磁共振弥散张量成像在发作性睡病中的应用研究

发布时间：2018-06-15 11:59

本文选题：发作性睡病 + 弥散张量成像　；参考：《山东大学》2017年硕士论文

【摘要】：目的:发作性睡病(narcolepsy)是以日间过度嗜睡、猝倒发作、夜间睡眠障碍为特征的终生性睡眠-觉醒疾患,其中夜间睡眠障碍包括睡眠瘫痪、睡眠幻觉、夜间睡眠中断、觉醒次数增多、睡眠质量下降、频繁梦魇及REM睡眠期行为障碍等。除此之外,发作性睡病患者常常伴有向心性肥胖、阻塞性睡眠呼吸暂停综合征、偏头痛等,还可见情绪调节及认知功能损害。其发病机制可能与免疫损伤导致的下丘脑分泌素细胞凋亡有关。近20年来,许多神经影像学研究试图证实发作性睡病患者颅脑结构及功能的异常,但到目前为止其结果还是有争议的。弥散张量成像(diffusion tensor imaging,DTI)是新兴的唯一可以在活体呈现脑白质纤维束走行的无创性成像方法,并可以定量研究水分子的自由热运动。本研究将利用DTI的定量参数部分各向异性(fractional anisotropy,FA)、表观扩散系数(apparent diffusion coefficient,ADC)及纤维束追踪技术(fibertractography,FT),对发作性睡病患者的脑区损害进行研究,并探讨其脑区损害与发作性睡病患者的临床特征、情绪调节与认知功能异常之间的关系。方法：连续收录2015年02月至2017年04月在山东大学第二医院经夜间多导睡眠图检查(nPSG)及标准的多次睡眠潜伏期试验(MSLT)后确诊的发作性睡病患者7名,并招募年龄及性别相匹配的7名健康志愿者作为对照组。首先,所有研究对象均接受神经心理学评测:1.Epworth嗜睡量表(ESS);2,抑郁量表:未成人接受流调中心儿童抑郁量表(CES-DC)评估;成年人则接受抑郁Beck抑郁量表-Ⅱ(BDI-Ⅱ)评估;3.蒙特利尔认知量表(MoCA)中文版。再者,受试者均进行磁共振DTI的检查,通过CTE工作站Functool软件包对扫描后的数据进行后处理:1.生成FA、ADC图,分别于额上回、中央前回、中央后回、额顶白质、楔前叶、顶下小叶、额下回、缘上回、扣带回、胼胝体膝、尾状核、丘脑、内囊前肢、海马旁回、下丘脑、额眶皮质、颞区、脑桥及杏仁核设置感兴趣区并测量其FA、ADC值;2.根据FACT算法描绘经下丘脑外侧区的纤维束走行。最后利用统计工具IBM SPSS17.0对受试者影像学数据与临床特征、神经心理学评测结果之间进行相关性分析。结果:1.发作性睡病患者与健康对照组在研究人数、性别、年龄均未见统计学差异,而在BMI、ESS评分方面存在显著性差异,CES-DC评分无统计学意义,BD1-Ⅱ评分、MoCA评分未见统计学差异;2.发作性睡病患者左侧额上回、右侧额下回、右侧缘上回、双侧尾状核及双侧内囊前肢可见FA值显著减低;3.发作性睡病患者左侧中央前回、左侧中央后回及左侧顶下小叶可见ADC值显著增高;4.发作性睡病患者FA值、ADC值与年龄、病程、BMI以及ESS评分之间无明显相关性;5.发作性睡病患者经下丘脑区域纤维密度减低。结论:我们通过对7例发作性睡病患者及年龄、性别相匹配的健康志愿者进行磁共振弥散张量成像研究发现,发作性睡病患者的下丘脑、尾状核和内囊前肢以及广泛的大脑皮质,如额上回、额下回、中央前后回、缘上回、顶下小叶等可见微观结构异常。该研究结果支持下丘脑hypocretin系统及其纤维投射区域直接参与发作性睡病的发病机制的理论。
[Abstract]:Objective: narcolepsy (narcolepsy) is a lifelong sleep awakening disorder characterized by excessive daytime somnolence, sudden onset and nocturnal sleep disorders, in which nocturnal sleep disorders include sleep paralysis, sleep hallucinations, nocturnal sleep interruptions, increased arousal times, decline in sleep quality, frequent nightmare and REM sleep disorder, in addition to this. Episodes of narcolepsy are often associated with centripetal obesity, obstructive sleep apnea syndrome, migraine, and emotional regulation and cognitive impairment. The pathogenesis may be related to the apoptosis of hypothalamic secretory cells caused by immune injury. In the last 20 years, many neuroimaging studies have attempted to confirm the patients with narcolepsy. The abnormal craniocerebral structure and function, but the results are still controversial so far. Diffusion tensor imaging (DTI) is the only new noninvasive imaging method that can present the white matter bundle of the brain in vivo, and can quantitatively study the free heat movement of water molecules. This study will make use of the quantitative parameters of DTI. Partial anisotropy (fractional anisotropy, FA), apparent diffusion coefficient (apparent diffusion coefficient, ADC) and fiber bundle tracking technique (fibertractography, FT) were used to study brain damage in patients with narcolepsy, and to explore the clinical characteristics of brain damage and narcolepsy, and the abnormal emotion regulation and cognitive function. Methods: 7 cases of narcolepsy were collected from 02 months to 04 months from 2015 to 04 months in the second hospital of Shandong University, after night polysomnography (nPSG) and standard multiple sleep latency test (MSLT), and 7 healthy volunteers with matched age and sex were recruited as the control group. The subjects received neuropsychological assessment: 1.Epworth sleepiness scale (ESS); 2, the Depression Scale: the assessment of the children's Depression Scale (CES-DC) in the center of non adults; adults accepted the depression Beck Depression Scale - II (BDI- II) assessment; 3. Montreal cognitive scale (MoCA) Chinese version. Furthermore, the subjects performed the MRI DTI examination, through CTE Workstation Functool software package after scanning the data after the post-processing: 1. generate FA, ADC map, respectively the upper back, the central back, the central back, the top white matter, the anterior lobe, the lower lobe, the lower frontal gyrus, the cingulate gyrus, the corpus callosum, the thalamus, the forelimb of the hippocampus, the hypothalamus, the frontal and the temporal, frontal, temporal, pontine, and amygdala Place the region of interest and measure its FA, ADC value; 2. according to the FACT algorithm to describe the fiber bundles through the lateral hypothalamus. Finally, the statistical tool IBM SPSS17.0 is used to analyze the correlation between the subjects' imaging data and clinical features, and the results of the neuropsychological evaluation. Results: the number of 1. sex sleep patients and the healthy control group is in the study number, There was no statistical difference in sex and age, but there was significant difference in BMI, ESS score, CES-DC score was not statistically significant, BD1- II score and MoCA score were not statistically significant; 2. the left upper frontal gyrus, right superior frontal gyrus, bilateral caudate nucleus and bilateral internal capsule front were significantly lower in FA; 3. The left central precentral gyrus, left posterior central gyrus and left apical lobule showed a significant increase in ADC value, and there was no significant correlation between the FA value of 4. narcolepsy patients, the ADC value with age, the course of disease, the BMI and the ESS score, and the reduction of fiber density in the hypothalamus region of the 5. narcolepsy patients. Conclusion: we passed 7 cases of narcolepsy. A study of magnetic resonance diffusion tensor imaging of patients with age and sex matched healthy volunteers found that the hypothalamus, caudate nucleus, and the forelimb of the inner capsule, as well as the extensive cerebral cortex, such as the upper frontal gyrus, the lower frontal gyrus, the central back and back, the upper and lower lobes, were found in the hypothalamus of the patients with narcolepsy. The results supported the lower colliculus. The brain hypocretin system and its fiber projection area are directly involved in the pathogenesis of narcolepsy.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R740

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