本文選題：輕度認知障礙 + 彌散張量成像　； 參考：《昆明醫(yī)科大學(xué)》2016年碩士論文

【摘要】：[目的]通過簡易智能精神量表(Mini-Mental State Examination, MMSE)以及蒙特利爾認知評估量表(Montreal Cognitive assessment, MoCA)對患者認知功能進行評估,篩查并收集輕度認知功能障礙的患者,并進一步進行磁共振彌散張量成像(Diffusion Tensor Imaging, DTI)檢查,分析輕度認知障礙(Mild Cognitive Impairment, MCI)患者腦白質(zhì)彌散張量成像的影像學(xué)改變,為臨床早期診斷輕度認知障礙提供客觀依據(jù)，分析輕度認知障礙患者神經(jīng)心理學(xué)量表評測結(jié)果與DTI檢查結(jié)果的相關(guān)性。[方法]收集2015年7月至2016年2月在昆明醫(yī)科大學(xué)第二附屬醫(yī)院干療三科住院的患者,通過MMSE及MoCA進行篩查評估并根據(jù)結(jié)果分別納入輕度認知障礙組和正常對照組；記錄患者一般情況,如性別、年齡、受教育年限；同時記錄既往史,包括卒中病史及精神病史等,并對不滿足條件的患者進行剔除。被納入的研究對象均進行漢密爾頓抑郁評分量表、日常生活能力量表評分及癡呆量表評分并記錄分值,以便進一步進行篩選。最終納入研究的對象中,輕度認知障礙組共納入34例,對照組22例,最后對所有入選病例行常規(guī)頭顱磁共振以及彌散張量成像檢查。原始圖像在Philips Achieva 3.0 TXS掃描完成后上傳到Philips公司提供的Extended MR Workspace 2.6.3.4工作站,重建出FA平滑圖像,利用FiberTrak軟件包對圖像進行后處理重建出FA彩圖,以便追蹤纖維,方便測量；在T2WI EPI(b=0)的FA圖上采用圓形感興趣區(qū)(rigion-of-interest, ROI,大小約20mmm2)對不同腦區(qū)白質(zhì)纖維進行FA值測量。以掃描層面完全匹配的常規(guī)T1WI和T2WI序列作為解剖參考圖像。每個ROI測量的纖維束均利用FA彩圖及T1WI疊加技術(shù)追蹤同束纖維在其連續(xù)層面的上下層面取值,3個值求得的算術(shù)均數(shù)為最終結(jié)果。最后應(yīng)用應(yīng)用SPSS17.0統(tǒng)計學(xué)軟件對所有數(shù)據(jù)進行統(tǒng)計分析。[結(jié)果]比較分析輕度認知障礙組及對照組整體情況,發(fā)現(xiàn)性別、年齡、受教育年限沒有統(tǒng)計學(xué)差異,(P0.05),輕度認知障礙組MMSE、MoCA得分均低于對照組,兩組比較具有統(tǒng)計學(xué)意義(P0.01),而輕度認知障礙組]HDRS評分高于正常對照組,差異有統(tǒng)計學(xué)意義(p0.05)。在各認知域得分情況方面,輕度認知障礙組MMSE各認知域得分均低于正常對照組,其中定向力、注意與計算力以及臨摹圖形具有統(tǒng)計學(xué)差異(P0.05),而定記憶力能力具有顯著差異(P0.01)。輕度認知障礙組MoCA各項認知域得分均低于正常對照組,除視空間與執(zhí)行以及命名得分無統(tǒng)計學(xué)差異外,注意與計算力、語言能力、抽象思維、記憶力及定向能力具有統(tǒng)計學(xué)意義(P0.05),其中記憶力、定向力及注意與計算力具有顯著統(tǒng)計學(xué)差異(P0.01)。輕度認知障礙組患者與正常對照組相比,左側(cè)額葉白質(zhì)、頂葉白質(zhì)、右側(cè)顳葉白質(zhì)、枕葉白質(zhì)及胼胝體壓部白質(zhì)的FA值之間無統(tǒng)計學(xué)差異(p0.05)。而MCI組右側(cè)額葉FA值(0.335±0.068)、左側(cè)顳葉白質(zhì)FA值(0.391±0.032)及胼胝體膝部FA值(0.658±0.053)均較NC組相應(yīng)部位FA值低,且兩組間比較均具有統(tǒng)計學(xué)意義(p0.05)；把MCI組和NC組比較有統(tǒng)計學(xué)意義的FA值和MoCA量表中的認知域在進行典型相關(guān)分析,結(jié)果發(fā)現(xiàn)右側(cè)額葉白質(zhì)FA值與注意與計算力R值為0.332,左側(cè)顳葉白質(zhì)FA值與記憶力R值為0.456,胼胝體膝部FA值與記憶力R值為0.429,p值均小于0.05,具有統(tǒng)計學(xué)意義。是把MCI組和NC比較有差異的FA值和MMSE量表中認知域進行典型相關(guān)分析,結(jié)果發(fā)現(xiàn)只有右側(cè)額葉白質(zhì)FA值與注意與計算力R為0.342,p值小于0.05,具有統(tǒng)計學(xué)意義。[結(jié)論]輕度認知障礙患者相對認知功能正常人可能更容易合并有抑郁障礙。輕度認知障礙患者記憶力障礙可能與左側(cè)顳葉白質(zhì)及胼胝體膝部白質(zhì)的損害相關(guān),注意與計算力的障礙可能與右側(cè)額葉白質(zhì)損害有關(guān)。腦白質(zhì)病變可導(dǎo)致認知功能障礙,磁共振彌散張量成像檢查可為早期診斷MCI提供客觀依據(jù),即表現(xiàn)為相應(yīng)損害腦區(qū)白質(zhì)的FA值降低。
[Abstract]:[Objective] to evaluate the cognitive function of patients through the simple intelligent mental scale (Mini-Mental State Examination, MMSE) and the Montreal cognitive assessment scale (MoCA), to screen and collect patients with mild cognitive impairment and to carry out magnetic resonance diffusion tensor imaging (Diffusion Tensor Imagi). Ng, DTI) examination, analysis of the imaging changes of white mass diffusion tensor imaging in patients with Mild Cognitive Impairment (MCI), to provide an objective basis for early diagnosis of mild cognitive impairment, and to analyze the correlation between the evaluation of neuropsychological scale and the results of DTI examination in patients with mild cognitive impairment. [Methods] collect 7 2015. The patients who were hospitalized at the Second Affiliated Hospital of Kunming Medical University from January to February 2016 were screened by MMSE and MoCA and were included in the mild cognitive impairment group and the normal control group according to the results. The patient's general condition, such as sex, age, years of education, and history of stroke, including history and spirit of stroke, were recorded. The patients who were not satisfied were eliminated. The subjects were included in the Hamilton depression scale, the daily living ability scale score and the Dementia Scale score and record scores for further screening. Among the subjects of the study, 34 cases were included in the group of light degree cognitive impairment and 22 cases in the control group. After the Philips Achieva 3 TXS scan, the original image was uploaded to the Extended MR Workspace 2.6.3.4 workstation provided by the Philips company, the FA smooth image was reconstructed, and the FA color image was rebuilt by the FiberTrak software package to reconstruct the FA color map. Tracking fiber, convenient measurement; using circular interest zone (rigion-of-interest, ROI, size about 20mmm2) on the T2WI EPI (b=0) FA map to measure the FA value of white matter fibers in different brain regions. The conventional T1WI and T2WI sequences that are completely matched at the scanning level are used as the anatomical reference images. The value of the same bundle fiber at the upper and lower levels of the continuous layer was traced and the arithmetic average of the 3 values was the final result. Finally, all the data were analyzed with SPSS17.0 statistics software. [results] the overall situation of the mild cognitive impairment group and the control group was compared and analyzed, and the gender, age, and the number of years of education were found to have no statistics. The scores of MMSE and MoCA in the mild cognitive impairment group were all lower than those in the control group (P0.05), and the two groups were statistically significant (P0.01), while the]HDRS score in the mild cognitive impairment group was higher than that of the normal control group (P0.05). In the cognitive domains, the scores of the cognitive domains of the mild cognitive impairment group were all lower than those of the normal group (P0.05). There were statistically significant differences (P0.05) between the attention and the computational force and the copying pattern (P0.01). The scores of MoCA in the mild cognitive impairment group were lower than those in the normal control group, and the attention and computational power, language ability, and the language ability, were not significantly different from the visual space and the execution and naming scores. Abstract thinking, memory and orientation had statistical significance (P0.05), of which memory, orientation and attention had significant statistical differences (P0.01). Patients with mild cognitive impairment were compared with normal control group, left frontal lobar white matter, parietal white matter, right lateral temporal white matter, occipital white matter and FA of corpus callosum pressure white matter. There was no statistical difference (P0.05). The FA value of the right frontal lobe in group MCI (0.335 + 0.068), the FA value of white matter in the left temporal lobe (0.391 + 0.032) and the FA value of the corpus callosum (0.658 + 0.053) were lower than those of the NC group, and the two groups were statistically significant (P0.05). The FA values and MoCA scales were compared between the MCI and NC groups. Canonical correlation analysis was carried out. The results showed that the FA value of the right frontal lobe white matter and the R value of attention and calculation were 0.332, the FA value of white matter in the left temporal lobe and the memory R value were 0.456, the FA value of the genu of the corpus callosum and the memory R value was 0.429, the p value was less than 0.05, and was statistically significant in the FA values and MMSE scales which were different between the MCI and NC. The domain was canonical correlation analysis. The results showed that only the FA value of the right frontal lobe white matter and the attention and calculation force R were 0.342 and the p value was less than 0.05. [Conclusion] the patients with mild cognitive impairment may be more likely to be associated with depressive disorder. The memory impairment in patients with mild cognitive impairment may be associated with left temporal white matter. The impairment of white matter in the genu of the corpus callosum may be related to the impairment of the right frontal lobes. Brain white matter can lead to cognitive impairment. Magnetic resonance diffusion tensor imaging can provide an objective basis for the early diagnosis of MCI, that is, the reduction of the FA value of the white matter in the brain region.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R749.1

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