發(fā)布時(shí)間：2018-03-15 18:26

  本文選題：兒童　切入點(diǎn)：屈光參差性弱視　出處：《蘭州大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：本研究采用血氧水平依賴性功能性磁共振成像(Blood oxygen level dependent-function magnetic resonance imaging, BOLD-fMRI)技術(shù),研究屈光參差性弱視兒童在規(guī)范弱視訓(xùn)練前后,立體視覺映射的腦皮層的功能變化,確定兒童屈光參差性弱視臨床治療的真正終點(diǎn)。 方法：初診屈光參差性弱視患兒11例(男6例,女5例),年齡5.5～11歲,平均(8.6±3.35)歲。將被試分為5.5～7歲組和8-11歲組；所有被試均為遠(yuǎn)視性弱視,中心凹注視；屈光參差范圍3.0D～6.0D；均為右利手；所有被試無(wú)眼部及神經(jīng)系統(tǒng)疾患；MRI檢查時(shí)排除由視網(wǎng)膜至外側(cè)膝狀體核間的疾病。試驗(yàn)前充分矯正屈光不正；規(guī)范化弱視訓(xùn)練后1周、2周及4周時(shí)復(fù)查fMRI。 實(shí)驗(yàn)數(shù)據(jù)由SIEMENS MAGNETOM Verio3T磁共振掃描系統(tǒng)獲取。視覺刺激呈現(xiàn)采用腦功能視聽覺刺激系統(tǒng)(SAMRTEC,SA-9900)。任務(wù)設(shè)計(jì)程序均采用E-Prime2.0軟件編寫。刺激模式采用對(duì)比度接近80%的隨機(jī)點(diǎn)立體圖像,患兒采用佩戴紅藍(lán)眼鏡獲得雙眼立體視覺。采用組塊式(blocks)設(shè)計(jì),由激活狀態(tài)(activation state)和控制狀態(tài)(control state)組成,分別是交替的隨機(jī)點(diǎn)立體圖像與固定于屏幕中央的黑色“+”圖標(biāo)。 試驗(yàn)數(shù)據(jù)導(dǎo)入一臺(tái)64位操作系統(tǒng)工作站,進(jìn)行離線處理。采用基于MATLAB7.12.0.635(The MathWorks, Inc.)的SPM8(Statistical Parametric Mapping)軟件包進(jìn)行數(shù)據(jù)分析。高斯平滑的半高寬度(Full-width at half maximum, FWHM)為6mm。采用隨機(jī)效應(yīng)法分別獲得各組腦皮層激活的矩陣數(shù)據(jù),對(duì)被試治療前及治療后1周、2周及4周時(shí)相應(yīng)腦皮層激活范圍的差異進(jìn)行自身前后配對(duì)t檢驗(yàn)(閾值設(shè)定為P0.001時(shí)具有統(tǒng)計(jì)學(xué)意義,未多重矯正)。 結(jié)果：1.當(dāng)設(shè)定P值為0.05,激活范圍閾值為6個(gè)體素時(shí),兩年齡組間大腦皮層激活無(wú)顯著差異；2.自身前后對(duì)照分析結(jié)果顯示,各治療階段較前具有顯著地激活差異,主要集中在雙側(cè)枕葉(BA18)、舌回(BA17)、枕中回(BA19)及雙側(cè)頂上小葉(BA7),以右枕葉(BA18)最顯著；1周時(shí)雙側(cè)枕中回(BA19)小面積激活；2周時(shí)左側(cè)頂上小葉(BA7)與雙側(cè)頂葉(BA40)小面積激活；4周后左側(cè)頂上小葉(BA7)激活；3.治療2~4周時(shí),腦皮層視功能區(qū)的增進(jìn)幅度滯后于隨機(jī)點(diǎn)立體視。 結(jié)論： 1.兒童屈光參差性弱視對(duì)與立體覺相關(guān)腦皮層的功能損害嚴(yán)重,短期內(nèi)恢復(fù)困難。 2.屈光參差性弱視治療的效果在一定程度上取決于患兒對(duì)疾病的認(rèn)識(shí)與配合程度。 3.腦皮層視功能區(qū)的功能重建速度滯后于臨床上廣泛應(yīng)用的隨機(jī)點(diǎn)立體視銳度的恢復(fù)速度。因此,隨機(jī)點(diǎn)立體視覺檢查無(wú)法全面評(píng)價(jià)弱視治療效果。 4.伴隨立體視覺的建立,視皮層的中樞激活由雙側(cè)枕葉向頂葉等多個(gè)腦功能區(qū)延伸。
[Abstract]:Objective: to study the cortical function of anisometropia amblyopia before and after normal amblyopia training by using blood oxygen level dependent-function magnetic resonance imaging (BOLD-fMRI) technique in children with anisometropic amblyopia before and after standardized amblyopia training. To determine the true end point of clinical treatment for anisometropic amblyopia in children. Methods: eleven children with anisometropia amblyopia (6 males and 5 females, mean age: 8.6 鹵3.35) were divided into 5. 5 + 7 years old group and 8-11 years old group, all of them were hyperopic amblyopia and central foveal fixation. The range of anisometropia was 3.0 DX 6.0D, all of them were right-handed. All subjects were excluded from retinal to lateral geniculate nucleus in MRI examination of ocular and nervous system diseases. After 1 week, 2 weeks and 4 weeks after normal amblyopia training, fMRI was reexamined. The experimental data were obtained by SIEMENS MAGNETOM Verio3T magnetic resonance scanning system. Visual stimuli were presented by brain functional audiovisual stimulation system SAMRTECS SA-99000.The task design programs were all compiled by E-Prime2.0 software. The stimulation mode was random dot stereoscopic images with a contrast of nearly 80%. Binocular stereoscopic vision was obtained by wearing red and blue glasses. A block block design was used, which consisted of activation state and control state. They were alternately random dot stereoscopic images and black "icon" fixed in the center of the screen. The test data is imported into a 64-bit operating system workstation, Off-line processing. The data were analyzed by SPM8(Statistical Parametric Mapping software package based on MATLAB7.12.0.635(The MathWorks (Inc.). Gao Si's smooth half-width Full-width at half maximum (FWHM) was 6mm. the matrix data of cortical activation in each group were obtained by random effect method. The difference of activation range of cerebral cortex before treatment and 1 week and 4 weeks after treatment was compared with self-matched t test (the threshold was set to P0.001 with statistical significance and no multiple correction). Results: 1.When the value of P was 0.05 and the threshold of activation range was 6 individuals, there was no significant difference in cerebral cortex activation between the two age groups. It was mainly concentrated in bilateral occipital lobes (BA18), lingual gyrus (BA17), middle occipital gyrus (BA19) and bilateral superior parietal lobules (BA7). The right occipital lobe was the most significant (BA19) in bilateral occipital middle gyrus at 1 week) and in left superior parietal lobules (BA7) and bilateral parietal lobe (BA40) at 2 weeks. BA7) activated 3. 4 weeks after treatment, The enhancement of visual function area of cerebral cortex lags behind that of stereopsis of random dots. Conclusion:. 1. The anisometropia amblyopia in children has serious damage to the cortical function associated with stereosensory, and it is difficult to recover in a short time. 2. The effect of anisometropia amblyopia depends on the understanding and cooperation of children. 3. The speed of functional reconstruction in visual functional area of cerebral cortex lags behind that of restoration of stereopsis acuity of random spot, which is widely used in clinic, therefore, random dot stereopsis can not fully evaluate the effect of amblyopia treatment. 4. With the establishment of stereo vision, the central activation of visual cortex extends from bilateral occipital lobe to parietal lobe.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R778

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