本文選題：屈光不正性弱視 + 兒童��； 參考：《蘭州大學(xué)》2011年碩士論文

【摘要】：背景和目的：屈光不正性弱視是一種兒童常見病,其發(fā)病本質(zhì)在于視覺發(fā)育的早期,視通路及視皮層未得到相關(guān)視覺信號(hào)的刺激而導(dǎo)致其功能和結(jié)構(gòu)的改變,影響視覺信息的形成。目前已經(jīng)有研究證實(shí)屈光不正性弱視初級(jí)視覺皮層的功能改變,枕葉視覺皮層厚度改變及視輻射、外側(cè)膝狀體的功能障礙。高級(jí)別視覺皮層是否也存在著功能障礙?分析屈光狀態(tài)對(duì)視皮層的影響,矯正弱視眼屈光不正對(duì)視皮層神經(jīng)元活動(dòng)有什么影響?弱視視覺皮層功能損害與弱視程度之間的關(guān)系怎樣?本研究采用血氧水平依賴性功能性磁共振成像(BOLD-fMRI)技術(shù),分析屈光不正性弱視視覺皮層功能的改變情況；矯正屈光不正后,弱視視皮層神經(jīng)元活動(dòng)有何改變,弱視眼皮層功能損害與弱視程度是否呈線性相關(guān),可對(duì)弱視發(fā)病機(jī)制及視皮層功能損害有進(jìn)一步認(rèn)識(shí)。 材料與方法：選取2010年07月至2010年8月蘭州軍區(qū)總醫(yī)院眼科門診就診的18例屈光不正性弱視患兒為實(shí)驗(yàn)組,18例正常視力兒童志愿者為對(duì)照組。采用BOLD-fMRI技術(shù),以SIEMENS AVANTO 1.5T磁共振掃描儀獲取圖像數(shù)據(jù)。視覺刺激為自制黑白旋轉(zhuǎn)光柵。實(shí)驗(yàn)采用組塊設(shè)計(jì)模式,任務(wù)狀態(tài)組塊和控制狀態(tài)組塊分別為旋轉(zhuǎn)光柵和靜止光柵,兩種組塊交替進(jìn)行。實(shí)驗(yàn)組雙眼裸眼、雙眼屈光矯正分別接受刺激,對(duì)照組雙眼裸眼接受刺激。實(shí)驗(yàn)中T1WI結(jié)構(gòu)圖像采用快速自旋回波TSE (Turbo Spin Echo)序列采集。BOLD數(shù)據(jù)采用平面回波EPI(Echoplanar Imaging)序列采集,三維解剖圖像采用磁化準(zhǔn)備快速梯度回波MPRAGE(Magnetization Prepared Rapid Gradient Echo)序列采集。受試者完成視覺刺激及數(shù)據(jù)采集后,將功能激活圖像及三維解剖圖像Talairach標(biāo)準(zhǔn)化后,進(jìn)行相關(guān)測量及分析。采用本核磁掃描儀自帶皮層定位及分析軟件,選擇枕葉紋狀區(qū)、紋狀旁區(qū)及紋周區(qū)作為感興趣區(qū)(Region of Interest, ROI)。取ROI激活的總體素?cái)?shù)為視覺皮層激活范圍。采用SPSS 18.0統(tǒng)計(jì)軟件,數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差(x±S)表示。對(duì)同一弱視受試者裸眼和屈光矯正后皮層激活體素進(jìn)行兩配對(duì)樣本t檢驗(yàn),弱視即時(shí)屈光矯正后皮層的激活體素與對(duì)照組皮層激活體素進(jìn)行兩獨(dú)立樣本t檢驗(yàn),不同年齡組弱視即時(shí)屈光矯正后皮層的激活體素及對(duì)照組皮層激活體素進(jìn)行兩獨(dú)立樣本t檢驗(yàn),對(duì)弱視程度與皮層激活體素進(jìn)行Spearman相關(guān)分析,取P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果：實(shí)驗(yàn)組及對(duì)照組所有受試者的興奮區(qū)域均位于枕葉視皮層距狀裂周圍的紋狀區(qū)、紋狀旁區(qū)及紋周區(qū)。弱視組y|眼視皮層平均激活范圍為(9.42±4.22)×103體素,弱視組戴眼鏡即時(shí)矯正后為(10.57±4.39)×103體素,對(duì)照組平均激活體素為(14.30±2.09)×103體素。對(duì)弱視組裸眼及弱視組即時(shí)屈光矯正后皮層激活體素進(jìn)行兩配對(duì)樣本t檢驗(yàn)(t=-6.524,P=0.00),差異有統(tǒng)計(jì)學(xué)意義。弱視即時(shí)屈光矯正后皮層激活范圍明顯大于裸眼皮層激活范圍。對(duì)弱視組即時(shí)屈光矯正后和對(duì)照組皮層激活體素進(jìn)行兩獨(dú)立樣本t檢驗(yàn)(t=3.248,P=0.003),差異有統(tǒng)計(jì)學(xué)意義,弱視即時(shí)屈光矯正后視覺皮層激活范圍均明顯小于對(duì)照組。對(duì)不同年齡組皮層激活范圍比較發(fā)現(xiàn),4-6歲對(duì)照組與即時(shí)屈光矯正后皮層激活范圍無明顯差異(t=0.25,P=0.981),7～8歲與9～歲對(duì)照組皮層激活范圍大于即時(shí)屈光矯正后皮層激活范圍(t=2.23,P=0.034,t=-3.626,P=0.002)。對(duì)皮層激活體素與弱視程度進(jìn)行Spearman相關(guān)分析,Spearman等級(jí)相關(guān)系數(shù)r=0.181,P=0.472,取P0.05為差異具有統(tǒng)計(jì)學(xué)意義,故二者無線性相關(guān)。 結(jié)論： 1.屈光不正性弱視視皮層功能有損害。 2.弱視矯正屈光不正后可提高視皮層激活范圍,屈光不正性弱視患者應(yīng)盡早屈光矯正治療。 3.弱視的皮層功能損害與弱視程度無線性相關(guān),因此臨床上的弱視程度分級(jí)可能并不能反映皮層功能減弱的情況。
[Abstract]:Background and objective: ametropic amblyopia is a common disease of children, the incidence of early visual development lies in the visual pathway and the visual cortex was not related to visual stimulus signals due to the structural and functional changes, affecting the formation of visual information. There has been change research confirmed ametropia amblyopia with primary visual cortex the function, occipital visual cortex thickness and optic radiation, lateral geniculate body dysfunction. High level visual cortex is also exist dysfunction? Influence analysis of refractive status of visual cortex, what is the effect of correction of ametropia amblyopia visual cortex neuron activity? How the relationship between amblyopia visual cortex function and the degree of amblyopia was used in this study? Blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) technology, analysis of ametropic amblyopia visual cortex function changes. After correction of ametropia, what is the change of neuronal activity in amblyopic visual cortex, and whether the impairment of eyelid function is related to the degree of amblyopia? It can further recognize the pathogenesis of amblyopia and the impairment of visual cortex function.
Materials and methods: 18 cases of ametropia amblyopia from general hospital in 2010 07 months to August 2010 Lanzhou military ophthalmic clinic as the experimental group, 18 cases of normal vision children volunteers as control group. Using BOLD-fMRI technology, image data acquisition based on SIEMENS AVANTO 1.5T magnetic resonance scanner. Visual stimuli for self rotating grating. The experimental group using black and white block design, task state blocks and control state blocks are respectively rotary and stationary grating grating, two blocks alternately. The experimental group binocular uncorrected refractive correction, eyes received stimulation, stimulation of the control group. T1WI binocular uncorrected image using fast spin echo (Turbo TSE Spin Echo.BOLD) sequence acquisition data using echo planar EPI (Echoplanar Imaging) sequence acquisition, 3D anatomical images using a magnetization prepared rapid gradient echo (Magnetization MPRAGE Prepared Rapid Gradient Echo) sequence acquisition. Subjects completed visual stimulation and data acquisition, the function of image and 3D anatomical images of Talairach activation after standardization for measurement and analysis. The MRI scanner with cortical mapping and analysis software, selection of occipital striate area, parastriate area and grain area as a region of interest (Region of, Interest, ROI). The overall prime number ROI for activation of visual cortex activation area. Using SPSS 18 statistical software, data with standard deviation (x + S). On the same amblyopia subjects with naked eye and light correction after flexor cortex activation two paired samples t test, instant amblyopia after refractive correction of cortical activation voxels and cortex activation control group body two independent samples t test, amblyopia in different age groups immediately after refractive correction of cortex activated voxel and the control group was induced into cortex in vivo Two independent sample t test was used to analyze the degree of amblyopia with Spearman of cortical activator, and the difference between P0.05 and amblyopia was statistically significant.
Results: the excited region of the experimental group and control group in all subjects were located in the occipital cortex calcarine area around the parastriate area and peripheral area. Lines of y| in amblyopia eye visual cortex average activation range (9.42 + 4.22) * 103 voxel, amblyopia group prompt corrective glasses after the (10.57 + 4.39) * 103 voxels, the control group mean activated voxel (14.30 + 2.09) x 103 voxels. The naked eye amblyopia group and amblyopia group immediately after refractive correction, cortical activation two paired samples t test (t=-6.524, P=0.00) of elements, the difference was statistically significant. Instant amblyopia after refractive correction, cortical activation was significantly greater than the bare eyelid layer activation range. For instant refractive amblyopia group and control group after cortical activation two independent samples t test elements (t=3.248, P=0.003), the difference was statistically significant, immediate after refractive amblyopia visual cortex activation area was significantly lower than that of control Group. Different age groups of cortical activation range comparison, 4-6 year old control group and immediately after refractive correction, cortical activation had no significant difference (t=0.25, P=0.981), 7~8 years old and 9 years old to control cortical activation than activated cortex instant after refractive correction (t=2.23, P, =0.034, t=-3.626, P=0.002). Cortex voxel Spearman correlated with the degree of amblyopia, Spearman rank correlation coefficient r=0.181, P=0.472, P0.05 as the difference has statistical significance, no linear correlation is two.
Conclusion:
The function of visual cortex in 1. ametropia amblyopia is impaired.
2. amblyopia can improve the range of visual cortex activation after correction of ametropia. The patients with ametropia amblyopia should be treated with refractive correction as soon as possible.
3. the impairment of cortical function in amblyopia has no linear correlation with the degree of amblyopia, so the classification of the degree of amblyopia may not reflect the weakening of cortical function.

【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】：2011
【分類號(hào)】：R779.7

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 邵淑君;石妮妮;周華祥;;fMRI在弱視方面的研究進(jìn)展[J];湖南中醫(yī)雜志;2013年01期

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本文編號(hào)：1752162