發(fā)布時間：2018-07-10 09:42

  本文選題：擴(kuò)散張量成像 + 遺忘型輕度認(rèn)知功能障礙��； 參考：《吉林大學(xué)》2012年博士論文

【摘要】：輕度認(rèn)知功能障礙（Mild Cognitive Impairment，MCI）是指出現(xiàn)輕度記憶或認(rèn)知功能障礙，但不影響日常生活能力，是介于正常老化和早期癡呆之間的一種臨床狀態(tài)，被公認(rèn)為老年癡呆早期干預(yù)治療最合適的研究群體。依據(jù)損害的類型和數(shù)量的不同，將MCI分為遺忘型MCI和非遺忘型MCI�；谟跋駥W(xué)特征、神經(jīng)心理學(xué)、神經(jīng)精神病學(xué)和行為學(xué)量表及病因?qū)W等因素，也可將MCI分為兩型：神經(jīng)退行性病變型MCI和血管型MCI。遺忘型MCI進(jìn)展為AD，皮質(zhì)下血管型輕度認(rèn)知障礙進(jìn)展為VaD的風(fēng)險都非常高。我們應(yīng)用多模態(tài)的核磁共振技術(shù)對兩種發(fā)病率最高的輕度認(rèn)知障礙患者進(jìn)行研究明確其結(jié)構(gòu)與功能的變化，為發(fā)現(xiàn)一種臨床適用的生物學(xué)標(biāo)記物，能夠盡早識別和早期診斷MCI患者，并判斷其進(jìn)展為癡呆的可能。 1、輕度認(rèn)知功能障礙患者腦白質(zhì)變化的擴(kuò)散張量成像研究 目的：遺忘型輕度認(rèn)知功能障礙患者具有很高的進(jìn)展為阿爾茨海默�。ˋlzheimer’s disease，AD）的風(fēng)險。尸檢證據(jù)表明，兩者的腦的病理學(xué)改變是非常相似的。磁共振擴(kuò)散張量成像的發(fā)展，使研究人員在體的研究大腦微觀結(jié)構(gòu)成為可能。利用DTI技術(shù)，觀察遺忘型輕度認(rèn)知功能障礙白質(zhì)結(jié)構(gòu)完整性的變化，通過測量部分各向異性（FA）和平均擴(kuò)散率（MD）的變化，明確：1)aMCI患者是否在相應(yīng)的腦區(qū)出現(xiàn)FA顯著減少；2）aMCI組是否在相應(yīng)的腦區(qū)出現(xiàn)顯著MD增加；3）aMCI腦結(jié)構(gòu)的變化。方法：40例aMCI患者和28例正常對照組（NC）首先進(jìn)行臨床癡呆量表（CDR）和簡易精神狀態(tài)量表（MMSE）及MoCA等神經(jīng)系統(tǒng)測定及神經(jīng)心理學(xué)分析，然后作為被試者進(jìn)行DTI掃描。應(yīng)用基于體素的全腦空間統(tǒng)計法（TBSS）分析檢測各向異性（FA）和平均擴(kuò)散率（MD）數(shù)值的變化，并進(jìn)行組內(nèi)和組間比較。結(jié)果：正常對照組NC相比，aMCI患者的雙側(cè)額葉、頂葉、和顳葉、胼胝體、聯(lián)合纖維、投射纖維、雙側(cè)放射冠、右丘腦后輻射和右矢狀層FA顯著的減少（p0.05）。同時，，在雙側(cè)的額葉、頂葉和顳葉、胼胝體、聯(lián)合纖維和投射纖維MD也出現(xiàn)顯著增加（p0.05）。結(jié)論：利用DTI技術(shù)檢測額葉、頂葉、顳葉、胼胝體、扣帶回腦白質(zhì)完整性的變化，有助于早期診斷aMCI。 2、皮質(zhì)下血管型MCI患者腦部結(jié)構(gòu)和功能改變的核磁共振研究 目的：皮質(zhì)下血管型輕度認(rèn)知障礙是皮質(zhì)下血管型癡呆的前期可逆狀態(tài)，與小血管性疾病有十分密切的關(guān)系，因此闡明此期的生物學(xué)特征有重要的臨床診斷意義。方法：入組被試者共33人，其中svMCI患者組11人，正常對照組22人，首先進(jìn)行臨床癡呆量表（CDR）和簡易精神狀態(tài)量表(MMSE)及MoCA等神經(jīng)系統(tǒng)測定及神經(jīng)心理學(xué)分析，采用結(jié)構(gòu)磁共振成像技術(shù)評估被試者大腦灰質(zhì)體積的變化，采用靜息態(tài)功能fMRI（resting-state functionalMRI，rs-fMRI）評估自發(fā)性低頻波動的改變，然后計算分析每個被試腦部灰質(zhì)體積和功能性低頻波動的變化，使用基于體素的形態(tài)測量學(xué)進(jìn)行多元回歸分析比較組間差異。結(jié)果：與正常對照組相比，svMCI患者組腦部出現(xiàn)明顯的灰質(zhì)體積減少區(qū)域包括：額下回、頂葉下部、扣帶前皮質(zhì)、島葉和顳上回區(qū)域（P0.05）；低頻振幅波動（amplitude of low-frequencyfluctuations，ALFF）在以下區(qū)域明顯降低：扣帶后皮質(zhì)、楔前葉、顳回頂葉下部（P0.05）。然而，ALFF在svMCI患者腦部的其他一些區(qū)域卻有明顯的增加：枕葉和小腦區(qū)域（P0.05）。上述ALFF的組間差別在調(diào)整了組間的結(jié)構(gòu)差別之后仍然存在。結(jié)論：svMCI患者腦部多個腦區(qū)出現(xiàn)結(jié)構(gòu)和功能的異常。svMCI患者大腦結(jié)構(gòu)上的萎縮并不能解釋大腦功能的異常。
[Abstract]:Mild Cognitive Impairment (MCI) refers to the occurrence of mild memory or cognitive dysfunction, but does not affect the daily living ability. It is a clinical state between normal aging and early dementia. It is recognized as the most suitable research group for the early intervention treatment of Alzheimer's disease. Similarly, MCI can be divided into amnestic MCI and non amnestic MCI. based on imaging features, neuropsychology, neuropsychiatry and behavioral scale and etiology, and MCI can be divided into two types: neurodegenerative MCI and vascular MCI. amnestic MCI are progressing to AD, and mild cognitive impairment of subcortical vascular type is the risk of VaD It is very high. We use multimodal magnetic resonance imaging (MRI) to study the changes in the structure and function of two patients with the highest incidence of mild cognitive impairment. In order to find a clinically applicable biological marker, we can identify and early diagnose MCI patients as early as possible, and judge the possibility of dementia.
1, diffusion tensor imaging study of white matter changes in patients with mild cognitive impairment
Objective: Patients with amnestic mild cognitive impairment have a high risk of progressing to Alzheimer's disease (Alzheimer 's disease, AD). Autopsy evidence shows that the pathological changes in the brain are very similar. The development of MR diffusion tensor imaging makes it possible to study the microstructures of the brain in the human body. Using D TI technique was used to observe the changes in the white matter structure integrity of amnestic mild cognitive impairment. By measuring the changes in partial anisotropy (FA) and average diffusivity (MD), it was clear: 1) whether aMCI patients had a significant decrease in FA in the corresponding brain region; 2) whether the aMCI group had a significant MD increase in the corresponding brain region; 3) the change of the aMCI brain structure. Methods: 40 aMCI patients and 28 normal control groups (NC) were first performed the clinical dementia scale (CDR), the simple mental state scale (MMSE) and MoCA, and the neuropsychological analysis, and then performed DTI scan as the subjects. The total brain spatial statistics (TBSS) was used to detect the anisotropy (FA) and the average diffusion. Results: the rate (MD) values were changed in group and between groups. Results: compared with the normal control group NC, the bilateral frontal, parietal, temporal, corpus callosum, combined fibers, projective fibers, bilateral radiated crowns, right colliculus and right sagittal FA decreased significantly in aMCI patients (P0.05). At the same time, bilateral frontal, parietal and temporal lobes, corpus callosum, combined MD also increased significantly (P0.05). Conclusion: the changes in the white matter integrity of the frontal, parietal, temporal, corpus callosum and cingulate gyrus were detected by DTI technique, which was helpful to the early diagnosis of aMCI..
2, changes in brain structure and function in patients with subcortical vascular MCI: a magnetic resonance imaging study
Objective: the mild cognitive impairment of subcortical vascular type is the prophase reversible state of subcortical vascular dementia and has a close relationship with the small vascular diseases. Therefore, it is important to clarify the biological characteristics of this period. Methods: 33 people were enrolled in the group, including 11 svMCI patients and 22 normal controls, first carried out. The clinical dementia scale (CDR), the simple mental state scale (MMSE) and MoCA were measured and the neuropsychological analysis was used to evaluate the changes in the volume of gray matter in the subjects of the subjects by structural magnetic resonance imaging (fMRI). The changes of spontaneous low frequency fluctuations were evaluated by resting state function fMRI (resting-state functionalMRI, rs-fMRI), and then the scores were calculated. The changes in the gray matter volume and functional low frequency fluctuation of the brain were analyzed in each group. The difference between the groups was compared with the morphometry based on voxel based morphometry. Results: compared with the normal control group, there was a significant reduction in the gray matter volume in the brain of the svMCI patients: the lower frontal gyrus, the lower parietal lobe, the anterior cingulate cortex, the insula, and the temporomidi. The upper gyrus (P0.05); low frequency amplitude fluctuation (amplitude of low-frequencyfluctuations, ALFF) significantly decreased in the following regions: the posterior cingulate cortex, the anterior lobe of the wedge, and the lower temporal parietal lobe (P0.05). However, the ALFF in some other regions of the brain of the svMCI patients was significantly increased: the occipital lobe and the cerebellar region (P0.05). The differences between the above-mentioned ALFF groups After adjusting the structural differences between the groups, conclusion: the atrophy of the brain structure in patients with abnormal.SvMCI in svMCI patients with multiple brain areas and functions does not explain the abnormalities of the brain function.
【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】：R749.1

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