本文關(guān)鍵詞：化瘀通絡(luò)合劑對(duì)腦小血管病致認(rèn)知功能障礙的功能網(wǎng)絡(luò)研究　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腦小血管病 認(rèn)知功能障礙 化瘀通絡(luò) 功能核磁 靜息態(tài)

【摘要】：目的：腦小血管病(Cerebral small vessel disease,CSVD)其常見的臨床表現(xiàn)有認(rèn)知功能損害(Cerebral small vascular cognitive Impairment,CSVCI)、腔隙綜合癥、步態(tài)平衡障礙、情緒低落等。研究表明CSVD是血管性認(rèn)知功能障礙(vascular cognitive Impairment,VCI)及年齡相關(guān)性認(rèn)知功能減低最主要的病因,但由于其起病比較隱匿,進(jìn)展相對(duì)緩慢,臨床癥狀往往不是很典型,因此CSVD容易被人忽視,一旦進(jìn)展為血管性癡呆(Vascular dementia,VaD)后會(huì)嚴(yán)重影響患者生活質(zhì)量,同時(shí)給家庭社會(huì)造成嚴(yán)重的經(jīng)濟(jì)負(fù)擔(dān)。雖然目前尚無(wú)有效藥物能逆轉(zhuǎn)其最終發(fā)展為血管性癡呆,但可根據(jù)其危險(xiǎn)因素進(jìn)行早期干預(yù)治療,延緩其發(fā)展進(jìn)程。結(jié)合前期研究成果表明,化瘀通絡(luò)合劑具有“化瘀生新以通絡(luò)”的功效,能促進(jìn)腦梗死后血管新生,有促進(jìn)腦缺血組織的血循環(huán)及改善神經(jīng)功能缺損的療效；能改善腦小血管病所致認(rèn)知功能障礙。本課題應(yīng)用靜息態(tài)功能磁共振觀察化瘀通絡(luò)合劑對(duì)大腦各功能區(qū)激活的影響,進(jìn)一步探討化瘀通絡(luò)合劑改善認(rèn)知功能的可能的機(jī)制。方法：按照納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)入組了40例腦小血管病患者,體檢健康者15例作為空白組,將40例患者按照就診的時(shí)間順序隨機(jī)分為治療組和對(duì)照組,每組各20例。治療組除了接受常規(guī)的基礎(chǔ)藥物治療和康復(fù)治療外,予以口服化瘀通絡(luò)合劑1瓶／天,共干預(yù)1月,對(duì)照組只接受常規(guī)的藥物治療和康復(fù)治療,健康空白組不做任何治療。治療組、對(duì)照組和空白組在治療后30天行靜息態(tài)功能性磁共振成像檢查(functional Magnetic Resonance Imaging,fMRI),三組治療前均使用蒙特利爾認(rèn)知評(píng)估表(Montreal Cognitive Assessment,MoCA)進(jìn)行總體認(rèn)知功能評(píng)定。選取雙側(cè)后扣帶回(posterior cingulate cortex,PCC)為感興趣區(qū),利用腦功能數(shù)據(jù)輔助處理軟件(Data processing assistant forresting-state fMRI,DPARSF)和統(tǒng)計(jì)參數(shù)圖軟件(Statistical parametric mapping,SPM)對(duì)數(shù)據(jù)進(jìn)行預(yù)處理,采用REST軟件自帶統(tǒng)計(jì)工具對(duì)組內(nèi)行單樣t檢驗(yàn)和對(duì)組間行雙樣本t檢驗(yàn),得到腦功能連接圖,觀察化瘀通絡(luò)合劑對(duì)治療后大腦靜息態(tài)功能連接模式的影響,進(jìn)一步探討其改善認(rèn)知的可能機(jī)制。結(jié)果：1、與空白組比較,治療后對(duì)照組右側(cè)扣帶回與左側(cè)額中回/顳中回/眶部額下回、右側(cè)額下回連接增強(qiáng),與右側(cè)額中回、海馬旁回連接減弱；左側(cè)扣帶回與左側(cè)顳葉(顳上回、顳下回)、小腦功能連接增強(qiáng)。2、與空白組比較,治療后治療組右側(cè)后扣帶回與左側(cè)頂下小葉、右側(cè)枕上回/海馬/額下回的功能連接增強(qiáng),與右側(cè)海馬旁回/眶內(nèi)額上回/內(nèi)側(cè)額上回/額中回的功能連接減弱：左側(cè)后扣帶回與右側(cè)小腦/顳下回/顳上回、左側(cè)顳下回/海馬/顳上回/顳中回的功能連接增強(qiáng),與左側(cè)頂下小葉/內(nèi)側(cè)額上回/背外側(cè)額上回的功能連接減弱。3、與對(duì)照組比較,化瘀通絡(luò)合劑干預(yù)1月后治療組的MoCA評(píng)分顯著增高,證明化瘀通絡(luò)合劑具有改善認(rèn)知的療效。結(jié)論：化瘀通絡(luò)合劑有改善腦小血管病致認(rèn)知功能障礙療效,其改善認(rèn)知功能缺損的機(jī)制尚不明確。與空白組相比,治療后治療組認(rèn)知改善可能與腦區(qū)(如頂下葉、海馬、枕葉、部分額顳葉)的功能網(wǎng)絡(luò)連接增強(qiáng)有關(guān),特別是默認(rèn)網(wǎng)絡(luò)連接的增強(qiáng)相關(guān),但由于課題的自身的局限性需進(jìn)一步研究予以證實(shí)。
[Abstract]:Objective: cerebral small vessel disease (Cerebral small vessel disease, CSVD) the clinical manifestations are common cognitive impairment (Cerebral small vascular cognitive Impairment, CSVCI), lacunar syndrome, gait disorder balance, such as depression. Research shows that CSVD is a vascular cognitive impairment (vascular cognitive, Impairment, VCI) and age related cognitive function to reduce the main cause, but because of its onset is hidden, the relatively slow progress, clinical symptoms are not typical, so CSVD can easily be ignored, once the progress of vascular dementia (Vascular dementia, VaD) will seriously affect the quality of life of patients, and caused serious economic burden to family and society. Although there is no effective drug that can reverse the final development of vascular dementia, but early intervention according to the risk factors, delaying the development process. Preliminary research results show that Huayutongluo decoction has "Tongluo Huayu health new to" effect, can promote angiogenesis after cerebral infarction, cerebral ischemia can promote blood circulation and improve nerve function defect curative effect; can improve cerebral small vessel disease caused by cognitive dysfunction. The application of resting state functional magnetic resonance effects of removing blood stasis the activation of the Tongluo mixture of each functional area of the brain, to further explore the Huayutongluo mixture to improve cognitive function mechanisms. Methods: according to the inclusion and exclusion criteria included 40 cases of patients with cerebral small vessel disease, health examination in 15 cases as control group, 40 cases of patients in clinic were randomly divided into time the treatment group and control group, 20 cases in each group. The treatment group in addition to accept conventional drug treatment and rehabilitation treatment, treated with Huayu Tongluo mixture of 1 bottles per day, a total of January intervention, control Group only received drug therapy and routine rehabilitation, the healthy control group without any treatment. The treatment group, control group and the control group in 30 days after treatment of resting state functional magnetic resonance imaging (functional Magnetic Resonance Imaging, fMRI), the three groups before treatment were using Montreal cognitive assessment (Montreal Cognitive Assessment. MoCA) for the assessment of cognitive function. The overall selection of bilateral posterior cingulate (posterior cingulate, cortex, PCC) for the region of interest, the auxiliary processing software using functional brain data (Data processing assistant forresting-state fMRI, DPARSF) and statistical parametric mapping software (Statistical parametric, mapping, SPM) to preprocess the data, with statistical tools for group within one sample t test and the differences between the two sample t test using REST software, get the connection diagram of the brain function, observation of blood stasis Tongluo mixture after treatment of brain dead Effect of resting state functional connectivity pattern, to further explore the possible mechanism of cognitive improvement. Results: 1, compared with the control group, the control group after treatment right cingulate gyrus and left frontal gyrus / middle temporal gyrus / orbital frontal gyrus, right inferior frontal gyrus and enhanced connection, right middle frontal gyrus, parahippocampal gyrus connection decreased; left cingulate gyrus and left temporal lobe (temporal gyrus, inferior temporal gyrus, cerebellum) increased functional connectivity of.2, compared with the control group, after treatment, right posterior cingulate and left inferior parietal lobule, right occipital gyrus / hippocampus / inferior frontal gyrus increased functional connectivity, and the right side of the parahippocampal gyrus / orbital superior frontal gyrus / medial frontal gyrus / back function frontal weakening connection: the left posterior cingulate cortex and right cerebellum / inferior temporal gyrus / superior temporal gyrus, left inferior temporal gyrus / hippocampus / superior temporal gyrus / back temporal connection enhancement, connected with the left inferior parietal lobule / medial frontal gyrus / dorsolateral frontal gyrus function .3 decreased, compared with the control group, Huayu Tongluo mixture intervention in January after the MoCA score of treatment group increased significantly, that of Huayutongluo decoction has curative effect to improve cognition. Conclusion: Huayutongluo Decoction improve the curative effect of cognitive dysfunction caused by cerebral small vessel disease, improve the cognitive impairment mechanism is not clear. Compared with blank control group. After treatment, cognitive improvement may be associated with brain regions (e.g., parietal lobe, occipital lobe, hippocampus, part of frontotemporal enhancement is related to the function of network connection), especially enhance the default network connectivity, but due to limitations need to be confirmed further research on the topic of their own.

【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】：2016
【分類號(hào)】：R277.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 江林;張?bào)w江;;靜息態(tài)fMRI在神經(jīng)精神疾病中的研究進(jìn)展[J];國(guó)際醫(yī)學(xué)放射學(xué)雜志;2015年02期

2 馬思懿;張宗軍;;皮質(zhì)下血管性認(rèn)知功能障礙的腦默認(rèn)網(wǎng)絡(luò)靜息態(tài)功能磁共振研究[J];醫(yī)學(xué)影像學(xué)雜志;2015年02期

3 賈俊棟;岳衛(wèi)東;;腦小血管病研究進(jìn)展[J];中國(guó)現(xiàn)代神經(jīng)疾病雜志;2015年02期

4 肖向建;呂佩源;;靜息態(tài)功能磁共振在認(rèn)知障礙中的應(yīng)用[J];國(guó)際神經(jīng)病學(xué)神經(jīng)外科學(xué)雜志;2014年05期

5 韓利坤;姚婧t，

本文編號(hào)：1435325