帕金森病伴嗅觉障碍患者脑结构和脑功能改变的MRI评价

发布时间：2018-01-14 18:15

  本文关键词：帕金森病伴嗅觉障碍患者脑结构和脑功能改变的MRI评价　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 帕金森病 嗅觉障碍 结构磁共振 灰质体积 功能磁共振 功能连接

【摘要】：背景和目的帕金森病是一种常见的中枢神经系统变性疾病,多见于中老年人,平均发病年龄约为60岁。其临床表现主要包括静止性震颤、运动迟缓和肌强直等,同时患者可伴有嗅觉障碍、睡眠障碍和认知障碍等非运动症状。帕金森病患者不能治愈和逆转,患者晚期容易失去独立自主能力,给家庭及社会造成严重负担。嗅觉功能障碍是帕金森病患者最常见的前期临床非运动症状之一。帕金森病患者的嗅觉磁共振研究有助于其临床早期诊断、鉴别诊断以及发病机制的探究,具有重要的研究意义和临床诊断价值。近年来研究者们使用磁共振各种成像技术,发现了帕金森病伴嗅觉障碍患者存在脑结构和脑功能的改变。本研究采用高分辨磁共振成像技术、基于体素的形态学分析(VBM)及功能连接(FC)相结合的分析方法,探究帕金森病伴嗅觉障碍患者的嗅球、大脑灰质结构及脑功能的变化。材料与方法本研究共收集56例帕金森病伴嗅觉障碍患者和43例年龄、性别相匹配的正常对照。采用Prisma 3.0 T磁共振扫描仪对所有被试进行高分辨磁共振成像(T2-spc-cor)序列、3D-T1WI结构像(T1-mprage)序列和静息态功能磁共振(rs-fMRI)序列扫描。扫描时尽可能固定住被检查者的头部,同时嘱其闭眼、保持清醒、精神放松、全身静止。1.在T2-spc-cor序列图像上逐层手工勾画出嗅球轮廓,各层面内嗅球面积乘以层厚相加得到嗅球体积,每例均测量3次取平均值。2.采用基于Matlab平台的SPM8软件对3D-T1WI结构像行预处理:分割配准、空间标准化、重采样和空间平滑。3.采用DPARSFA和SPM8软件对rs-fMRI数据进行后处理。选取两组大脑灰质体积有差异的脑区作为ROI,然后与全脑进行静息态功能连接分析。4.统计学分析:运用SPSS 19.0软件,对病例组和对照组的嗅球体积行两独立样本t检验。运用Spearman相关分析法对嗅球体积结果和临床指标的相关性进行分析。采用SPM8软件进行两独立样本t检验,分别比较病例组和对照组大脑灰质体积及静息态功能连接的差异。各统计分析过程以α=0.05为检验水准,当P0.05时,认为差异有统计学意义。结果1.帕金森病伴嗅觉障碍组的左、右侧及平均嗅球体积,与正常对照组相比明显减小,差异有统计学意义(t值分别为-3.804,-4.945,-4.593,P均0.05);与临床病程、H-Y分级、UPDRS总分均未发现相关关系(P均0.05);与嗅觉测试分值呈正相关(P0.05)。2.与正常对照组相比,帕金森病伴嗅觉障碍组的双侧颞上回(STG)灰质体积(GMV)显著减小(P0.05,cluster size1004voxels)。3.将双侧颞上回(STG)作为感兴趣区(ROI)进行全脑体素水平的静息态功能连接分析,发现帕金森病伴嗅觉障碍组左侧颞上回(STG)与右侧中央前回(MPG)、右侧枕中回(MOG)的rs FC减低(P0.05,cluster size139voxels)。结论1.帕金森病伴嗅觉障碍患者嗅球体积明显减小,嗅球体积定量分析有助于帕金森病嗅觉障碍的评估,为临床诊断提供帮助。2.帕金森病伴嗅觉障碍患者较正常人存在脑内嗅觉相关区域的结构和功能异常,主要表现为灰质体积萎缩和功能连接减弱。
[Abstract]:Background and objective: Parkinson's disease is a common neurodegenerative disease, more common in the elderly, the average age is about 60 years old. The main clinical manifestations include resting tremor, bradykinesia and myotonia, while patients with olfactory dysfunction, sleep disorders and cognitive impairment in patients with no other non motor symptoms. Parkinson's disease cure and reversion, patients with advanced easy to lose independent ability, a serious burden to family and society. It is the most common clinical early olfactory dysfunction in patients with Parkinson's disease. One of the non motor symptoms of olfactory magnetic resonance imaging study in patients with Parkinson's disease may contribute to the early clinical diagnosis, differential diagnosis and explore the pathogenesis, clinical and the diagnostic value of significance. The researchers used magnetic resonance imaging technology in recent years, found Parkinson's disease with olfactory dysfunction The brain structure and brain function change. This study uses high resolution magnetic resonance imaging, voxel based morphometry (VBM) and functional connectivity (FC) analysis method combining the study of Parkinson disease with the olfactory bulb, changes in brain gray matter structure and brain function. Materials and methods of this data were collected from 56 cases of Parkinson disease with olfactory dysfunction patients and 43 age and sex matched normal controls. Using Prisma 3 T magnetic resonance scanner. All of the subjects were high resolution magnetic resonance imaging (T2-spc-cor) sequence, 3D-T1WI like structure (T1-mprage) sequence and resting state functional magnetic resonance imaging (rs-fMRI) sequences. Scanning as much as possible to fix the head of the inspector is, at the same time have their eyes closed, stay awake, relax, the body still.1. in the T2-spc-cor sequence image layer manually outline the olfactory bulb outline, each level within the area multiplied by the layer of olfactory bulb The thickness can be obtained by adding the olfactory bulb volume were measured 3 times the average.2. Matlab platform using SPM8 software based on 3D-T1WI structure as the preprocessing: segmentation and registration, spatial normalization, resampling and spatial smoothing.3. using the rs-fMRI data DPARSFA and SPM8 software. The postprocessing selects two groups of brain gray matter volume the differences in brain regions as ROI, then.4. was employed to analyze the resting state functional connectivity analysis and whole brain: the use of SPSS 19 software, olfactory bulb volume of the patients and the control group of two independent samples t test. Correlation analysis using Spearman correlation of olfactory bulb volume results and clinical indicators were analyzed by two independent. Sample t test using SPM8 software were compared between cases and group differences in brain gray matter volume and resting state functional connectivity control. The process of statistical analysis to test the level of a =0.05, when P0.05, that difference There was statistical significance. Results of the 1. patients with Parkinson's disease olfactory disorder group left, right and average olfactory bulb volume, compared with the normal control group was significantly decreased, the difference was statistically significant (t = -3.804, -4.945, -4.593, P 0.05); and the clinical course, H-Y grade, UPDRS score were not found the relationship (P 0.05); positively correlated with olfactory test scores (P0.05.2.) compared with the normal control group, Parkinson disease with olfactory disorder group bilateral superior temporal gyrus (STG) gray matter volume (GMV) decreased significantly (P0.05, cluster size1004voxels).3. double lateral temporal gyrus (STG) as a region of interest (ROI) analysis on the connection of the resting state functional whole brain voxel level, found Parkinson's disease with olfactory dysfunction group (STG) and the left superior temporal gyrus, right precentral gyrus (MPG), right middle occipital gyrus (MOG) of RS FC (P0.05 cluster size139voxels) decreased. Conclusion 1. with Parkinson's disease patients with olfactory disorder of olfactory bulb The volume of olfactory bulb volume decreased significantly, the quantitative evaluation is helpful to olfactory dysfunction of Parkinson's disease, Parkinson's disease with.2. to help patients with olfactory disorders than normal people are the structure and function of brain olfactory related regional abnormalities for clinical diagnosis, mainly for the volume of gray matter atrophy and decreased functional connectivity.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5;R445.2
，

本文编号：1424734