【摘要】：【目的】 采用靜息態(tài)功能磁共振（rs-fMRI）功能連接分析技術,觀察不同組內(nèi)側顳葉癲癇（MTLE）患者發(fā)作間期靜息態(tài)腦網(wǎng)絡的改變，與記憶功能進行相關性分析，探討MTLE患者記憶功能損害的機制以及內(nèi)側顳葉結構在人類記憶保持中的作用，為MTLE病人認知障礙的預防及治療提供理論基礎。 【方法】 1.13例左側內(nèi)側顳葉癲癇（L-MTLE）患者、11例右側內(nèi)側顳葉癲癇（R-MTLE）患者和13例正常對照組分別進行閉眼靜息態(tài)腦功能成像掃描及臨床記憶量表功能測評。 2.分別以左側海馬、右側海馬為種子點，比較不同側癲癇組與正常組的腦區(qū)差異，并將臨床記憶量表資料的結果與“患者VS對照”的差異腦區(qū)，做基于體素的Pearson相關性分析（p0.05，，AlphaSim校正）。 【結果】 1. MTLE各組指向記憶、聯(lián)想學習、圖形自由回憶、無意義圖形再認、人物特點回憶及記憶商均顯著低于正常組。指向記憶分值，L-MTLE組明顯低于R-MTLE組；但無意義圖像再認，L-MTLE組明顯高于R-MTLE組，余量表分值在兩組MTLE組間差異無統(tǒng)計學意義。 2. L-MTLE組左側海馬功能連接高于正常組的腦區(qū)：右額上回、右額中回、右顳上回、右顳下回、右楔前葉；低于正常組的腦區(qū)：右嗅皮層、右額中回、左丘腦、左中央前回、左運動前皮質、雙側顳上回。 3.R-MTLE組右側海馬功能連接高于正常組的腦區(qū)：右額中回、右額下回、右運動前皮質、左頂下小葉、左額中回、雙側腦干；低于正常組的腦區(qū)：右楔前葉、右尾狀核、左距狀皮層、左殼核、雙側小腦。 4.L-MTLE組左側海馬和左側中央后回的功能連接與聯(lián)想學習記憶年齡量表分呈負相關，右側海馬和左側海馬/杏仁核的功能連接與指向記憶年齡量表分、記憶商呈正相關。 5.R-MTLE組左側海馬和右側枕中回的功能連接與指向記憶年齡量表分、記憶商呈負相關，左側海馬和左側顳中回的功能連接與指向記憶、聯(lián)想學習記憶年齡量表分呈正相關，左側海馬和左側額下回的功能連接與圖像自由回憶、無意義圖形再認年齡量表分及記憶商呈正相關；右側海馬和右額中回的功能連接與圖像自由回憶年齡量表分呈正相關。 【結論】 1. L-MTLE組和R-MTLE組，都存在廣泛的記憶損害，但以各自優(yōu)勢側的損害為主，即L-MTLE組以純語言記憶損害為主，R-MTLE組以純視覺記憶損害為主。 2. MTLE患者廣泛的腦網(wǎng)絡連接異常，形成癲癇網(wǎng)絡，其分布模式可能與癲癇活動的傳播有關。 3.單側MTLE患者海馬與病灶同側的功能連接減弱，而與病灶對側的功能連接增強，這兩個顯著特點提示增強與病灶對側腦區(qū)的功能連接是其提高記憶功能的重要補償機制之一。
[Abstract]:[objective] to observe the changes of interictal resting brain network in patients with medial temporal lobe epilepsy (MTLE) using resting functional magnetic resonance (rs-fMRI) functional connection analysis technique, and to analyze the correlation between resting brain network and memory function in patients with medial temporal lobe epilepsy. To explore the mechanism of memory impairment in patients with MTLE and the role of medial temporal lobe structure in human memory preservation. [methods] 1.Thirteen patients with left medial temporal lobe epilepsy (L-MTLE), 11 patients with right medial temporal lobe epilepsy (R-MTLE) and 13 normal controls, respectively. The function of closed eyes resting brain function imaging and clinical memory scale were evaluated. 2. Using the left hippocampus and the right hippocampus as seed points, the differences of brain regions between the different epilepsy groups and the normal group were compared, and the results of the clinical memory scale were compared with the difference of the "patient VS control". Pearson correlation analysis based on voxel (p 0.05 AlphaSim correction). [results] 1. MTLE group was significantly lower than normal group in pointing memory, associative learning, figure free recall, recognition of meaningless figure, character characteristic memory and memory quotient. The point memory score of L-MTLE group was significantly lower than that of R-MTLE group, but that of L-MTLE group was significantly higher than that of R-MTLE group. The left hippocampal functional junction in L-MTLE group was higher than that in normal group: right superior frontal gyrus, right middle frontal gyrus, right superior temporal gyrus, right infratemporal gyrus, right anterior cuneate lobe, and lower than that in normal group: right olfactory cortex, right middle frontal gyrus, left thalamus, left precentral gyrus. Left premotor cortex, bilateral superior temporal gyrus. The right hippocampal functional junction in 3.R-MTLE group was higher than that in normal group: right middle frontal gyrus, right inferior frontal gyrus, right premotor cortex, left inferior parietal lobule, left middle frontal gyrus, bilateral brain stem; The functional connections of left hippocampus and left posterior central gyrus in 4.L-MTLE group were negatively correlated with the age scale scores of associative learning and memory in the right anterior wedge, right caudate nucleus, left talus cortex, left putamen nucleus and bilateral cerebellum. The functional connections of the right hippocampus and the left hippocampus / amygdala were positively correlated with the scores of the directed memory age scale and the memory quotient. In 5.R-MTLE group, the functional connections between the left hippocampus and the right middle occipital gyrus were negatively correlated with the scores of the directed memory age scale and the memory quotient. The functional connections of left hippocampus and left middle temporal gyrus were positively correlated with directed memory, associative learning and memory age scale scores, and the functional connections between left hippocampus and left inferior frontal gyrus were associated with image free recall. The scores of age scale and memory quotient were positively correlated, and the functional connections of right hippocampus and right middle frontal gyrus were positively correlated with the score of age scale of image free recall. [conclusion] 1. There were extensive memory impairment in L-MTLE group and R-MTLE group, but mainly in their dominant side, that is, pure language memory damage in L-MTLE group and pure visual memory impairment in R-MTLE group. 2. MTLE patients have extensive abnormal connections of brain network to form epileptic network, its distribution pattern may be related to the spread of epileptic activity. 3. 3. The functional connections between the hippocampus and the ipsilateral side of the lesion were weakened and the contralateral functional connections were enhanced in patients with unilateral MTLE. These two significant features suggest that the enhancement of the functional connections with the contralateral brain regions is one of the important compensatory mechanisms for improving the memory function of the patients with unilateral MTLE.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R742.1

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相關博士學位論文 前1條

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