). The scanning range included all the cerebrum, the brain, brain, brain, brain, brain, brain, brain, brain, brain, brain, brain, brain, brain and brain. Infants excluded from conventional MRI sequences with abnormal imaging findings. The regional homogenicity (ReHoA) and low frequency amplitude amplitude of low frequency structure (ALFF) were used to analyze the RS-fMRI data of GDD infants and normal infants, and to evaluate the changes of regional brain nerve activity in GDD infants. The spatial statistical analysis based on tracer of fiber bundle was used to analyze the DTI data of GDD infants and infants with normal term development. The characteristics of anisotropic fraction (FA) and mean diffusivity (MD) of white matter in the whole brain of GDD infants and normal infants were compared and analyzed, and the white matter fibers with significant difference were found. Results: compared with normal infant group, ALFF decreased cerebellar area including left middle temporal gyrus and right cingulate gyrus. Compared with normal infant group, the prefrontal lobe ReHo decreased and ReHo increased in the right hemisphere superior frontal gyrus. Compared with normal infant group, the FA value of fibrous bundles in GDD group decreased significantly, including bilateral radio-coronal area, right anterior limb of internal capsule, right sagittal layer, frontal cortex and near fusiform gyrus, left fornix, superior longitudinal bundle. The fiber bundle in the posterior side of the internal capsule lens and the upper part of the cerebellar foot increased the FA value of the right superior longitudinal bundle. Compared with normal infant group, the areas with increased MD value of white matter fiber bundle in stunted infants included left cerebellum, middle cerebellar foot and cerebellar vermis, right fusiform gyrus and medial thalamus, and decreased MD of white matter fiber bundle in left wedge lobe. Conclusion: compared with normal infants, the local cerebral cortex function and white matter fiber bundle microstructures of stunted infants have their particularities, which may be related to the pathological basis of the disease. The study of functional neuroimaging changes in infants with developmental retardation is helpful to understand its pathogenesis and to provide early diagnostic imaging indicators.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R749.94

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