本文選題：空間導(dǎo)航能力 + 輕度認(rèn)知功能障礙�。� 參考：《南京大學(xué)》2017年碩士論文

【摘要】：第一部分輕度認(rèn)知障礙患者空間導(dǎo)航能力相關(guān)的腦白質(zhì)完整性改變目的:采用基于纖維束空間統(tǒng)計(jì)分析方法(Tract-Based Spatial Statistics,TBSS)探索輕度認(rèn)知障礙(Mild cognitive impairment,MCI)患者腦白質(zhì)完整性改變,并與其空間導(dǎo)航能力進(jìn)行相關(guān)性分析,以期揭示MCI患者空間導(dǎo)航障礙的白質(zhì)改變的微觀結(jié)構(gòu)基礎(chǔ)。方法:病例組來(lái)自南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院的神經(jīng)內(nèi)科門診以認(rèn)知障礙為主訴的患者,其中診斷為MCI的患者27例,時(shí)間為2015年5月到2016年2月,然后通過(guò)社區(qū)招募正常認(rèn)知對(duì)照組(Normal Control,NC),共24例,其性別、年齡以及受教育程度與病例組無(wú)統(tǒng)計(jì)學(xué)差異。所有被試均進(jìn)行了計(jì)算機(jī)模擬空間導(dǎo)航能力測(cè)試以及3.0T頭顱MRI彌散張量成像(Diffusion Tensor Imaging,DTI)掃描,然后采用PANDA軟件對(duì)原始數(shù)據(jù)進(jìn)行預(yù)處理,之后采用TBSS對(duì)受試者的部分各向異性(FractionalAnisotropy,FA)圖進(jìn)行全腦非參數(shù)統(tǒng)計(jì)的比較,以及纖維束FA值與空間導(dǎo)航能力的相關(guān)性分析。結(jié)果:與NC組相比,MCI組的混合(環(huán)境+自我)導(dǎo)航、自我導(dǎo)航及環(huán)境導(dǎo)航能力均有下降,其中自我導(dǎo)航能力減退達(dá)到統(tǒng)計(jì)學(xué)差異(t=-2.202,p0.05)。MCI患者FA值減低的纖維束主要位于雙側(cè)上縱束(左側(cè)t=2.950,右側(cè)t=2.950,p0.05)、雙側(cè)下縱束(左側(cè) t=2.660,右側(cè) t=2.960,p0.05),胼胝體束(t=2.090,p0.05)及雙側(cè)扣帶束(左側(cè) t=2.760,右側(cè) t=2.410,p0.05),穹窿(t=4.830,p0.05),雙側(cè)皮質(zhì)脊髓束(左側(cè)t=2.330,右側(cè)t=2.260,p0.05)。其中,雙側(cè)下縱束(左側(cè) r=-0.338,右側(cè) r=-0.336,p0.05)、雙側(cè)上縱束(左 r=-0.354,右 r=-0.347,p0.05)、右側(cè)皮質(zhì)脊髓束(r=-0.362,p0.05)和穹隆束(r=-0.369,p0.05)以及扣帶束(左r=-0.395,右r=-0.370,p0.05)的FA值與自我導(dǎo)航平均誤差距離呈負(fù)相關(guān)關(guān)系。環(huán)境導(dǎo)航的平均誤差距離與雙側(cè)上縱束(左r=-0.329,右r=-0.350,p0.05)、雙側(cè)下縱束(左r=-0.349,右r=-0.378,p0.05)、雙側(cè)扣帶束(左r=-0.340,右r=-0.406,p0.05)及胼胝體束壓部(r=-0.364,p0.05)的FA值呈明顯負(fù)相關(guān)關(guān)系。結(jié)論:本研究通過(guò)分析腦白質(zhì)纖維束FA值和空間導(dǎo)航障礙的相關(guān)性,證實(shí)了白質(zhì)微觀結(jié)構(gòu)的改變與MCI患者的空間導(dǎo)航能力障礙有一定的關(guān)聯(lián),進(jìn)而對(duì)日后深入探究有關(guān)人類空間導(dǎo)航能力的神經(jīng)生物學(xué)機(jī)制奠定了相關(guān)基礎(chǔ)。第二部分輕度認(rèn)知障礙患者空間導(dǎo)航能力相關(guān)的皮質(zhì)下核團(tuán)體積研究目的:探討輕度認(rèn)知障礙(Mild cognitive impairment,MCI)患者皮質(zhì)下核團(tuán)體積改變的規(guī)律,及其與空間導(dǎo)航能力之間的關(guān)系,以期揭示MCI患者空間導(dǎo)航障礙的皮層下核團(tuán)改變的結(jié)構(gòu)基礎(chǔ)。方法:選取2016年1月-2016年10月在南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院神經(jīng)內(nèi)科就診的30例MCI患者和年齡、性別、受教育程度匹配的28例正常認(rèn)知對(duì)照組(Normal Control,NC)進(jìn)行頭顱MRI掃描,采用計(jì)算機(jī)模擬空間導(dǎo)航系統(tǒng)測(cè)試所有被試的空間導(dǎo)航能力。用FreeSurfer 5.3.0軟件對(duì)3D T1WI MRI圖像進(jìn)行結(jié)構(gòu)分割,軟件自動(dòng)計(jì)算出雙側(cè)丘腦、尾狀核、殼核、海馬、蒼白球、伏隔核和杏仁體等皮質(zhì)下核團(tuán)的體積。然后采用偏相關(guān)統(tǒng)計(jì)方法來(lái)分析被試各皮層下核團(tuán)體積與空間導(dǎo)航能力行為學(xué)評(píng)分的關(guān)系。結(jié)果:與NC相比較,MCI組患者的所有核團(tuán)體積有輕微萎縮,但沒有達(dá)到統(tǒng)計(jì)學(xué)差異。MCI組患者在控制年齡、性別、教育程度及全腦體積后,左側(cè)蒼白核體積(r=-0.284,p=0.034)和左側(cè)海馬體積(r=-0.265,p=0.048)與混合導(dǎo)航(環(huán)境及自我)平均誤差距離負(fù)相關(guān),提示左側(cè)蒼白核體積和左側(cè)海馬體積越小,混合(環(huán)境及自我)導(dǎo)航能力越差;環(huán)境導(dǎo)航平均誤差距離與左側(cè)殼核體積(r=-0.305,p=0.022)具有負(fù)相關(guān)關(guān)系,提示左側(cè)殼核體積體積越小,環(huán)境導(dǎo)航能力越差。結(jié)論:本研究揭示了 MCI患者皮層下核團(tuán)體積與空間導(dǎo)航能力的關(guān)系,豐富了相關(guān)的空間導(dǎo)航能力結(jié)構(gòu)基礎(chǔ)的研究,對(duì)進(jìn)一步研究空間導(dǎo)航障礙發(fā)生的機(jī)制有重要價(jià)值。
[Abstract]:The first part of the patients with mild cognitive impairment (Tract-Based Spatial Statistics, TBSS) was used to explore the white matter integrity changes in patients with mild cognitive impairment (Mild cognitive impairment, MCI) based on the spatial navigation ability of patients with mild cognitive impairment and to explore the spatial navigation ability of patients with mild cognitive impairment (Mild cognitive impairment, MCI). In order to reveal the microstructural basis of the white matter changes in MCI patients with spatial navigation disorders, the case group came from the neurology outpatient department of the Drum Tower Hospital Affiliated to the Nanjing University Medical College, who was diagnosed with cognitive impairment, of which 27 patients were diagnosed with MCI, from May 2015 to February 2016, and then recruited through community recruitment. The normal cognitive control group (Normal Control, NC), with a total of 24 cases, had no statistical difference between the sex, age, and the degree of education and the case group. All subjects performed the computer simulation space navigation ability test and the 3.0T head MRI diffusion tensor imaging (Diffusion Tensor Imaging, DTI) scan, and then used PANDA software to carry out the original data. Preprocessing, then using TBSS to compare the nonparametric statistics of the whole brain with the partial anisotropy (FractionalAnisotropy, FA) diagram of the subjects, and the correlation analysis of the fiber bundle FA value and the spatial navigation ability. Results: compared with the NC group, the mixed (environment + self) navigation, self navigation and environmental navigation ability of the MCI group have decreased. The t=-2.202 (P0.05).MCI patients with decreased FA value were mainly located in the bilateral superior longitudinal fascicles (left t=2.950, right t=2.950, P0.05), bilateral inferior longitudinal fascicles (left t=2.660, right t=2.960, P0.05), corpus callosum (t=2.090, P0.05) and bilateral cingulate tract (left side, right side), and dome 4.830, P0.05), bilateral corticospinal tract (left t=2.330, right t=2.260, P0.05). Among them, bilateral inferior longitudinal fascicles (left r=-0.338, right r=-0.336, P0.05), bilateral superior longitudinal fasciculus (left r=-0.354, right r=-0.347, P0.05), right corticospinal tract (r=-0.362, P0.05) and dome bundle The mean error distance of the navigation is negatively correlated with the distance between the average error distance of the environment navigation and the bilateral upper longitudinal beam (left r=-0.329, right r=-0.350, P0.05), bilateral lower longitudinal fasciculus (left r=-0.349, right r=-0.378, P0.05), bilateral cingulate bundle (left r=-0.340, right r=-0.406, P0.05) and the corpus callosum pressure (r=-0.364, P0.05). Conclusion: by analyzing the correlation between the FA value of the white matter fiber bundle and the spatial navigation disorder, this study confirms that the changes of the white matter microstructures are related to the spatial navigation ability of MCI patients, and then lay the foundation for the further exploration of the neurobiological mechanism of human spatial navigation ability in the future. Second parts Study on the volume of subcortical nuclei associated with spatial navigation ability in patients with mild cognitive impairment Objective: To explore the changes in the volume of subcortical nuclei in patients with Mild cognitive impairment (MCI) and the relationship between the subcortical nuclei and their spatial navigation ability in order to reveal the structure of subcortical nuclei changes in MCI patients with spatial navigation disorders. Methods: 30 patients with MCI in the Department of Neurology, affiliated to Drum Tower Hospital Affiliated to Nanjing University Medical College, January 2016 -2016 years, and 28 cases of normal cognitive control group (Normal Control, NC) matched for age, sex and educational level were scanned for head MRI, and the space navigation system of computer simulated space navigation system was used to test the space guide of all the subjects. FreeSurfer 5.3.0 software is used to divide the structure of 3D T1WI MRI images. The software automatically calculates the volume of the subcortical nuclei of bilateral thalamus, caudate nucleus, putamen, hippocampus, globus pallidus, nucleus accumbens and amygdala. Then the statistical method of partial correlation is used to analyze the behavior score of the volume and space navigation ability of the subcortical nuclei of the subjects. Results: compared with NC, the volume of all the nuclei in the MCI group had a slight atrophy, but there was no statistical difference in the control age, sex, education and total brain volume in group.MCI, and the left pallid nucleus volume (r=-0.284, p=0.034) and the left hippocampal volume (r=-0.265, p=0.048) and the average error of mixed navigation (environment and self). The negative correlation of difference distance suggests that the smaller the volume of the left pallid nucleus and the smaller the volume of the left hippocampus, the worse the mixing (environment and self) navigation ability; the negative correlation between the average error distance of the environmental navigation and the r=-0.305 (p=0.022) of the left putamen, which suggests that the smaller the volume of the left shell nucleus is, the worse the environmental navigation ability is. Conclusion: This study reveals the MCI The relationship between the volume of subcortical nuclei and the spatial navigation ability of the patients enriches the research on the basis of the spatial navigation ability structure, which is of great value to the further study of the mechanism of the spatial navigation obstacle.

【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.1
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本文編號(hào)：1824974