本文關鍵詞： 腦梗死 基于體素的形態(tài)學分析 彌散張量成像 運動皮層 錐體束　出處：《天津醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的： 采用基于體素的形態(tài)學分析(VBM)與彌散張量成像(DTI)方法,研究慢性期腦梗死患者腦灰質(zhì)和白質(zhì)的繼發(fā)性改變及其相關性,為闡明腦梗死后運動功能損傷的內(nèi)在機制提供理論依據(jù)。 方法： 選擇運動功能恢復良好的慢性期單側(cè)基底節(jié)區(qū)腦梗死患者20例,另選取22名性別、年齡相匹配的健康志愿者作為對照。采用GE3.0T HDX超導型磁共振掃描儀對所有受試者行全腦高分辨率T1WI結(jié)構(gòu)像和DTI掃描。運用SPM8軟件包對T1WI結(jié)構(gòu)像數(shù)據(jù)進行VBM分析。以受試者性別、年齡為協(xié)變量,采用兩樣本t檢驗在全腦水平比較患者組與對照組灰質(zhì)體積(GMV)改變的腦區(qū),并以GMV改變腦區(qū)作為模板,分別提取每個患者相應腦區(qū)GMV值。DTI數(shù)據(jù)采用FSL4.1軟件包進行預處理,追蹤雙側(cè)錐體束(PT),選取腦橋以上至中央前回皮層下走行的PT進行分析,計算其纖維數(shù)量及各彌散指標值(FA值、MD值、λ‖值、λ⊥值),所得數(shù)據(jù)采用SPSS18.0軟件包進行統(tǒng)計學處理,以P0.05作為檢驗水準。分別比較兩組受試者患(右)側(cè)與健(左)側(cè)PT纖維數(shù)量和各彌散指標的差異,以及患者組與對照組各相對彌散指標(患[右]側(cè)/健[左]側(cè))的差異。以每個厘米為一段,將所選區(qū)間的雙側(cè)PT分為8段,分別比較各節(jié)段患者組患側(cè)與健側(cè)各彌散指標的差異,以及患者組與對照組各相對彌散指標的差異。將GMV改變腦區(qū)的GMV值與PT總體各相對彌散指標做相關性分析,闡明兩者變化趨勢。 結(jié)果： 1、VBM分析結(jié)果顯示患者組患側(cè)初級運動皮層(M1區(qū))GMV減小(FDR校正P0.05) 2、DTI研究結(jié)果顯示患者組與對照組健(左)側(cè)PT,總體纖維數(shù)量及各彌散指標值比較均無顯著差異(P0.05)。與對照組相比,患者組PT總體rNum、rFA值明顯減低,rMD、rλ⊥值增高(P0.05) 3、PT分段研究結(jié)果顯示,患者組患側(cè)PT的第2-7節(jié)段FA值較健側(cè)減低,MD值及λ⊥值較健側(cè)增高；第5節(jié)段λ‖值較健側(cè)增高(P0.05)。與對照組相比,患者組PT的第3-7節(jié)段rFA值減低,rλ⊥值增高；第3-6節(jié)段rMD值增高；rλ‖值僅第4、5節(jié)段增高(P0.05)。且患側(cè)PT的結(jié)構(gòu)改變以病灶為中心呈順行性和逆行性擴展。 4、相關分析顯示患者組患側(cè)M1區(qū)GMV值的改變與PT總體的rFA值呈正相關(R=0.54,P0.05),與rλ⊥上值呈負相關(R=-0.49,P0.05)。 結(jié)論： 1、基底節(jié)區(qū)腦梗死患者患側(cè)半球M1區(qū)存在GMV減小區(qū)域,提示遠隔梗死灶的腦皮層灰質(zhì)也可發(fā)生結(jié)構(gòu)損傷。 2、基底節(jié)區(qū)腦梗死患者患側(cè)PT存在結(jié)構(gòu)損害,這種損害以病灶為中心呈順行性和逆行性擴展,距離病灶距離越近損傷越嚴重,距離越遠損傷越輕微。 3、PT的逆行性結(jié)構(gòu)損害表現(xiàn)為軸索變性和髓鞘脫失,為遠隔梗死灶的腦皮層灰質(zhì)出現(xiàn)結(jié)構(gòu)損傷的原因。 4、PT的結(jié)構(gòu)損害與腦皮層灰質(zhì)的結(jié)構(gòu)損害呈正相關,即患側(cè)PT損害越嚴重,M1區(qū)灰質(zhì)萎縮也越明顯。
[Abstract]:Objective: The secondary changes of gray matter and white matter in patients with chronic cerebral infarction were studied by VBM-based morphologic analysis and diffusion Zhang Liang imaging (DTI). To provide theoretical basis for elucidating the intrinsic mechanism of motor function injury after cerebral infarction. Methods: Twenty patients with chronic unilateral basal ganglia infarction with good motor function were selected and 22 patients with sex were selected. Age-matched healthy volunteers were used as controls. GE3.0T was used. HDX superconducting magnetic resonance scanner was used to scan the whole brain of all subjects with high resolution T1WI structure image and DTI. The T1WI structural image data were analyzed by VBM using SPM8 software package. Sex. Age was used as a covariable. Two t-test samples were used to compare the changes of gray matter volume (GMV) between the patient group and the control group at the whole brain level, and the GMV changes were used as a template. The GMV data of each patient's brain region were preprocessed with FSL4.1 software package to track the bilateral pyramidal bundles (PTT). PT from the top of the pons to the subcortical part of the precentral gyrus was selected for analysis, and the number of fibers and the values of each diffusing index (FA) were calculated. The data were processed by SPSS18.0 software package. Using P05 as the test level, the difference of PT fiber quantity and diffusion index between the right side and the healthy side of the two groups were compared, as well as the relative diffusive indexes between the patient group and the control group (P < 0.05). [Right side / health. [Using each centimeter as a segment, the PT of the selected interval was divided into 8 segments, and the diffusive indexes of the affected side and the healthy side were compared respectively. And the difference of relative diffusion index between the patient group and the control group. The correlation analysis was made between the GMV value of the brain area changed by GMV and the relative diffusion index of PT as a whole, and the change trend of the two indexes was clarified. Results: 1) the results of VBM analysis showed that the GMV of the M1 area of primary motor cortex of the affected side of the patients decreased and the correction of FDR was P0.05). 2the results of DTI study showed that there was no significant difference in PTT, total fiber quantity and diffusion index between the patients group and the control group (P 0.05), and compared with the control group (P < 0.05). In the patient group, the total rNumn rFA value was significantly decreased and the rMDN r 位-位 value was increased (P0.05). 3The results of PT segmental study showed that the FA value of segment 2-7 of PT in the patient group was lower than that of the healthy side and the value of MD and 位 Karabakh was higher than that of the healthy side. Compared with the control group, the rFA value of segment 3-7 in the patient group was lower than that in the control group, and the value of r 位 was higher than that in the control group. The rMD value of segment 3-6 was increased. The r位 value was only increased in the 4th and 5th segment (P 0.05), and the structural changes of PT were anterograde and retrograde with the focus as the center. 4. Correlation analysis showed that there was a positive correlation between the change of GMV value in M1 area and the total rFA value of PT (P 0.05). There was a negative correlation between r 位 and the upper value of r 位 _ (-) 0.49% (P _ (0.05)). Conclusion: 1. The decrease of GMV in M1 region of the affected hemispheres in patients with cerebral infarction in basal ganglia region suggests that the cortical gray matter of distant infarct can also occur structural damage. 2. There was structural damage to PT in patients with cerebral infarction in basal ganglia area. The lesion was anterograde and retrograde. The closer the lesion was to the lesion, the more serious the injury was, and the less the distance was. 3The retrograde structural damage of PT was caused by axonal degeneration and demyelination, which was the cause of structural damage in the cortex gray matter of the distant infarct. 4the structural damage of PT was positively correlated with the structural damage of cerebral cortex gray matter, that is, the more serious the PT damage was, the more obvious the gray matter atrophy in M1 area was.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3;R445.2

【參考文獻】

相關期刊論文 前1條

1 林琳;汪洋;孟亮亮;秦文;劉寧寧;薛蓉;于春水;張敬;;皮質(zhì)下腦梗死患者初級運動皮質(zhì)結(jié)構(gòu)損傷和運動功能恢復的相關性研究[J];中華老年心腦血管病雜志;2013年03期

，

本文編號：1471179