本文選題：肌萎縮側(cè)索硬化　切入點(diǎn)：吞咽造影　出處：《廣州中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：初步探討吞咽造影檢查及影像學(xué)在肌萎縮側(cè)索硬化(ALS)檢查中的應(yīng)用價(jià)值及ALS患者的吞咽造影功能總分及影像學(xué)與患者臨床資料之間的相關(guān)性。方法：在廣東省中醫(yī)院神經(jīng)四科的肌萎縮側(cè)索硬化癥住院患者中選取17例具有不同診斷級(jí)別的肌萎縮側(cè)索硬化癥患者,其中包括確診的肌萎縮側(cè)索硬化癥(10例)、很可能的肌萎縮側(cè)索硬化癥(4例)、可能的肌萎縮側(cè)索硬化癥(3例)的患者,分別進(jìn)行吞咽造影檢查,將患者吞咽造影的結(jié)果與其臨床資料之間進(jìn)行相關(guān)性分析。同時(shí)選取54例具有不同診斷級(jí)別的肌萎縮側(cè)索硬化癥患者,包括確診(21例)、很可能(22例)、可能(11例)的患者,并選取23名健康體檢的志愿者作為健康對(duì)照。分別行磁共振彌散張量成像(DTI)掃描,測(cè)量各感興趣區(qū)(ROI)的平均擴(kuò)散系數(shù)(ADC)和各向異性系數(shù)(FA),分析兩組間ADC和FA的差異,并對(duì)肌萎縮側(cè)索硬化癥組患者ADC值及FA值與臨床資料的相關(guān)性進(jìn)行分析。結(jié)果：相關(guān)分析顯示吞咽造影總分與體重指數(shù)呈正相關(guān)(r=0.031,P0.05),與年齡、起病方式、病程、病情進(jìn)展速度、診斷級(jí)別、ALS功能評(píng)分、ALS球部功能評(píng)分等臨床資料之間沒有相關(guān)性。與健康對(duì)照組比較,肌萎縮側(cè)索硬化癥患者大腦腳、內(nèi)囊后肢區(qū)的ADC值升高(P0.05),大腦腳、內(nèi)囊后肢及中央前回區(qū)的FA值降低(P0.05)；相關(guān)分析顯示肌萎縮側(cè)索硬化癥患者內(nèi)囊后肢的ADC值與診斷級(jí)別呈負(fù)相關(guān)(r=-0.289,P0.05),與上運(yùn)動(dòng)神經(jīng)元損傷評(píng)分呈正相關(guān)(r=0.304,P0.05)；大腦腳及內(nèi)囊后肢的FA值與診斷級(jí)別呈正相關(guān)(r=0.394, P0.05; r=0.547, P 0.01),與上運(yùn)動(dòng)神經(jīng)元損傷評(píng)分呈負(fù)相關(guān)(r=-0.301, P0.05; r=-0.653, P0.01)。結(jié)論：吞咽造影檢查可以客觀的發(fā)現(xiàn)肌萎縮側(cè)索硬化癥患者存在的吞咽功能障礙,吞咽造影檢查對(duì)于評(píng)估肌萎縮側(cè)索硬化癥患者的吞咽功能具有重要意義。DTI可客觀定量評(píng)估肌萎縮側(cè)索硬化癥患者錐體束的損傷情況,在肌萎縮側(cè)索硬化癥的診斷中具有重要的輔助價(jià)值。
[Abstract]:Objective: to explore the application value of swallowing angiography and imaging in the examination of amyotrophic lateral sclerosis (ALS) and the correlation between the total functional score of swallowing and imaging and the clinical data of patients with ALS. Among the inpatients with amyotrophic lateral sclerosis in four departments of neurology, 17 patients with amyotrophic lateral sclerosis with different diagnostic levels were selected. These include 10 cases of amyotrophic lateral sclerosis, 4 cases of amyotrophic lateral sclerosis and 3 cases of possible amyotrophic lateral sclerosis. The correlation between the results of swallowing angiography and clinical data was analyzed. At the same time, 54 patients with amyotrophic lateral sclerosis with different levels of diagnosis were selected, including 21 patients diagnosed with amyotrophic lateral sclerosis, probably 22 patients with dysphagia and 11 patients with amyotrophic lateral sclerosis. 23 healthy volunteers were selected as healthy controls. The average diffusion coefficient (ADC) and anisotropic coefficient (FAA) of ADC and FA were measured by magnetic resonance diffusion-diffusion imaging (DTI) scan in each region of interest. The difference of ADC and FA between the two groups was analyzed. The correlation between ADC value, FA value and clinical data in patients with amyotrophic lateral sclerosis was analyzed. Results: correlation analysis showed that the total score of swallowing angiography was positively correlated with body mass index (BMI), and had a positive correlation with age, onset mode, course of disease and the speed of disease progression. There was no correlation between the clinical data such as ALS functional score and ALS ball function score. Compared with the healthy control group, the ADC value of the cerebral foot and the posterior limb area of the internal capsule increased in the patients with amyotrophic lateral sclerosis. The FA value of the posterior limb of the internal capsule and the precentral gyrus decreased (P 0.05). The correlation analysis showed that the ADC value of the posterior limb of the internal capsule in the patients with amyotrophic lateral sclerosis was negatively correlated with the diagnostic grade, and positively correlated with the injury score of the superior motor neuron. The FA value of the posterior limb was positively correlated with the diagnostic grade (P 0.05, r = 0.547, P 0.01), and negatively correlated with the injury score of the upper motor neuron (P 0.05). Conclusion: the swallowing examination can objectively find the dysphagia in the patients with amyotrophic lateral sclerosis. Swallowing angiography is of great significance in evaluating the swallowing function of patients with amyotrophic lateral sclerosis. DTI can objectively and quantitatively evaluate the damage of pyramidal tract in patients with amyotrophic lateral sclerosis. It has important auxiliary value in the diagnosis of amyotrophic lateral sclerosis.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R744.8

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