發(fā)布時(shí)間：2018-01-20 12:29

  本文關(guān)鍵詞： 擴(kuò)散張量成像(DTI) 腦癱 腦室周圍白質(zhì)軟化(PVL) 兒童　出處：《新鄉(xiāng)醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景 產(chǎn)科和新生兒重癥監(jiān)護(hù)技術(shù)的日新月異,出生的條件降的越來(lái)越低,以至于早產(chǎn)、低出生體重及極低出生體重兒存活率逐漸增高,然而伴隨的腦損傷問(wèn)題也愈來(lái)愈多,嚴(yán)重的影響了兒童的體格、智力發(fā)育及生活質(zhì)量問(wèn)題。據(jù)國(guó)內(nèi)外相關(guān)文獻(xiàn)報(bào)告,在早產(chǎn)兒腦損傷中,腦癱發(fā)生率是相當(dāng)高的。這類患兒最后總會(huì)在運(yùn)動(dòng)、記憶、學(xué)習(xí)及行為等各方面留下不同程度的后遺癥。導(dǎo)致患兒身體上的殘疾和社會(huì)適應(yīng)能力降低。這個(gè)問(wèn)題也是一個(gè)值得全球關(guān)注的嚴(yán)重公共衛(wèi)生問(wèn)題。是什么原因?qū)е履X癱的產(chǎn)生呢?其具體機(jī)制又是什么呢?人們應(yīng)該如何預(yù)防并治療這類疾病了?為此,現(xiàn)代醫(yī)學(xué)界進(jìn)行了不斷的探索。 就目前而言,60%以上的腦癱都是腦室周圍白質(zhì)軟化(PVL)發(fā)展而來(lái)。磁共振擴(kuò)散張量成像技術(shù)作為一種無(wú)創(chuàng)的新型的檢查方法,在臨床中運(yùn)用廣泛。主要功能是將人體內(nèi)的神經(jīng)纖維束的分布、走行及缺失完整的顯現(xiàn)出來(lái),比較敏感地提供病灶內(nèi)微小病理改變的信息,因此,是否可以通過(guò)DTI來(lái)證實(shí)PVL白質(zhì)的缺損,以及治療后的恢復(fù)?更好的輔助臨床。 目的 本研究旨在運(yùn)用磁共振擴(kuò)散張量成像技術(shù)對(duì)早期腦損傷及腦性癱瘓兒童腦白質(zhì)纖維束治療前后變化的評(píng)價(jià),從而指導(dǎo)臨床診治及預(yù)后的判斷。 方法 將17例臨床中已經(jīng)確診為腦癱的患兒與性別、年均相仿的6例健康兒童作為研究對(duì)象。首先進(jìn)行常規(guī)頭顱磁共振成像(Magnetic Resonance Imaging, MRI)平掃檢查后,再行頭顱的腦擴(kuò)散張量成像(Diffusion tensor imaging, DTI)檢查,得到各向異性分?jǐn)?shù)(fractional anisotropy, FA)和彩色編碼FA圖。分別將內(nèi)囊前／后支(anterior/posterior limb of internal capsule, ICAL/ICPL)、皮質(zhì)脊髓束(corticospinal tract,CST)、胼胝體膝部(genu of corpus callosum, GCC)、胼胝體壓部(splenium of corpus callosum,SCC),扣帶束(cingulated gyrus, CO)設(shè)置為本次實(shí)驗(yàn)的感興趣區(qū)(ROI),測(cè)定左右對(duì)稱部位ROI的FA值,腦癱組與對(duì)照組所得的FA值的變化進(jìn)行非配對(duì)t檢驗(yàn)。將實(shí)驗(yàn)組和對(duì)照組患兒頭顱平掃按PVL分級(jí)標(biāo)準(zhǔn),分為無(wú)異常、輕度異常、中度異常、重度異常四組,分別測(cè)量不同組別ROI的FA值。ROI組間比較采用單因素方差分析。應(yīng)用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,以P0.05認(rèn)為有統(tǒng)計(jì)學(xué)差異。 結(jié)果 實(shí)驗(yàn)組與對(duì)照組比較發(fā)現(xiàn)左側(cè)內(nèi)囊前肢(患兒組：0.507±0.054；對(duì)照組：0.676±0.054)、右側(cè)內(nèi)囊前肢(患兒組：0.524±0.062；對(duì)照組：0.649±0.048)、左側(cè)內(nèi)囊后肢(患兒組：0.561±0.056：對(duì)照組：0.690±0.053)、右側(cè)內(nèi)囊后肢(患兒組：0.543±0.057；對(duì)照組：0.702±0.053)、左側(cè)胼胝體膝部(患兒組：0.613±0.068；對(duì)照組：0.732±0.061)、左側(cè)皮質(zhì)脊髓束(患兒組：0.551±0.046；對(duì)照組：0.606±0.073)、右側(cè)皮質(zhì)脊髓束(患兒組：0.583±0.039；對(duì)照組：0.632±0.034)、扣帶回左側(cè)(患兒組：0.315±0.091；對(duì)照組：0.440±0.055)、扣帶回右側(cè)(患兒組：0.345±0.098；對(duì)照組：0.416±0.057)的FA值顯著減低,差異具有統(tǒng)計(jì)學(xué)意義(t值為3.176-4.884,P0.05)。上述數(shù)據(jù)顯示,腦癱患兒的ROI較正常兒童對(duì)應(yīng)部位的FA值明顯下降。將入組對(duì)象按照不同PVL程度分為四組,組組間對(duì)比發(fā)現(xiàn)雙側(cè)皮質(zhì)脊髓束、雙側(cè)內(nèi)囊前肢、雙側(cè)內(nèi)囊后肢、左側(cè)胼胝體壓部、雙側(cè)胼胝體膝部,雙側(cè)扣帶束的FA值有差異,其差異有統(tǒng)計(jì)學(xué)意義(F值為5.774-34.245,P0.05)。同時(shí),對(duì)實(shí)驗(yàn)組中2例患兒經(jīng)過(guò)規(guī)范治療,追蹤隨訪,治療前后DTI對(duì)比發(fā)現(xiàn),彩色成像圖明顯好轉(zhuǎn),治療前后的FA值明顯升高。 結(jié)論 DTI檢查能夠顯示白質(zhì)纖維損傷、中斷、異常等。從微觀上反應(yīng)了腦白質(zhì)纖維束的變化,對(duì)于腦癱早期的診斷,指導(dǎo)腦損傷及腦癱患兒治療前后對(duì)比,療效判斷具有明顯意義。
[Abstract]:background
Obstetric and neonatal intensive care technology change rapidly, birth conditions drop more and more low, so that premature birth, low birth weight and low birth weight infant survival rate increased gradually, but the problems associated with brain injury are also more and more serious impact on children's physical and mental development and the quality of life. According to the related literature at home and abroad report on brain injury in preterm infants, the incidence of cerebral palsy is very high. These children always end in sports, various aspects of learning and memory, behavior and other left sequelae in varying degrees. Which leads to the decrease of physically disabled children and the ability to adapt to the society. This is a serious public health problem of global concern what is the cause of cerebral palsy. The? What is the mechanism? People should be how to prevent and cure this kind of disease? Therefore, modern medicine for the time Exploration.
Currently, more than 60% of the cerebral palsy are periventricular leukomalacia (PVL). The development of diffusion tensor magnetic resonance imaging as a noninvasive method model, widely used in clinic. The main function is the distribution of human body nerve fiber bundle, walking and lack of complete show that is sensitive to the change of pathological lesions in small to provide information, therefore, whether can pass the DTI to confirm the PVL defect of the white matter, and recovered after treatment. Clinical assistant?
objective
The purpose of this study is to evaluate the changes of white matter fiber tracts before and after treatment in patients with early brain injury and cerebral palsy by magnetic resonance diffusion tensor imaging, so as to guide clinical diagnosis and prognosis.
Method
17 cases in children have been diagnosed with cerebral palsy and gender, 6 healthy children were similar to the average as the research object. Firstly, the conventional brain magnetic resonance imaging (Magnetic Resonance, Imaging, MRI) scan, then underwent brain diffusion tensor imaging (Diffusion tensor imaging, DTI), get the anisotropy score (fractional anisotropy, FA) and FA respectively. The color encoding map before and after internal capsule branch (anterior/posterior limb of internal capsule ICAL/ICPL (corticospinal), corticospinal tract tract, CST), corpus callosal (genu of corpus callosum knee GCC), splenium of corpus callosum (splenium of corpus callosum, SCC) (cingulated, midcingulate gyrus, CO) is set to the region of interest (ROI), the determination of the symmetrical part of ROI FA, the change of cerebral palsy group and the control group of the FA value of non paired t test of the experimental group. And the control group were plain scanning according to the PVL classification standard, divided into abnormal, mild abnormal, moderate abnormal, four severe abnormal group, ROI in different groups were measured FA values in.ROI group compared with single factor analysis of variance. SPSS17.0 software was used for statistical analysis, using P0.05 as a statistically significant difference.
Result
The experimental group compared with the control group found that the left anterior limb of the internal capsule (children group: 0.507 + 0.054; control group: 0.676 + 0.054), right anterior limb of internal capsule (Group: 0.524 + 0.062; control group: 0.649 + 0.048), the left posterior limb of the internal capsule (group: 0.561 + 0.056: control group: 0.690 + 0.053). On the right side of the posterior limb of the internal capsule (Group: 0.543 + 0.057; control group: 0.702 + 0.053), the left genu (Group: 0.613 + 0.068; control group: 0.732 + 0.061), the left corticospinal tract (group: 0.551 + 0.046; control group: 0.606 + 0.073), on the right side of the corticospinal tract (children group 0.583 + 0.039; control group: 0.632 + 0.034), cingulate gyrus (left group: 0.315 + 0.091; control group: 0.440 + 0.055), right cingulate (Group: 0.345 + 0.098; control group: 0.416 + 0.057) FA value was significantly decreased, the difference was statistically significant (t value 3.176-4.88 4, P0.05). The data showed that children with cerebral palsy ROI than normal children of the corresponding part of the value of FA decreased significantly. The subjects according to the different degree of PVL were divided into four groups, group comparison between the two groups showed bilateral corticospinal tract, bilateral anterior limb of internal capsule, bilateral posterior, left splenium, bilateral genu bilateral midcingulate, FA value difference, the difference was statistically significant (F-measure 5.774-34.245, P0.05). At the same time, the trace of the experimental group in 2 cases after standard treatment, follow-up, found DTI compared before and after treatment, color image is improved obviously, before and after the treatment of FA increased obviously.
conclusion
DTI examination can show white matter fiber damage, interruption, abnormality, etc. it reflects the change of white matter fiber bundle from microcosmic. It is significant for early diagnosis of cerebral palsy, guiding brain injury and comparing children's cerebral palsy before and after treatment.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.3;R445.2

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