本文選題：2型糖尿病 + 波譜　； 參考：《天津醫(yī)科大學》2017年博士論文

【摘要】：研究目的:聯(lián)合應用~1H-MRS、基于亞頻段ALFF法及基于圖論的腦功能網(wǎng)絡分析方法,檢測研究T2DM患者PCC區(qū)代謝物、亞頻段下自發(fā)神經(jīng)元活動及全腦功能網(wǎng)絡拓撲結構的變化特點,旨在從神經(jīng)影像學方面探尋T2DM伴認知障礙的早期生物標志物及其可能的發(fā)病機制。材料和方法:本研究共收集88個被試,根據(jù)MoCA評分將其分為T2DM認知正常組(T2DM組)31例,T2DM伴認知障礙組(T2DM-MCI組)22例,另35例為性別、年齡、受教育程度與T2DM組及T2DM-MCI組相匹配的健康對照者(HC組)。采集三組被試臨床實驗室指標及測試其認知功能。(1)采用單體素法采集雙側PCC區(qū)~1H-MRS波譜,讀取NAA、Cr、Cho、mI曲線下面積,計算NAA/Cr、Cho/Cr、mI/Cr、NAA/Cho、NAA/mI比值,三組間行兩兩組間比較,并與臨床實驗室指標及認知功能評分做相關分析。(2)采集三組被試靜息態(tài)fMRI數(shù)據(jù),利用DPARSF軟件預處理并分析Slow-5、Slow-4、Slow-2亞頻段下,T2DM及T2DM-MCI組患者腦內(nèi)ALFF值的改變。(3)采用BOLD-fMRI數(shù)據(jù),利用Gretna軟件以Power-264模板為模板構建大腦功能網(wǎng)絡,計算腦功能網(wǎng)絡的小世界屬性、全局效率(Eg)、局部效率(Eloc)、節(jié)點全局效率(Eg),分析三組被試的腦功能網(wǎng)絡小世界屬性及Eg、Eloc及節(jié)點Eg的改變,并將這些指標與認知功能評分做相關性分析。結果:1.T2DM組與HC組相比,PCC區(qū)出現(xiàn)Cr、Cho減低,mI/Cr升高,NAA/mI減低,差異具有統(tǒng)計學意義(p0.05);T2DM-MCI組與HC組相比,PCC區(qū)出現(xiàn)NAA、Cr減低,mI升高,NAA/Cr、Cho/Cr、mI/Cr升高,NAA/mI減低,差異具有統(tǒng)計學意義(p0.05);T2DM-MCI與T2DM組相比,PCC區(qū)出現(xiàn)Cho/Cr升高,NAA/mI降低,差異具有統(tǒng)計學意義(p0.05)。相關分析發(fā)現(xiàn),NAA含量與C肽呈正相關(r=0.948,p=0.042),NAA含量與AVLT評分趨向正相關(r=0.949,p=0.051),mI/Cr比值與MoCA評分呈負相關(r=-0.957,p=0.043)。2.T2DM及T2DM-MCI組在Slow-5及Slow-4頻段檢出異常的腦區(qū)均明顯多于Slow-2頻段;基底核團及島葉在Slow-5頻段檢出;扣帶回、楔前葉、SMA在Slow-5及Slow-4頻段檢出;額葉、顳葉、頂葉、小腦在三個頻段均可檢出,但是額葉ALFF減低在Slow-2段最明顯。T2DM組較HC組相比ALFF減低的腦區(qū)為舌回、距狀溝周圍皮質(zhì)及內(nèi)側前額葉;較T2DM組、HC組相比,T2DM-MCI組ALFF減低的腦區(qū)明顯增多,而功能增強的腦區(qū)明顯減少,減低的腦區(qū)涉及視覺系統(tǒng)、DMN網(wǎng)絡、執(zhí)行控制網(wǎng)絡等。3.在0.05-0.4稀疏度下,T2DM與T2DM-MCI組腦功能網(wǎng)絡仍具有小世界網(wǎng)絡屬性,但是其Lp增長、Eg減低,Cp及Eloc減低,差異無明顯統(tǒng)計學意義(p0.05);T2DM組較HC組相比,節(jié)點Eg減低的腦區(qū)為:左側內(nèi)側前額葉、頂下小葉、楔葉、PCC及右側中央后回、顳下回、舌回、距狀回;增高的腦區(qū)為左側顳上回。T2DM-MCI組較HC組相比,節(jié)點Eg減低的腦區(qū)為:左側額中回、額下回、顳下回、ACC、枕中回、角回及右側中央后回;T2DM-MCI組與T2DM組相比節(jié)點Eg減低的腦區(qū)為右側額中回、額下回、角回及左側ACC、小腦,增高腦區(qū)為:左側顳中回。相關分析顯示,T2DM-MCI組雙側額中回、額下回、雙側顳中回、雙側頂下小葉、右側島葉、左側顳上回Eg值與MoCA評分呈明顯正相關性,(FDR校正,p0.05)。結論:1.采用~1H-MRS技術選定PCC腦區(qū),探討T2DM患者認知功能相關腦區(qū)微損傷引起的代謝物異常改變及其規(guī)律是可行和有效的;T2DM患者PCC區(qū)存在以NAA、Cr含量減低為標志的神經(jīng)元破壞和能量代謝的減低;T2DM-MCI患者PCC區(qū)NAA/mI比值有望成為評估T2DM患者認知功能障礙的生物學指標。2.利用亞頻段ALFF方法可以全面、細致地檢出T2DM患者腦區(qū)自發(fā)神經(jīng)元活動的異常,而且活動異常的腦區(qū)具有依頻段分布的特點,即基底核團及島葉在Slow-5頻段檢出;扣帶回、楔前葉、SMA在Slow-5及Slow-4頻段檢出;額葉、顳葉、頂葉、小腦在三個頻段均可檢出,但是額葉ALFF減低在Slow-2段最明顯。3.本研究發(fā)現(xiàn),T2DM患者早期在枕葉及內(nèi)側前額葉即可出現(xiàn)損傷,而T2DM-MCI患者腦損傷進一步加重,損傷的腦區(qū)增多,主要累及視覺網(wǎng)絡、DMN、執(zhí)行控制網(wǎng)絡等多個系統(tǒng);說明T2DM患者出現(xiàn)認知功能障礙的機制可能是腦內(nèi)多系統(tǒng)功能損傷的綜合結果。4.T2DM與T2DM-MCI患者的腦功能網(wǎng)絡仍保持小世界屬性,但是功能整合及功能分化能力均呈減低的趨勢,其中額中回及額下回效率的減低可能在T2DM患者由認知功能正常進展為認知功能障礙過程中發(fā)揮關鍵的作用。
[Abstract]:The purpose of this study is to detect the changes in the PCC region metabolites of T2DM patients, the spontaneous neuronal activity and the topological structure of the whole brain function network, based on the sub band ALFF method and the graph based brain functional network analysis method, aiming at exploring the early biomarkers of T2DM with cognitive impairment from the aspect of neuroimaging. Material and its possible pathogenesis. Materials and methods: a total of 88 subjects were collected in this study. According to the MoCA score, they were divided into 31 cases of T2DM cognitive normal group (group T2DM), 22 cases of T2DM with cognitive impairment group (group T2DM-MCI), and 35 cases of sex, age, and education degree with group T2DM and T2DM-MCI group (HC group). Three groups of subjects were collected. The clinical laboratory index and its cognitive function test. (1) using the single body element method to collect the ~1H-MRS spectrum of bilateral PCC region, read the area under the NAA, Cr, Cho, mI curve, calculate NAA/Cr, Cho/Cr, mI/Cr, NAA/Cho, NAA/mI ratio, and compare the 22 groups between the three groups, and do the correlation analysis with the clinical laboratory index and cognitive function score. (2) collect three groups of subjects Resting state fMRI data, using DPARSF software to preprocess and analyze the changes of ALFF value in the brain of group T2DM and T2DM-MCI under Slow-5, Slow-4, Slow-2 sub band. (3) using BOLD-fMRI data, using Gretna software to construct brain function network with Power-264 template as a template, calculate the small world property of brain functional network, global efficiency (Eg) and local effect. Rate (Eloc), node global efficiency (Eg), analyze the small world attributes of the brain function network in the three groups and the changes of Eg, Eloc and node Eg, and make the correlation analysis between these indexes and the cognitive function score. Results: the 1.T2DM group is compared with the HC group, and the PCC area appears Cr, Cho decreased, mI /Cr increases, and the difference has statistical significance. Compared with group HC, NAA, Cr decreased, mI increased, NAA/Cr, Cho/Cr, mI/Cr increased, NAA/mI decreased, and the difference was statistically significant (P0.05). T2DM-MCI compared with T2DM group, increased, decreased, and had statistical significance. There was a positive correlation with the AVLT score (r=0.949, p=0.051), and the mI/Cr ratio was negatively correlated with the MoCA score (r=-0.957, p=0.043).2.T2DM and T2DM-MCI groups detected in the Slow-5 and Slow-4 frequencies more than the Slow-2 bands; the basal nuclei and the insula were detected in the frequency segment; the cingulate gyrus and the anterior lobe of the wedge were detected in the frontal, frontal lobe, and the frontal lobe, The temporal lobe, the parietal lobe and the cerebellum could be detected in three frequency bands, but the ALFF in the frontal lobe was lower in the Slow-2 segment than in the HC group and the ALFF decreased in the brain area of the tongue, the peripheral cortex and the medial prefrontal cortex. Compared with the T2DM group and the HC group, the decrease of ALFF in the T2DM-MCI group was significantly increased, while the brain area of the function enhanced brain decreased obviously and reduced the brain. The area involved in the visual system, the DMN network, the executive control network and other.3. in the 0.05-0.4 sparsity, the T2DM and T2DM-MCI group brain functional networks still have small world network properties, but their Lp growth, Eg decrease, Cp and Eloc decrease, the difference is not significant (P0.05). Compared to the HC group, the brain area of the node is: the left medial prefrontal lobe, the top of the brain. Lower lobule, cuneate, PCC and right central posterior gyrus, inferior temporal gyrus, lingual gyrus, and partaliform gyrus; compared with the HC group in the left temporal upper temporal gyrus.T2DM-MCI group, the lower frontal gyrus, lower frontal gyrus, inferior temporal gyrus, ACC, occipital gyrus, angular gyrus, and right central posterior gyrus, and the brain area of the T2DM-MCI group and T2DM group in the right frontal area compared with the T2DM group were in the right frontal area. The posterior frontal gyrus, the angular gyrus and the left ACC, the cerebellum and the elevation of the brain were the middle temporal gyrus. The correlation analysis showed that the bilateral middle frontal gyrus, the lower frontal gyrus, bilateral temporal gyrus, bilateral apical lobule, right Island lobe, left temporal gyrus Eg value were positively correlated with the MoCA score, (FDR correction, P0.05). Conclusion: 1. the PCC brain area was selected by ~1H-MRS technique, and 1. the PCC brain area was selected by ~1H-MRS technique, and the discussion was discussed. Discussion of PCC brain region by ~1H-MRS technique, exploration The abnormal changes and rules of metabolites associated with cognitive function related brain region injury in T2DM patients are feasible and effective. In the PCC area of T2DM patients, the neuronal destruction and the reduction of energy metabolism marked by the decrease of NAA and Cr, and the PCC zone NAA/mI ratio in T2DM-MCI patients are expected to be a biological indicator for evaluating the cognitive dysfunction of T2DM patients. 2. using the subband ALFF method, the abnormal activity of spontaneous neuronal activity in the brain area of T2DM patients can be carefully detected, and the abnormal activity of the brain region is characterized by the frequency band distribution, that is, the basal nuclei and the insula are detected in the Slow-5 band; the cingulate gyrus, the anterior lobe of the wedge, and the SMA in the Slow-5 and Slow-4 frequency bands; the frontal, temporal, parietal, and cerebellum are in the three frequency. Duan Junke was detected by Duan Junke, but the most obvious.3. in the Slow-2 segment was found in the frontal lobe of the frontal lobe. It was found that the early occipital and medial prefrontal lobes could be damaged in the T2DM patients, while the brain damage was further aggravated and the brain area of the T2DM-MCI patients increased, which mainly involved the visual network, DMN, and the control network and so on. It showed that the T2DM patients had cognitive work. The mechanism of disability can be a comprehensive result of the impairment of multi system function in the brain..4.T2DM still maintains a small world property in the brain functional network of patients with T2DM-MCI, but the ability to function integration and function differentiation is decreased. The decrease of the middle and lower frontal gyrus may be the cognitive function of the cognitive function in T2DM patients. Play a key role in the process of obstacle.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R445.2;R587.2

【相似文獻】

相關期刊論文 前10條

1 ;腦功能和腦重大疾病的基礎研究項目、依托單位及經(jīng)費[J];中國神經(jīng)科學雜志;2000年02期

2 胡竹菁;一本具有特色的腦功能開發(fā)研究的學術著作——讀沈德立教授主編的《腦功能開發(fā)的理論與實踐》[J];心理學探新;2002年01期

3 馮前進;劉潤蘭;;腦功能只是在腦里嗎?[J];山西中醫(yī)學院學報;2006年04期

4 ;大腦功能年齡[J];醫(yī)藥世界;2008年07期

5 ;關于《腦象圖對教育提升幼兒腦功能的研究》一文的更正[J];現(xiàn)代電生理學雜志;2011年03期

6 顏文偉;;成年腦功能輕微失調(diào)[J];國外醫(yī)學.精神病學分冊;1981年04期

7 ;環(huán)境與腦功能[J];陜西中醫(yī);1986年04期

8 ;繪制語言及其記憶的腦功能圖[J];神經(jīng)科學;1994年02期

9 ;大腦功能有新說[J];發(fā)明與革新;2000年09期

10 江承騏;能改善大腦功能的食品[J];價格月刊;2001年03期

相關會議論文 前10條

1 李飛;蘇林雁;曹楓林;范方;;沖動兒童的腦功能的初步研究[A];中國心理衛(wèi)生協(xié)會第五屆學術研討會論文集[C];2007年

2 李飛;蘇林雁;劉軍;周順科;嚴莉榮;黃幸;李寶君;胡德文;;沖動兒童腦功能的初步研究[A];中國心理衛(wèi)生協(xié)會兒童心理衛(wèi)生專業(yè)委員會第十次學術交流會論文集[C];2006年

3 許守榮;王世杰;羅立民;;空間獨立成分分析方法在腦功能連通性研究中的應用[A];中國生物醫(yī)學工程進展——2007中國生物醫(yī)學工程聯(lián)合學術年會論文集（下冊）[C];2007年

4 李廷玉;;生命早期營養(yǎng)與后續(xù)腦功能健康[A];中華醫(yī)學會第五次全國兒科中青年學術交流大會論文匯編（上冊）[C];2008年

5 周建新;;腦功能的多元化監(jiān)測[A];重癥醫(yī)學——2011[C];2011年

6 張慧瑋;左傳濤;黃U哸\;;厭食癥腦功能網(wǎng)絡~(18)F-FDG PET/CT顯像[A];中華醫(yī)學會第九次全國核醫(yī)學學術會議論文摘要匯編[C];2011年

7 竇昊穎;朱烈烈;張鵬;劉純艷;;心臟術后腦功能監(jiān)測與評估[A];全國心臟內(nèi)外科專科護理學術交流暨專題講座會議論文匯編[C];2004年

8 劉波;劉峴;陳俊;龍玉;陳志光;尚曉靜;莫偉釗;李曉凡;;應用腦功能連接分析技術分析針刺穴位的特異性[A];第十一次全國中西醫(yī)結合影像學術研討會暨全國中西醫(yī)結合影像學研究進展學習班資料匯編[C];2010年

9 王慧;沈國華;杜小霞;李鯁穎;;外界評價在手勢模仿中對腦功能的影響[A];第十七屆全國波譜學學術會議論文摘要集[C];2012年

10 賴建強;蔭士安;徐青梅;胡善明;;不同鋅硒水平對鉛抑制腦功能的改善作用[A];中國營養(yǎng)學會第五屆婦幼營養(yǎng)學術會議論文摘要匯編[C];2002年

相關重要報紙文章 前10條

1 北京宣武醫(yī)院神經(jīng)內(nèi)科主任醫(yī)師 高利;醫(yī)患攜手對付腦功能障礙[N];健康報;2007年

2 北京軍區(qū)總醫(yī)院教授 張俊杰;解九連環(huán)開發(fā)右腦功能[N];健康報;2008年

3 南京軍區(qū)南京總醫(yī)院 副主任醫(yī)師 蔣琪霞;預防腦衰老 增強腦功能[N];家庭醫(yī)生報;2004年

4 蒲昭和;觸摸與老年腦功能疾病[N];中國老年報;2003年

5 陳維強;延緩腦功能退化[N];農(nóng)村醫(yī)藥報（漢）;2008年

6 記者 鄭曉春;以開發(fā)出可模擬小腦功能的電子芯片[N];科技日報;2011年

7 劉麗;探索兩半球[N];中華讀書報;2001年

8 中央教科所教育心理研究室主任、教授、博士生導師 俞國良;暢游神秘的大腦世界[N];光明日報;2001年

9 本報記者 游雪晴;“腦網(wǎng)絡組”讓腦功能清晰化[N];科技日報;2011年

10 中科院院士中科院上海生科院神經(jīng)所研究員 郭愛克;中國腦計劃：在宏觀與微觀間“架橋”[N];文匯報;2013年

相關博士學位論文 前10條

1 秦冬雪;T2DM患者腦代謝及腦功能的fMRI系列研究[D];天津醫(yī)科大學;2017年

2 王贊;阿爾茨海默病高風險人群中基于圖論分析的全腦功能網(wǎng)絡研究[D];東南大學;2015年

3 歐進利;基于磁共振成像的腦功能連接網(wǎng)絡研究[D];浙江大學;2014年

4 鹿麒麟;身心調(diào)節(jié)訓練的大腦功能與結構特性改變研究[D];大連理工大學;2012年

5 謝永宏;腦脊液酸堿失衡在高原腦功能障礙發(fā)生中的作用及機制[D];第三軍醫(yī)大學;2005年

6 王海;顱腦功能無創(chuàng)非接觸檢測技術的研究[D];東北大學;2008年

7 虎子穎;糖尿病認知功能與海馬體積及生化物質(zhì)的相關性研究[D];鄭州大學;2013年

8 夏蘭;失眠障礙患者認知功能與客觀睡眠、神經(jīng)內(nèi)分泌、細胞因子狀態(tài)的臨床研究[D];安徽醫(yī)科大學;2014年

9 王天成;特發(fā)性全面性癲癇的認知功能研究[D];重慶醫(yī)科大學;2014年

10 李從陽;額葉室周白質(zhì)高信號對認知功能的影響及功能磁共振研究[D];第三軍醫(yī)大學;2016年

相關碩士學位論文 前10條

1 韓慶宇;基于近紅外光譜法的駕駛員腦功能連接及振動響應分析[D];山東大學;2015年

2 高遠金;汽車振動對駕駛員心腦功能動態(tài)調(diào)整的影響分析[D];山東大學;2015年

3 張二寧;腦功能連接改變在2型糖尿病患者腦功能變化機制的研究[D];河南大學;2015年

4 張玲玲;慢性單側感音神經(jīng)性耳聾患者全腦功能網(wǎng)絡靜息態(tài)fMRI研究[D];東南大學;2015年

5 湯莉莉;多模式監(jiān)測下右美托咪定對老年脆弱腦功能患者胃腸手術術后轉歸的影響[D];安徽醫(yī)科大學;2016年

6 周桂妃;基于因果腦功能網(wǎng)絡分析的跨種族面孔加工發(fā)展機制研究[D];北京交通大學;2016年

7 譚啟濤;基于近紅外光譜法的汽車駕駛員腦功能網(wǎng)絡特征分析[D];山東大學;2016年

8 張曼玉;汽車駕駛負荷對駕駛員心腦功能連接的影響分析[D];山東大學;2016年

9 李雨堯;腦功能網(wǎng)絡可視化算法設計與工具實現(xiàn)[D];西南交通大學;2016年

10 唐進;基于靜息態(tài)fMRI的EMCI和AD腦功能網(wǎng)絡研究[D];南京郵電大學;2016年

，

本文編號：1778258