基于静息态BOLD-fMRI卒中后运动性失语患者脑功能可塑性的研究

发布时间：2018-05-21 07:13

本文选题：卒中 + 运动性失语症　；参考：《石河子大学》2017年硕士论文

【摘要】：第一部分基于ReHo的静息态BOLD-fMRI在卒中后运动性失语患者的研究目的:采用ReHo的方法研究卒中后运动性失语患者(发病7天内和康复1月后)和无失语患者在静息状态下局部脑区活动的差异,探讨脑卒中后运动性失语患者康复前后的脑功能区变化情况。方法:失语组根据纳入标准选取12例卒中后运动性失语症患者,男性6例,女性6例,平均年龄57.75±7.71岁,其中6例患者1月后行第二次fMRI检查,男性4例,女性2例,平均年龄61.5±8.34岁;对照组10例,男性5例,女性5例,平均年龄59.2±7.08岁。静息态数据均采用西门子3.0T磁共振扫描仪进行扫描获得,应用SPM8和DPARSF软件对数据预处理,去除每一位被试的前10个时间点以保证数据的稳定性。数据处理包括时间校正、头动校正、空间标准化、消除线性趋势、消除低频漂移及高频噪声。ReHo计算是采用肯德尔系数(Kendall's coefficient of concordance,KCC))对团块(采用27个体素)进行时间序列变化一致性进行度量,得到每个被试的KCC脑,然后通过对每个体素的KCC划分,把KCC脑进行ReHo图标准化,最后进行空间平滑。ReHo统计分析在REST软件里完成,对失语组和对照组患者分别行配对和两样本t检验,采用Slice Viewer生成激活图进行查看(P0.05,Alphasim校正,体素大小58 voxels)相关的脑区激活图。结果:本实验经过预处理,排除2例头动过大的患者,最终得到失语组患者10例;排除3例中途退出和1例头动过大的患者,康复1月后6例失语组患者行第二次fMRI检查;对照组10例。失语组患者(发病7天内)ReHO高于对照组的脑区有左侧小脑、左侧枕叶和右侧颞中回,ReHO低于对照组的脑区有左侧前额叶内侧回、左侧额上回、左侧额中回、左侧角回、左侧顶叶、右侧枕叶、右侧角回、右侧缘上回、双侧顶上小叶和顶下小叶;失语组(康复1月后)ReHO高于对照组的脑区有左侧额下回岛盖部、左侧楔前叶、左侧中央前回、左侧顶上小叶、左侧额中回、右侧海马旁回和右侧角回,低于对照组的脑区有左侧小脑、左侧额上回、左侧内囊前肢、右侧额中回、右侧顶叶和双侧顶下小叶;失语组患者康复前后对比的ReHO结果显示,相对失语组(发病7天内)患者,激活增高的脑区为左侧中央前回和左侧顶上小叶。结论:1、左侧前额叶内侧回、左侧额上回、左侧额中回、左侧角回、左侧顶叶、右侧角回、右侧缘上回、右侧枕叶、双侧顶上小叶和顶下小叶的ReHo 信号在失语组(发病7天内)减低,提示这些脑区出现了功能改变,可能与大脑局部病灶影响神经元的活动有关。2、左侧额下回岛盖部、左侧楔前叶、左侧中央前回、左侧顶上小叶、左侧额中回、右侧海马旁回和右侧角回的ReHo信号在失语组康复1月后增高,在失语恢复期这些功能脑区神经元活性增高,可能对语言的恢复起一定的代偿作用。3、对于卒中后运动性失语症患者,急性期出现右侧大脑半球的功能脑区激活增多,而在恢复期患者则出现左侧大脑半球病灶周围未受损脑区的激活增多,同时右侧大脑半球的激活减少,这种变化考虑失语后脑功能恢复机制是急性期以右侧大脑半球的代偿为主,恢复期以左侧大脑半球病灶周围未损伤脑区的功能重组为主,是两侧大脑半球共同作用的结果。第二部分基于FC的静息态BOLD-fMRI在卒中后运动性失语患者脑功能可塑性的研究目的:采用种子点功能连接方法分析卒中后运动性失语患者脑功能区的功能连接变化,探讨运动性失语患者脑功能区的可塑性变化机制。方法:采用第一部分预处理后的数据,然后去除协变量,主要为去除头动、全脑信号、白质信号和脑脊液对低频同步振荡信号的影响。根据第一部分的结果选择左侧额中回(LMFG)后部作为感兴趣区(ROI),ROI种子点的坐标为MNI(-40,10,55),用REST中的slice viewer生成一个覆盖58体素的Mask,然后以ROI中各体素时间信号的平均值作为ROI的时间信号,通过分析ROI与全脑各体素的时间序列得到Pearson相关图。在REST中分别采用单样本、两样本或配对t检验进行组内或组间分析,得到统计参数图叠加到REST软件中的Slice Viewer的MNI标准模板脑,生成功能连接图,查看相关强度的大小。结果:静息状态下,失语组(发病7天内)与LMFG-ROI正相关的脑区有右侧额中回、右侧额下回,失语组(发病7天内)与 LMFG-ROI负相关的脑区有左侧小脑、左侧扣带回后部、左侧外囊、左侧岛叶、左侧枕叶、左侧顶上小叶;失语组(康复1月后)与LMFG-ROI正相关的脑区有左侧额中回、额下回、左侧额上回、左侧岛叶皮质、左侧内囊,失语组(康复1月后)与LMFG-ROI负相关的脑区有左侧小脑、右侧颞叶、右侧岛叶、右侧中央后回、双侧扣带回、双侧枕叶;与对照组相比,失语组(发病7天内)与LMFG-ROI功能连接增强的脑区有右侧岛叶、右侧额顶叶岛盖部、右侧额下回(三角部、眶部)、右侧颞上回和颞中回、右侧缘上回、右侧角回,功能连接减少的脑区有左侧扣带回后部、左侧楔前叶;与对照组相比,失语组(康复1月后)与LMFG-ROI功能连接增强的脑区有左侧尾状核头部、左侧额中回和额下回、左侧苍白球、左侧中央前回和中央后回、左侧岛叶,功能连接减少的脑区有左侧扣带回后部、左侧小脑、右侧海马、右侧舌回、右侧枕叶、右侧楔前叶;与失语组(发病7天内)患者相比,失语组(康复1月后)功能连接增强的脑区有左侧额中回、左侧额顶叶岛盖、左侧中央前回和中央后回,功能连接减低的脑区有右侧颞上回、右侧颞中回、右侧岛叶、右侧缘上回。结论:1、对于卒中后运动性失语症患者,急性期与LMFG-ROI功能连接正相关明显的脑区在右侧大脑半球,提示这可能是大脑损伤后机体出现的代偿反应。2、失语患者康复1月后与与LMFG正相关明显的脑区主要在病灶周围未受损脑区,提示功能脑区的代偿机制出现了转移,与ROI功能连接增强的脑区从右侧大脑半球转移到左侧大脑半球,考虑左侧半球损伤后失语的恢复机制包括急性期右侧半球功能脑区的代偿激活和恢复期左侧大脑半球病灶周围未受损脑区的激活,这也可能是大脑功能恢复的主要机制。3、无论是失语急性期还是恢复期,均出现了左侧扣带回后部的激活减低,考虑这是卒中后运动性失语发生的关键脑区。
[Abstract]:The first part of the study based on ReHo's resting state BOLD-fMRI in patients with poststroke motor aphasia: the ReHo method was used to study the difference in the local brain activity in the patients with apoplexy aphasia (7 days after the onset and after January) and the silent patients in the resting state. Methods: according to the inclusion criteria, the aphasia group selected 12 patients with poststroke motor aphasia, 6 males and 6 females, with an average age of 57.75 + 7.71 years, of which 6 patients underwent second fMRI examinations after January, 4 men and 2 women, with an average age of 61.5 + 8.34 years, and the control group 10, male 5, female 5, average age and average age. 7.08 years of age. Resting state data are scanned by SIEMENS 3.0T MRI scanner. SPM8 and DPARSF software are used to preprocess data to remove the first 10 time points of each person to ensure the stability of the data. Data processing includes time correction, head motion correction, spatial standardization, elimination of linear trends, low frequency drift and high The frequency noise.ReHo calculation uses the Kendall coefficient (Kendall's coefficient of concordance, KCC) to measure the conformance of the time series change of the mass (using 27 individual elements), get the KCC brain of each test, and then standardize the ReHo diagram of the KCC brain by dividing the KCC of each voxel, and finally carry out the spatial smoothness.ReHo statistical score. In the REST software, the patients were paired with the aphasia group and the control group, and the patients in the control group were paired and two samples t test respectively. The activation map of the Slice Viewer generated activation map was used to examine the brain area activation map (P0.05, Alphasim correction, voxel size 58 voxels). Results: the experiment was pretreated to exclude 2 patients with oversize head, and finally get 10 of the aphasia group. Cases of 3 cases of Midway withdrawal and 1 cases of high head movement were excluded, and second times of fMRI examination were performed in 6 cases of aphasia after January, and 10 cases in the control group. The ReHO in the aphasia group (7 days of onset) was higher than that of the control group with left cerebellum, left occipital lobe and right medial temporal gyrus, and ReHO in the brain area of the control group with the medial frontal gyrus of the left prefrontal lobe and the left upper part of the brain. Gyrus, left frontal gyrus, left angular gyrus, left parietal lobe, right occipital lobe, right angular gyrus, right margin of upper gyrus, bilateral upper lobule and inferior parietal lobule. The aphasia group (after rehabilitation January) was higher than the control group with left inferior frontal gyrus, left anterior cuneate, left precentral gyrus, left superior lobule, left middle frontal gyrus, right parahippocampal gyrus and right side. In the angular gyrus, the cerebral area of the control group had the left cerebellum, the left superior frontal gyrus, the left inner capsule forelimb, the right frontal gyrus, the right parietal lobe and the bilateral inferior parietal lobule. The results of the ReHO in the aphasia group before and after the rehabilitation showed that the relative aphasia group (7 days of onset) activated the higher brain area to the left precentral gyrus and the left superior lobule. Conclusion: 1, left The medial prefrontal gyrus, left superior frontal gyrus, left frontal gyrus, left angular gyrus, left parietal lobe, right angular gyrus, right margin of upper gyrus, right occipital lobe, bilateral apical lobule and inferior lobular ReHo signal decreased in aphasia group (7 days of onset), suggesting that these brain areas were altered and may affect neuronal activity with local lesions of the brain. .2, left inferior frontal gyrus, left anterior lobe, left anterior central gyrus, left parietal gyrus, left parietal lobule, left middle frontal gyrus, right lateral frontal gyrus, right hippocampal gyrus and right angle gyrus, increased in the aphasia group after January. In the aphasia recovery period, the neuronal activity of these functional brain regions increased, which might be a compensatory function of.3 for the recovery of language. In the patients with moderate and posterior motor aphasia, the activation of the functional brain area in the right hemisphere increases in the acute stage, while in the recovery period the activation of the undamaged brain area around the left hemisphere is increased and the activation of the right hemisphere decreases. This change considers the mechanism of the recovery of the brain function after aphasia is in the acute phase of the right brain. The compensatory hemisphere is the main part of the recovery period with the functional reorganization of the undamaged brain regions around the left hemisphere of the cerebral hemisphere, which is the result of the joint action of the bilateral cerebral hemispheres. The second part of the resting state BOLD-fMRI based on FC in the study of the cerebral function plasticity in the patients with motor aphasia after stroke: using the seed point function connection method to analyze the stroke The function connection of the brain functional area of the patients with post motor aphasia was changed to explore the mechanism of the plasticity of the functional area of the motor aphasia. Methods: the first part of the pre processed data was used to remove the covariate, which was mainly to remove the head movement, the whole brain signal, the white matter signal and the cerebrospinal fluid on the low frequency synchronous oscillation signal. In part, the posterior part of the left middle frontal gyrus (LMFG) is selected as the region of interest (ROI), the coordinates of the ROI seed point are MNI (-40,10,55), and a Mask of 58 voxel is generated by slice viewer in REST, and then the mean value of the time signal of each voxel in ROI is used as a ROI time signal, and the time series of the ROI and the whole brain is obtained by analyzing the time series of the whole brain voxel. Arson correlation diagram. In REST, single sample, two sample or paired t test were used to carry out intra group or inter group analysis. The MNI standard template brain of Slice Viewer in REST software was superimposed on the statistical parameter map, and the function connection graph was generated and the relative intensity was examined. Results: in resting state, the aphasia group (7 days of onset) was positively related to LMFG-ROI. The brain area had the right frontal gyrus and the right frontal gyrus, and the aphasia group (7 days after the onset) had the left cerebellum, the left cingulate gyrus, left lateral cingulate, left insula, left occipital lobe, left superior lobule, and the brain area associated with LMFG-ROI in the aphasia group (after January) had the left middle frontal gyrus, the lower frontal gyrus, left upper frontal gyrus, left side, left side, left side, left side, left side, left side, left side, left side of frontal gyrus, left left upper frontal gyrus, left side, left side, left side of the left side, left upper frontal gyrus, left side, left side of the left side, left upper frontal gyrus, left left side, left left upper frontal gyrus, left side, left left side of the brain area The insula cortex, left internal capsule, and aphasia group (after January rehabilitation) had the left cerebellum, right temporal lobe, right Island lobe, right posterior central gyrus, bilateral cingulate gyrus, bilateral occipital lobe, and the brain area with the LMFG-ROI function connection enhanced with the control group, the right frontal parietal insula, right side, right frontal parietal insula, right side, and the right side were compared with the control group. Lower frontal gyrus (triangle, orbital), right superior temporal gyrus and middle temporal gyrus, right margin of upper gyrus, right angular gyrus, left cingulate gyrus and left anterior wedge of the left cingulate cortex. Compared with the control group, the brain area of the aphasia group (after recovery January) has the left caudate nucleus, left middle frontal gyrus and inferior frontal gyrus, and left paleness of the left side of the brain. Ball, left anterior central gyrus and posterior central gyrus, left insula, functional connection reduced brain area with left cingulate gyrus, left cerebellum, right hippocampus, right lingual gyrus, right occipital lobe, right anterior wedge. Compared with aphasia group (7 days of onset), the aphasia group (after January rehabilitation) has the left middle frontal gyrus, left frontal parietal lobe island. The brain areas with lower functional connectivity include right right temporal gyrus, right temporal gyrus, right Island lobe, right margin upper gyrus. Conclusion: 1, in patients with postapoplexy aphasia, acute phase with LMFG-ROI function connection is positively related to the right hemisphere in the brain area, suggesting that this may be the body after brain injury. The present compensatory response.2, after the recovery of the aphasia, after January, the brain region, which is positively related to LMFG, is not damaged in the brain area around the lesion, suggesting that the compensatory mechanism of the functional brain region is transferred. The brain region which is enhanced by the function of the ROI is transferred from the right hemisphere to the left hemisphere, considering the recovery mechanism of the aphasia after the left hemisphere injury. The activation of compensatory activation in the right hemisphere of the right hemisphere and the activation of the undamaged brain area around the left hemisphere of the cerebral hemisphere in the convalescence of the right hemisphere, which may also be the main mechanism for the recovery of brain function,.3, both in the aphasia and in the recovery period, both in the left cingulate gyrus and at the back of the left cingulate gyrus, considering this is a poststroke motor aphasia. The key brain area of birth.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R743.3

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