慢性皮层下脑梗死患者灰质体积的变化和短时记忆功能的受损

发布时间：2018-05-21 16:04

本文选题：灰质体积 + 病灶侧别　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:虽然有一些关于中风后灰质体积变化的神经影像学研究,但是关于中风后病灶侧别和运动恢复程度对灰质体积的影响还不清楚。本研究根据梗死病灶侧别和运动功能恢复程度对右利手的慢性期皮层下缺血性脑梗死患者进行分组,从而探究病灶侧别和运动恢复程度对中风后灰质体积的影响。另外,虽然有研究报道了中风患者短时记忆功能的损害,但是关于中风后短时记忆损害的机制仍是不清楚的。本研究通过评估病灶本身和远隔脑区灰质体积的减少与短时记忆评分的关系来探究短时记忆损害的神经机制。资料与方法:选取慢性期皮层下脑梗死患者97例(男72,女25),这些患者均伴有不同程度的运动功能恢复,并且都是病灶位于内囊及其周围结构的单发病灶者。同时选取了79名(男50,女29)年龄、性别相匹配的健康志愿者作为对照组。采用3.0T磁共振扫描仪进行3D高分辨率T1WI解剖像扫描。首先,基于病灶侧别的不同,将慢性皮层下中风患者分成两组,即左侧病灶组和右侧病灶组。然后,根据运动恢复程度的不同,分别将左侧病灶组和右侧病灶组的中风患者分为完全恢复和部分恢复亚组。对左侧病灶组和右侧病灶组分别进行分析:采用一般线性模型对完全恢复、部分恢复和正常对照组这三组之间体素水平的灰质体积进行比较,同时控制年龄、性别和扫描设备的影响;然后提取出有差异脑区的灰质体积进行事后(post-hoc)分析来确定完全恢复和部分恢复的皮层下中风患者相对于正常对照组的灰质体积的变化是否相同;最后利用偏相关分析观察哪些脑区的灰质体积与部分恢复的中风患者的运动功能评分相关。另外,我们采用基于体素的病灶-症状图谱来探究病灶本身与短时记忆功能之间的关系。然后基于体素水平对中风病人和健康对照组的灰质体积进行比较,观察哪些脑区的灰质体积是减少的,同时控制年龄、性别和扫描设备的影响,其中左右侧病灶组分别与正常对照组进行比较;最后利用偏相关分析观察这些灰质体积减少的脑区与短时记忆评分的相关性。结果:1.与正常对照组相比,左侧病灶组的右侧中央旁小叶和右侧枕中回的灰质体积是增加的;右侧病灶组的双侧中央旁小叶、双侧辅助运动区和右侧枕中回的灰质体积是增加的。2.与正常对照组相比,只有右侧病灶组的右侧中央前回的灰质体积是减少的。3.完全恢复和部分恢复的慢性皮层下脑梗死患者灰质体积增加的程度是没有显著统计学差异的。4.梗死病灶位置和体积与短时记忆评分没有相关性。5.左侧病灶组患者的左侧感觉运动皮层、左侧岛叶皮层、左侧颞中回、左侧枕中回、左侧额下回的三角部和右侧额中回的灰质体积较正常对照组减少;右侧病灶组患者的右侧感觉运动皮层、右侧岛叶皮层、右侧颞中回、右侧眶额皮层、右侧背侧后扣带和左侧额上回的灰质体积较正常对照组减少。6.在左侧病灶组中,右侧额中回和左侧额下回的灰质体积与短时记忆评分正相关;在右侧病灶组中,右侧背侧后扣带皮层的灰质体积与短时记忆评分正相关。小结:1.慢性期皮层下缺血性中风患者灰质体积增加的脑区比灰质体积减少的脑区更广泛,提示慢性期皮层下缺血性中风患者中结构可塑性的存在。2.慢性期皮层下缺血性中风患者右侧病灶组灰质体积增加的脑区较左侧病灶组灰质体积增加的脑区更广泛,提示病灶侧别对右利手的慢性期皮层下缺血性中风患者的灰质体积是有影响的。3.慢性期皮层下缺血性中风患者灰质体积的增加在完全恢复和部分恢复的患者中表现相似,提示慢性期皮层下缺血性中风患者的结构重塑不是影响患者运动功能恢复程度的关键因素。4.慢性皮层下中风患者短时记忆功能的损害与病灶远隔脑区的继发损害有关,而与病灶的位置和大小没有显著的相关性,说明远隔脑区的继发损害在短时记忆功能受损过程中的重要作用,而且左右侧病灶组中与短时记忆功能相关的脑区不同,因此之后关于中风后认知功能的研究应该考虑到病灶侧别的影响。结论皮层下缺血性中风患者的慢性阶段存在广泛的结构重塑,其中病灶侧别对结构重塑是有影响的,而运动功能恢复程度与灰质体积的重塑没有显著的相关性。另外,慢性皮层下中风患者短时记忆功能的损害与病灶远隔脑区的继发损害有关,而与病灶的位置和大小没有显著的相关性,而且左右侧病灶组中与短时记忆功能相关的脑区不同,因此之后关于中风后认知功能的研究应该考虑到病灶侧别对研究结果的影响。
[Abstract]:Objective: Although there are some neuroimaging studies on the changes in the volume of gray matter after stroke, the effect of the lesion side and motion recovery on the volume of gray matter after stroke is not clear. In addition, the mechanism of short-term memory impairment after apoplexy is still unclear. However, the mechanism of short-term memory impairment after apoplexy is still unclear. This study evaluated the decrease and short-term volume of gray matter in the lesion itself and in the distant brain region. Data and methods: 97 patients with subcortical cerebral infarction (male 72, female 25) were selected with different degrees of motor function recovery, and all of them were single focal lesions located in the internal capsule and its surrounding structure, and 79 (men 50, 29) age were selected. 3.0T magnetic resonance scanner (3.0T) was used as a control group for 3D high resolution anatomical image scan. First, the patients with chronic subcortical apoplexy were divided into two groups, the left focus group and the right lesion group based on the difference of the lesion side. Then, the left focus group was divided into the left focus group according to the degree of movement recovery. The patients with apoplexy in the right lesion group were divided into complete recovery and partial recovery subgroups. The left focus group and the right lesion group were analyzed respectively: the general linear model was used to complete the complete recovery, the partial recovery and the normal control group were compared with the volume of the voxel levels between the three groups, and the age, sex and scanning equipment were controlled. The volume of gray matter in the different brain regions was then analyzed to determine whether the volume of gray matter in the subcortical stroke patients with complete recovery and partial recovery was the same as that in the normal control group; finally, the gray matter volume of the brain regions and the partial recovery of stroke patients were observed by partial correlation analysis. In addition, we used a voxel based focus - symptom map to explore the relationship between the focus itself and the short-term memory function. Then based on the voxel level, the volume of gray matter in the stroke patients and the healthy control group was compared, and the gray matter volume of the brain regions was reduced and the age, sex, and scan were controlled. The relationship between the left and right side focus groups was compared with the normal control group, and the correlation analysis was used to observe the correlation between the brain area and the short-term memory score of the gray matter volume reduction. Results: 1. compared with the normal control group, the gray matter volume of the right central paraleal lobule and right occipital gyrus was increased in the left focus group; The volume of gray matter in the bilateral central paraceal lobule, bilateral auxiliary motor area and right occipital gyrus was increased by.2. in the lesion group than in the normal control group. The gray matter volume of the right anterior central gyrus in the right lesion group was less than that of the reduced.3., and the increase in the volume of gray matter in the patients with chronic subcortical infarction was not significant. There was no correlation between the location and volume of.4. infarcts with statistical difference and short-term memory score. The left sensory motor cortex, left insula cortex, left temporal cortex, left temporal gyrus, left occipcipital gyrus, and the gray matter volume in the left inferior frontal gyrus and right middle frontal gyrus were less than that of the normal control group; the right focus group patients were found to have no correlation with the short-term memory score. The right sensory motor cortex, right insula cortex, right medial temporal gyrus, right orbital frontal cortex, right dorsal posterior cingulate and left superior frontal gyrus decreased.6. in the left focus group. The volume of gray matter in the right middle frontal gyrus and left inferior frontal gyrus was positively correlated with the short-term memory score; in the right lesion group, the right dorsal side was in the posterior side. A positive correlation between the gray matter volume of the cingulate cortex and the short-term memory score. Summary: 1. the increased gray matter volume in the patients with chronic subcortical ischemic stroke is more extensive than the gray matter volume, suggesting the existence of structural plasticity in the chronic subcortical ischemic stroke patients with.2. slow subcortical ischemic stroke on the right side of the patient. The increase of gray matter volume in the brain region is more extensive than that in the left focus group, suggesting that the volume of gray matter in patients with chronic subcortical ischemic stroke in the right hand side is an impact on the increase of gray matter volume in patients with.3. chronic subcortical ischemic stroke in patients with complete recovery and partial recovery. Similar, suggesting that structural remodeling in patients with subcortical ischemic stroke is not a key factor affecting the degree of motor function recovery in patients with.4., the impairment of short-term memory function in patients with chronic subcortical stroke is related to the secondary lesion of the distant brain area, but it has no significant correlation with the location and size of the lesion, indicating the distant brain region. Secondary damage is an important role in the impairment of short-term memory function, and the brain area related to short-term memory function in the left and right lesions group is different. Therefore, the study of cognitive function after stroke should take into consideration the effect of the lesion side. Conclusion the chronic stage of subcortical ischemic patients has extensive structural weight. There is no significant correlation between the degree of motor function recovery and the reshaping of the mass of gray matter. In addition, the impairment of short-term memory function in patients with subcortical stroke is related to the secondary lesion of the distant brain area, but there is no significant correlation with the location and size of the lesion. In the right lesion group, the brain regions associated with short-term memory function are different, so the subsequent study of cognitive function after stroke should take into account the effect of the focus side on the results of the study.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R743.33

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