不同部位皮层下运动通路中风脑结构改变的MRI研究

发布时间：2018-03-09 14:11

本文选题：皮层下中风　切入点：运动通路　出处：《天津医科大学》2017年博士论文　论文类型：学位论文

【摘要】：研究背景及目的:中风是世界范围内仅次于冠心病的第二位致死原因。中风后,梗死灶的位置往往差异很大,这种病灶位置的差异被认为与患者的功能预后相关。基底节区中风与脑桥中风虽然都可能损伤皮层下运动通路,但二者累及的邻近的脑内结构不同。大量研究证实,中风慢性期继发性脑结构损伤与可塑性是并存的。本研究的目的是通过比较慢性期基底节区中风、脑桥中风及正常被试继发性脑结构损伤及可塑性,得到不同部位皮层下运动通路中风隐匿性脑损害模式与神经康复机制的差异。研究内容及方法:在这个前瞻性的研究中,MRI数据的采集来源于国内三家三级甲等医院的四台磁共振扫描仪。所有被试在实验前都获知情同意,自愿参加实验,并经天津医科大学总医院伦理委员会批准。基于严格的入组标准及排除标准,115名基底节区中风(capsular stroke,CS)患者、47名脑桥中风(pontine stroke,PS)患者及116名正常被试(normal control,NC)进入最终的统计学分析。评估被试的神经功能并测量中风患者的梗死灶体积。所有被试的MRI数据经预处理后进行统计学分析。根据梗死灶的位置,将所有中风患者分为左侧病灶组和右侧病灶组,分别进行基于体素的形态学分析(voxel-based morphometry,VBM),比较组间灰质体积(gray matter volume,GMV)的差异。并进一步将上述VBM分析的结果中GMV有显著差异的团块定义为感兴趣区(regions of interest,ROI),提取每个ROI的GMV值并定量地进行组间比较,进行基于体素的事后分析(ROI分析)。本文的三部分内容分别进行如下研究:1、应用独立样本T检验,比较CS与NC之间GMV的差异。2、应用独立样本T检验,比较PS与NC之间GMV的差异。3、应用单因素协方差分析,比较CS、PS与NC之间GMV的差异。最后应用基于表面的形态学分析方法Freesurfer比较GMV的组间差异,对VBM分析的结果进行验证。在Freesurfer分析中GMV有显著组间差异且团块位置与前述VBM分析结果一致的团块定义为ROI,进行基于表面的事后分析,定量评价每个ROI的GMV、皮层厚度(cortical thickness,CT)及皮层表面积(surface area,SA)的组间差异。结果:1、左侧及右侧病灶组CS患者病灶同侧感觉运动皮层(sensorimotor cortex,SMC)GMV均减低;右侧CS患者双侧小脑的GMV显著减低,而病灶对侧额中回及双侧辅助运动区(supplementary motor area,SMA)的GMV增加。2、在左侧及右侧病灶组,PS患者均表现为双侧小脑的GMV显著减低。左侧病灶组中PS患者双侧SMA的GMV增加。右侧病灶组中PS患者双侧前岛叶皮层GMV显著减低,但双侧旁中央小叶及病变同侧额中回GMV增加。3、在左侧和右侧病灶组中,CS和PS患者都表现为病灶同侧前岛叶皮层GMV的减低及双侧SMA的GMV的增加。CS患者表现为病灶同侧SMC的GMV减低,而PS患者表现为双侧小脑GMV的减低。此外,左侧病灶组PS患者还表现为楔前叶GMV的增加,右侧病灶组CS患者表现为病灶同侧额中回GMV的增加。4、在Freesurfer分析的结果中,有3个GMV有显著差异的团块与VBM分析结果的位置是一致的(包括左侧病灶组中病灶同侧SMC,右侧病灶组中病灶同侧SMC及病灶同侧前岛叶皮层)。其中,在左侧病灶组病灶同侧SMC,CS及PS患者的GMV及CT均显著下降。在右侧病灶组病灶同侧SMC,CS患者的GMV、CT及SA都减低。在右侧病灶组病灶同侧前岛叶皮层,CS患者的GMV,CT及SA均减低,且PS患者的GMV及SA减低。结论:1、基底节区中风患者的继发性损伤主要存在于感觉运动区,而脑桥中风患者主要表现为小脑的萎缩,提示这两种不同部位皮层下中风患者继发性结构损伤的解剖结构是不同的。2、基底节区中风与脑桥中风患者辅助运动区的灰质体积都增加,提示在这两种不同部位皮层下中风患者都可以将辅助运动区作为康复治疗一个潜在的靶点。3、虽然都累及运动通路,基底节区与脑桥中风患者都表现为认知相关脑区的结构损伤与重塑,可能为临床评估和监测中风后的认知功能提供一个新方法。4、基底节区中风患者与脑桥中风患者继发性脑结构损伤及可塑性的模式是存在差异的,这种差异可能为不同部位皮层下运动通路中风患者更有针对性的个体化康复治疗措施的制订提供理论支持。
[Abstract]:Background and objective: stroke is the second leading cause of death worldwide after coronary heart disease. After a stroke, the infarct location often differ greatly, the difference of the location of the lesion was associated with prognosis. The function of patients with basal ganglia stroke and pons stroke may although subcortical motor pathway damage, but the two involved the adjacent brain structures are different. A number of studies have demonstrated that the chronic stage of apoplexy secondary brain injury and structural plasticity coexist. The purpose of this study is to compare the chronic stroke in basal ganglia, pons stroke and normal subjects in secondary brain damage and plasticity, differences in motor pathways of occult brain damage in stroke model and neural rehabilitation mechanism in different parts of the cortex. The research contents and methods: in this prospective study, MRI data collection from three domestic three hospitals in four A magnetic resonance scanner. All of the subjects in the experiment are given informed consent, participated in the experiment voluntarily, and approved by the ethics committee of General Hospital Affiliated to Tianjin Medical University. Inclusion criteria and exclusion criteria strictly based on the 115 basal ganglia stroke (capsular stroke, CS) patients, 47 cerebral stroke bridge (pontine stroke, PS) and patients 116 normal subjects (normal, control, NC) into the final statistical analysis. The evaluation subjects and measurement of nerve function in patients with stroke infarct volume. All of the subjects of the MRI data after pretreatment were analyzed. According to the location of the infarction foci, all stroke patients were divided into left and right lesion group focus groups were voxel based morphometry (voxel-based, morphometry, VBM) were compared between gray matter volume (gray matter volume, GMV). The differences and further the analysis results of VBM in GMV has a significant difference The same as the mass defined region of interest (regions of, interest, ROI, ROI) from each of the GMV value and the quantitative comparison between groups, after the voxel based analysis (ROI analysis). The three part of this paper are as follows: 1, independent samples T test was used to compare the difference between CS NC and GMV.2, independent samples T test was used to compare the difference between PS and NC GMV.3, CS analysis, comparison of covariance using the single factor, the difference between PS and NC GMV. Finally the application based on the difference in surface morphology analysis method of Freesurfer GMV group, to verify the results of VBM analysis. Freesurfer analysis in GMV analysis has significant difference between the groups and the mass position and results of VBM mass define a consistent ROI, after the analysis of the surface based on the quantitative evaluation of each ROI GMV, cortical thickness (cortical thickness, CT (surface) and cortical surface area Area, SA) the difference between the groups. Results: 1, left and right side group. Patients with CS lesion ipsilateral sensorimotor cortex (sensorimotor, cortex, SMC) GMV were decreased in CS patients; the right cerebellum GMV was significantly decreased, and the lesions in the back side and bilateral supplementary motor area (supplementary motor area, volume SMA GMV) increased.2 in the left and right lesion group, PS patients showed bilateral cerebellar lesions. GMV was significantly decreased in the group of PS patients with bilateral left SMA GMV. Right side in the group of PS patients with bilateral anterior insular cortex GMV was significantly decreased, but the bilateral paracentral lobule and ipsilateral frontal gyrus GMV.3, on the left and right lesion group, CS and PS patients showed reduction of ipsilateral and bilateral SMA lesions anterior insular cortex GMV GMV increased.CS patients showed ipsilateral SMC lesions reduced GMV and PS patients showed reduction of bilateral cerebral GMV. In addition, the left The lesion group of PS patients also showed increased leaf GMV CS patients with right precuneus, lesion group showed GMV ipsilateral to the lesion volume increased in.4, in the results of Freesurfer analysis, and mass VBM analysis results of 3 GMV had significant difference in position is consistent (including left infarction lesions SMC in the same side, right side group lesion ipsilateral SMC and ipsilateral anterior insular cortex lesions). Among them, in the left infarction lesion ipsilateral SMC, GMV and CT, CS and PS were significantly decreased. In the right side were the ipsilateral SMC, CS with GMV, CT and SA were decreased on the right side. The lesions were ipsilateral anterior insular cortex in patients with CS, GMV, CT and SA were reduced, and the GMV and SA of PS patients decreased. Conclusion: 1. The secondary injury of basal ganglia stroke mainly exists in the sensorimotor cortex, and pons stroke patients mainly manifested as cerebellar atrophy, suggesting that the two different parts of the skin The anatomical structure of injury in stroke patients secondary structure layer under different.2, the gray matter volume of basal ganglia stroke and the stroke patients in the supplementary motor area have increased, suggesting that in these two different parts of the subcortical stroke patients can be the supplementary motor area as the rehabilitation of a potential target of.3, although all involved the path of movement, basal ganglia and pons stroke patients showed the structure damage and remodeling of brain regions related to cognition, may provide a new method for.4 clinical assessment and monitoring of cognitive function after stroke, basal ganglia stroke patients with pontine stroke patients with secondary brain damage and plasticity model is different this difference may, for different parts of subcortical motor pathway in stroke patients and provide theoretical support for a more individualized rehabilitation measures of.

【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R445.2;R743.3

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