原发性闭角型青光眼患者手术前后初级视觉皮层功能连接的静息态fMRI研究

发布时间：2018-03-30 23:12

本文选题：原发性闭角型青光眼　切入点：静息态功能磁共振　出处：《南昌大学》2017年硕士论文

【摘要】：目的:本研究应用静息态功能磁共振(resting-state functional MRI,rs-fMRI)技术研究原发性闭角型青光眼(primary angle-closure glaucoma,PACG)患者小梁网联合周边虹膜切除手术前后初级视觉皮层(primary visual cortex,V1)功能连接的变化情况,旨在为PACG患者术前中枢损害机制提供功能影像证据及提高对其术后功能重塑的认识。方法:收集临床确诊的手术前PACG患者(pre-PACG组)及年龄、性别相匹配的健康对照组(HCs组)进行3T磁共振T1结构像及静息态血氧水平依赖功能磁共振(BOLD-fMRI)扫描,最终纳入pre-PACG组和HCs组各25例进行rs-fMRI分析,其中9例PACG患者手术后3个月(post-PACG组)复查rs-fMRI。数据经预处理后,以左、右侧V1中心区作为种子点,分别计算其与全脑体素时间序列的相关性并比较组间静息态功能连接的差异,pre-PACG组与HCs组组间差异采用两独立样本t检验,采用配对样本t检验分析post-PACG组与pre-PACG组组间差异。同时,分析pre-PACG组显著差异脑区功能连接系数与其临床变量的相关性。结果:1、与HCs组相比,pre-PACG组与左侧V1功能连接减低的脑区包括右侧高级视觉皮层(V2,包括右侧楔叶,距状皮层、舌回)和右侧后扣带回。与左侧V1功能连接增强的脑区包括左侧颞顶区,左侧及右侧岛盖-脑岛-基底节区,及右侧顶下小叶。2、与pre-PACG组相比,post-PACG组与左侧V1功能连接增强的脑区包括双侧V2(左侧楔前叶,楔叶,右侧枕上回),左侧及右侧中央后回,顶下小叶。而左侧前额叶皮层及右侧小脑后叶与左侧V1功能连接减低。3、在Pre-PACG组,左侧颞顶区与左侧V1功能连接与视敏度(Visual acuity,VA)呈正相关,右侧顶下小叶与左侧V1功能连接与VA呈正相关。4、在pre-PACG和post-PACG患者,右侧V1功能连接改变与左侧V1功能连接改变模式基本相同。结论:1、与正常对照者相比,PACG患者存在初-高级视觉皮层通路视觉信息功能整合的下降,同时存在与视敏度相关的功能代偿。为进一步理解PACG患者的中枢损害机制提供思路。2、与术前相比,PACG患者术后表现出初-高级视觉皮层通路视觉信息整合功能的增加,可能为局部脑功能重塑。为探索PACG患者的术后脑功能转归提供线索。
[Abstract]:Objective: to study the changes of functional junctions of primary visual cortexus V1 in primary angle-closure glaucoma patients before and after primary angle-closure glaucoma.com (PACGG), using resting functional magnetic resonance imaging (resting-state functional MRIr rs-f MRI) technique. The purpose of this study was to provide functional imaging evidence for preoperative central nervous system damage in patients with PACG and to improve their understanding of functional remodeling after operation. Methods: the pre-PACG patients with pre-PACG were collected and their ages were collected. Sex matched healthy control group (HCs group) were examined by 3T Mr T1 structure imaging and resting blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI), and 25 cases in pre-PACG group and 25 cases in HCs group were included in rs-fMRI analysis. In 9 patients with PACG, after 3 months post-PACG), the data of rs-f MRI. were pretreated, and the left and right central V1 regions were used as seed points. To calculate the correlation with the whole brain voxel time series and to compare the differences of resting functional junctions between pre-PACG group and HCs group, two independent samples t test were used to analyze the difference between post-PACG group and pre-PACG group by paired sample t-test, and the difference between pre-PACG group and pre-PACG group was analyzed. Results: compared with HCs group, the decreased functional connectivity between pre-PACG group and left V1 group included V2 in the right advanced visual cortex, including right cuneate lobe and talar cortex. The right posterior cingulate gyrus and the right posterior cingulate gyrus. The regions with enhanced V1 function include the left temporal parietal region, the left and right insular tectone-insular insular basal ganglia, and the right posterior cingulate gyrus. Compared with the pre-PACG group, the right inferior parietal lobule. The areas in which the functional connections between post-PACG group and left V1 were enhanced included bilateral V2 (left precuneal lobe, cuneiform lobe, right superior occipital gyrus, left and right posterior central gyrus). In the Pre-PACG group, the functional connections between the left temporoparietal region and the left V1 were positively correlated with visual acuity. The right inferior parietal lobule and left V1 functional connection were positively correlated with VA. 4, in pre-PACG and post-PACG patients, The changes of right V1 functional connections were similar to those of left V1 functional connections. Conclusion: compared with the normal controls, the visual information integration of the primary and advanced visual cortex pathway decreased in the patients with PACG, and the changes of the right V1 functional connections were similar to those of the left V1 functional connections. At the same time, there are functional compensations related to visual acuity. 2. To further understand the mechanism of central lesion in PACG patients, compared with preoperative and postoperative patients, the visual information integration function of primary and advanced visual cortex pathway is increased. It may provide clues for local brain function remodeling and for exploring the outcome of postoperative brain function in patients with PACG.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R779.6

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