【摘要】：多發(fā)性硬化(multiple sclerosis,MS)是中樞神經(jīng)系統(tǒng)的脫髓鞘疾病,發(fā)病年齡高峰約為33歲,女性發(fā)病率較高,主要引起肢體無力、麻木及視覺障礙等臨床癥狀,是導(dǎo)致成人殘疾的常見原因[1],50%～70%的MS患者存在認知功能障礙,給對個人和社會帶來沉重的負擔。影響MS認知功能的因素有很多,包括年齡、病程、臨床亞型及認知儲備等[3],但尚不能作為明確認知障礙的預(yù)測因素。MS患者的認知功能受損主要累及記憶、信息處理速度、注意、視空間及執(zhí)行等多個方面。目前,應(yīng)用于MS認知功能檢測的方法主要有簡易重復(fù)神經(jīng)心理學(xué)量表(the brief repeatable neuropsychological battery,BRB-N)及多發(fā)性硬化認知功能最小評估測驗(minimal assessment of cognitive function in multiple sclerosis, MACFIMS),但國內(nèi)尚無相應(yīng)的版本,而且操作比較復(fù)雜,所需時間較長。因此,本研究選取針對某種功能所設(shè)計的相互獨立的簡易測試,對MS的認知功能障礙進行初步地分析。近年來,隨著影像學(xué)的不斷發(fā)展,人們對MS病理變化的認識不斷加深,但在傳統(tǒng)磁共振(conventional magnetic resonance image, cMRI)上顯示的病灶往往不能很好的解釋患者的臨床癥狀。非傳統(tǒng)MRI的應(yīng)用在研究認知障礙相關(guān)的腦組織損傷上具有顯著優(yōu)勢,如磁化傳遞成像(magnetization transfer imaging, MTI)、彌散張量成像(diffusion tensor imaging, DTI)、磁共振波譜分析(magnetic resonance spectroscopy, MRS)、功能磁共振成像(functional MRI, fMRI)及雙翻轉(zhuǎn)恢復(fù)序列(double inversion recovery, DIR)等[5],不但可以更加清晰的顯示炎性脫髓鞘病灶,還可發(fā)現(xiàn)在cMRI上看似正常的腦組織中的隱匿性結(jié)構(gòu)、代謝及功能損傷。本研究主要應(yīng)用DTI來分析看似正常的腦組織是否存在微結(jié)構(gòu)病變,并與認知功能進行相關(guān)性分析,探索MS患者認知功能損害的發(fā)病機理。研究目的：研究多發(fā)性硬化患者的認知功能損害及彌散張量成像特點,并分析兩者的相關(guān)關(guān)系。研究方法：1.選取自2013年6月至2015年1月于我院神經(jīng)內(nèi)科收集的多發(fā)性硬化患者23例(MS組),另選23例健康志愿者做對照組。對兩組進行認知功能測評,包括整體認知、執(zhí)行、注意及信息處理速度等方面,整體認知篩查量表采用簡明精神狀態(tài)量表(mini-mental state examnation, MMSE)和蒙特利爾認知功能量表(montreal cognitive assessment, MoCA),其他認知功能評估量表包括詞語流暢性測驗(verbal fluency test, VFT)、數(shù)字廣度測驗(digit span test, DST)、符號數(shù)字模式測驗(symbol digit modalities test, SDMT)、連線測驗(trail making test, TMT)、 Stroop色詞測驗(color word test, CWT)。2.對23例多發(fā)性硬化患者和23例健康志愿者進行常規(guī)MRI和DTI檢查,測量看似正常的腦組織(額葉白質(zhì)、枕葉白質(zhì)、胼胝體、尾狀核及丘腦)的部分各向異性(fractional anisotropy, FA)值和表觀彌散系數(shù)(apparent diffusion doefficient,ADC)值,分析腦組織的損傷情況。3.MS組MMSE、MoCA、VFI、DST、SDMT、TMT及CWT測評結(jié)果與看似正常腦組織的FA值和ADC值進行相關(guān)性分析。結(jié)果：1.MS患者整體認知功能下降,MMSE及MoCA得分低于對照組(P0.05),MS患者執(zhí)行、注意及信息處理速度存在功能受損,、VFT、DST及SDMT得分低于對照組(P0.05),CWT及TMT得分高于對照組(P0.05)。MS組SDMT及CWT結(jié)果與病程存在相關(guān)性(r=-0.430及0.455, P0.05); SDMT結(jié)果與擴展的殘疾狀態(tài)量表(expanded disability status scale, EDSS)結(jié)果成負相關(guān)(r=-0.505,P0.05)。2.MS患者額葉及枕葉白質(zhì)、胼胝體壓部、尾狀核的FA值較對照組降低,丘腦FA值較對照組升高(P0.05),額葉及枕葉白質(zhì)、胼胝體膝部、丘腦的ADC值較對照組升高(P0.05)。3.MS組多項認知功能測驗結(jié)果與腦內(nèi)不同部位的FA值和ADC之間存在相關(guān)關(guān)系：VFT得分與枕葉白質(zhì)的FA值呈正相關(guān),與額葉白質(zhì)的ADC值呈負相關(guān)(P0.05);Stroop-3得分與枕葉白質(zhì)及胼胝體壓部的FA值呈負相關(guān),與枕葉及胼胝體膝部的ADC值呈正相關(guān)(P0.05);DST結(jié)果與枕葉白質(zhì)的ADC值呈負相關(guān)(P0.05)；SDMT得分與丘腦的ADC值呈負相關(guān)(P0.05)。結(jié)論：1.MS患者認知功能存在不同程度的受損,尤其是注意、工作記憶、執(zhí)行及信息處理速度損害明顯,病程及EDSS對認知功能有不同程度的影響。2.MS患者看似正常的腦組織存在隱匿性損傷,FA值和ADC值可量化組織中的微小病變,與多項認知功能存在相關(guān)關(guān)系。
[Abstract]:Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. The peak age of onset is about 33 years. The incidence of MS is high in women. It mainly causes clinical symptoms such as limb weakness, numbness and visual impairment. It is a common cause of disability in adults [1]. Cognitive impairment exists in 50%-70% of MS patients, and it gives rise to cognitive impairment to individuals and society. There are many factors affecting cognitive function of MS, including age, duration, clinical subtypes and cognitive reserve, but they can not be used as a predictor of cognitive impairment. Functional testing methods mainly include the Brief Repeatable neuropsychological battery (BRB-N) and the minimal assessment of cognitive function in multiple sclerosis (MACFIMS), but there is no corresponding version in China, and the operation is complicated. In recent years, with the continuous development of imaging, people's understanding of the pathological changes of MS has been deepening, but in the traditional magnetic resonance image (cMRI) it is necessary to analyze the cognitive dysfunction of MS. Non-traditional MRI applications have significant advantages in the study of cognitive impairment-related brain tissue damage, such as magnetization transfer imaging (MTI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS). Cerebral spectroscopy, MRS, functional magnetic resonance imaging (fMRI) and double inversion recovery (DIR) sequences can not only display inflammatory demyelinating lesions more clearly, but also detect occult structures, metabolism and functional impairment in brain tissues that appear to be normal on cMRI. Objective: To study the characteristics of cognitive impairment and diffusion tensor imaging (DTI) in patients with multiple sclerosis (MS), and to analyze the relationship between them. Methods: 1. Choose from 20 to 20 years. From June 13, 2015 to January 2015, 23 patients with multiple sclerosis (MS group) and 23 healthy volunteers were selected as control group. Cognitive function of the two groups was assessed, including global cognition, execution, attention and speed of information processing. Mini-mental state exa was used as the global cognitive screening scale. Mnation, MMSE and Montreal Cognitive Assessment (MoCA), and other cognitive function assessment scales include verbal fluency test (VFT), digit span test (DST), Symbol Digit Modalities Test (SDMT), trail making test (TCT). St, TMT, and Stroop Color Word Test (CWT). 2. Conventional MRI and DTI were performed in 23 patients with multiple sclerosis and 23 healthy volunteers. Partial anisotropy (FA) values and apparent diffusion coefficient (apparenarenarenarenarently) of normal brain tissues (frontal white matter, occipital white matter, corpus callosum, caudate nucleus and thalamus) were measured. The correlation between the results of MMSE, MoCA, VFI, DST, SDMT, TMT and CWT in MS group and the FA and ADC values in seemingly normal brain tissues was analyzed. Results: 1. The overall cognitive function of MS patients decreased, and the scores of MMSE and MoCA were lower than those in control group (P 0.05). The scores of VFT, DST and SDMT were lower than those of the control group (P 0.05), the scores of CWT and TMT were higher than those of the control group (P 0.05). The FA values of frontal and occipital white matter, corpus callosum pressure, caudate nucleus, thalamus, frontal and occipital white matter, knee of corpus callosum and thalamus were significantly higher than those of the control group (P 0.05). 3. There was a correlation between FA values and ADC values in different parts of brain in MS group: VFT The scores of Stroop-3 were negatively correlated with the FA values of occipital white matter and corpus callosum, and positively correlated with the ADC values of occipital and corpus callosum knees (P 0.05); DST results were negatively correlated with the ADC values of occipital white matter and frontal white matter (P 0.05); SDMT scores were negatively correlated with the ADC values of thalamus and occipital white matter (P 0.05); Conclusion: 1. The cognitive function of MS patients is impaired in different degrees, especially attention, working memory, executive speed and information processing speed. The course of disease and EDSS have different degrees of influence on cognitive function. 2. The seemingly normal brain tissue of MS patients has occult damage, FA value and ADC value can quantify the micro-lesions in the tissue. It is related to multiple cognitive functions.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R744.51

【參考文獻】

相關(guān)期刊論文 前1條

1 段云云;李坤成;劉亞歐;任卓瓊;黃靖;葉靜;董會卿;陳海;;復(fù)發(fā)-緩解型多發(fā)性硬化患者丘腦擴散張量成像研究[J];中國現(xiàn)代神經(jīng)疾病雜志;2012年02期

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本文編號：2218675