基于静息态功能磁共振对不同运动亚型帕金森病患者脑功能改变的研究

发布时间：2017-12-28 00:30

本文关键词：基于静息态功能磁共振对不同运动亚型帕金森病患者脑功能改变的研究　出处：《南京医科大学》2017年博士论文　论文类型：学位论文

【摘要】：第一部分不同运动亚型帕金森病患者脑功能活动的改变:基于静息态fMRI脑局部一致性的研究目的:探讨不同运动亚型帕金森病(PD)患者静息态功能磁共振的局部脑活动的改变及意义。方法:采集77例PD患者和29例健康对照者(HC)的静息态功能磁共振数据,PD组根据统一帕金森病评定量表(UPDRS)相关评分分为震颤型(TD)43例和姿势不稳步态障碍型(PIGD)34例,采用局部一致性(ReHo)分析方法对所得数据进行分析,观察不同亚型帕金森患者的脑功能活动变化,通过协方差分析(ANCOVA)和Post-Hoc t检验进行组间比较。结果:与HC相比,TD-PD患者右侧额中回及额上回ReHo增强;左侧颞叶、左侧壳核、左侧旁中央小叶、双侧丘脑、双侧楔状叶及距状裂周围皮层、左侧小脑ReHo减低;PIGD-PD患者右侧额上回、额中回及扣带回前部ReHo增强;左侧壳核、左侧苍白球、左侧颞叶、右侧枕叶、双侧丘脑、双侧扣带回中部、双侧辅助运动区ReHo减低;TD-PD与PIGD-PD相比,左侧颞叶、左侧小脑、双侧扣带回中部ReHo增强;左侧颞叶、左侧旁中央小叶、双侧楔状叶、右侧额上回、右侧扣带回前部、右侧小脑脚ReHo减低;Pearson相关分析发现,TD评分与右侧内侧额上回ReHo值呈正相关,与左侧丘脑、左侧壳核、右侧丘脑、右侧舌回ReHo值呈负相关;PIGD评分与右侧内侧额上回、右侧扣带回前部ReHo值呈正相关,与左侧丘脑、左侧壳核、左侧颞下回、右侧丘脑、右侧舌回及右侧枕下回ReHo值呈负相关。结论:不同亚型PD患者存在着特异性的脑功能活动改变,TD-PD患者脑功能活动局部改变体现了纹状体-丘脑-皮层环路和小脑-丘脑-皮层环路的共同作用的结果,而PIGD-PD患者则主要体现了纹状体-丘脑-皮层环路相关脑区和视觉网络皮层的功能活动异常,这为进一步揭示不同运动亚型PD患者的神经病理机制、临床诊断和针对性的治疗提供新的思路。第二部分不同运动亚型帕金森病患者脑网络节点功能连接属性的改变:基于体素的静息态fMRI度中心度的研究目的:研究不同运动亚型帕金森病患者静息态功能磁共振的脑网络节点功能连接属性的变化特点及意义。方法:采集77例PD患者和29例健康对照者(HC)的静息态功能磁共振数据,PD组根据统一帕金森病评定量表(UPDRS)相关评分分为震颤型(TD)43例和姿势不稳步态障碍型(PIGD)34例。采用度中心度(DC)分析方法对所得数据进行分析,观察不同亚型帕金森患者的脑网络节点功能连接属性变化,通过协方差分析(ANCOVA)和Post-Hoc t检验进行组间比较。结果:与HC相比,TD-PD患者双侧丘脑、双侧尾状核DC值升高;双侧梭状回、双侧海马、双侧海马旁回、左侧眶额回(左侧眼眶部额下回、左侧眶部额中回)、左侧额上回、左侧岛叶、左侧壳核、右侧颞下回、右侧额上回DC值减低;PIGD-PD与HC相比,右侧顶上/下小叶、左侧丘脑DC值升高;左侧中央前/后回、左侧旁中央小叶、左侧枕中回、左侧缘上回、双侧辅助运动区、双侧扣带回DC值减低;TD-PD与PIGD-PD相比,双侧楔状叶、左侧楔前叶、双侧距状裂及其周围皮层、双侧辅助运动区、左侧中央前回、左侧旁中央小叶DC值升高;左侧眶额回、左侧额中回、左侧背外侧额上回DC值减低。Pearson相关分析发现,TD评分与左侧壳核、左侧梭状回、左侧海马、左侧海马旁回DC值负相关,未见明显正相关脑区。PIGD评分左侧辅助运动区、左侧颞中回DC值呈负相关,未见明显正相关脑区。结论:两种亚型PD患者均存在默认网络相关脑区节点的DC减低,不同亚型PD患者静息网络节点功能连接属性有着特异性的改变,TD-PD患者的网络节点功能连接属性改变主要表现在基底节、丘脑等神经环路相关脑区,而PIGD-PD患者则主要体现运动网络、视觉加工网络等相关脑区。静息态功能磁共振基于体素的度中心度功能连接分析方法为探索不同运动亚型PD患者的潜在发病机制提供了一种新的研究方法。第三部分冻结步态帕金森病患者脑功能活动及功能连接的改变:基于静息态fMRI脑局部一致性和功能连接的研究目的:观察冻结步态帕金森病患者静息态功能磁共振脑活动局部一致性和功能连接的变化特点,并探索冻结步态产生的神经病理机制。方法:采集30例PD患者和16例健康对照者(HC)的静息态功能磁共振数据,根据冻结步态量表评分(FOGQ)将PD组分为PD伴冻结步态患者(FOG(+)PD)14例和PD不伴冻结步态患者(FOG(-)PD)16例。采用局部一致性(ReHo)分析方法对所得数据进行分析,观察伴有和不伴有冻结步态PD患者的脑功能活动变化;同时选择脚桥核(PPN)为种子点,采用种子相关分析得到全脑中与脚桥核功能连接改变的区域。通过协方差分析(ANCOVA)和Post-Hoc t检验进行组间比较。结果:与HC相比,FOG(+)PD的左侧颞下回、右侧舌回、双侧梭状回、右侧枕下回、右侧矩状裂及其周围皮层及右侧小脑ReHo减弱;右侧额中回、右侧三角部额下回、右侧岛盖部额下回、右侧背外侧额上回、右侧中央前回及右侧辅助运动区ReHo增强;与FOG(-)PD相比,FOG(+)PD的右侧中央前回、右侧额中回、右侧额下回及右侧辅助运动区ReHo增强,未发现ReHo减弱的区域。在功能连接方面,与正常对照组及帕金森病不伴冻结步态组相比,帕金森病伴冻结步态组与PPN功能连接异常的脑区主要分布在皮质-脑桥核-小脑通路(包括双侧小脑和脑桥)以及视觉相关颞叶皮层(包括右侧颞中回和右侧颞下回)。结论:帕金森病冻结步态患者存在异常的脑功能活动和功能连接,FOG(+)PD患者脑内局部一致性异常的脑区包括了小脑、额叶以及视觉网路相关皮层;同时通过观察双侧PPN与全脑的功能连接,发现PD FOG(+)患者存在异常的PPN功能连接网络,主要影响皮质-脑桥核-小脑通路和参与视觉信息处理相关皮层,提示了 FOG的产生可能涉及的潜在神经功能异常和损伤机制,有助于我们进一步探知FOG的神经病理机制。
[Abstract]:Part one: the changes of brain function in patients with different motion subtypes of Parkinson's disease: Based on the regional coherence of resting fMRI brain, objective: To explore the changes and significance of resting brain functional changes in resting state functional magnetic resonance imaging (MRF) in patients with different subtypes of Parkinson's disease (PD). Methods: collected 77 cases of PD patients and 29 healthy subjects (HC) of the resting state fMRI data, PD group according to the unified Parkinson's Disease Rating Scale (UPDRS) score divided into tremor type (TD) and 43 cases of postural instability gait disorder (PIGD) in 34 cases, using local consistency (ReHo) analysis method to analyze the data, observe the changes of brain activity in patients with different subtypes of Parkinson, through the analysis of covariance (ANCOVA) and Post-Hoc t test were compared between the two groups. Results: compared with HC, ReHo and TD-PD were back to the superior frontal gyrus, right middle frontal enhancement; left temporal lobe, left putamen, left paracentral lobule, bilateral thalamus, bilateral cuneus and calcarine cortex around the left cerebellum ReHo decreased; PIGD-PD patients with right superior frontal gyrus, middle frontal gyrus and anterior cingulate cortex ReHo enhancement on the left side; the left putamen, globus pallidus, left temporal lobe, right occipital lobe, bilateral thalamus, bilateral middle cingulate gyrus, bilateral supplementary motor area ReHo decreased; TD-PD compared with PIGD-PD, the left temporal lobe and left cerebellum, bilateral middle cingulate cortex ReHo enhancement; left lateral temporal lobe and left paracentral lobule, bilateral wedge the right lobe, right superior frontal gyrus, anterior cingulate gyrus, right cerebellar peduncle ReHo decreased; Pearson correlation analysis showed that TD score and right medial frontal gyrus ReHo values were positively correlated with the left thalamus, left putamen, right thalamus, right lingual The ReHo value was negatively correlated. PIGD score was positively correlated with ReHo value in the right medial superior frontal gyrus and right cingulate gyrus, and negatively correlated with ReHo value in left thalamus, left putamen, left inferior temporal gyrus, right thalamus, right lingual gyrus and right occipital gyrus. Conclusion: PD patients with different subtypes exist in specific brain activity changes, functional activities of patients with cerebral TD-PD local change reflects the interaction of striatal thalamo cortical loop and cerebellar thalamo cortical loop results, while the PIGD-PD patients mainly reflects the abnormal function of brain areas related to cerebral cortex - striatum - Qiu loop network and visual cortex, which further reveal the neural pathological mechanism, different subtypes of PD patients with clinical diagnosis and targeted therapy to provide new ideas. Subtypes of patients with Parkinson's disease brain network node function second different motion connection attribute changes: the purpose of voxel resting fMRI centrality based on the changes and clinical significance of brain functional network nodes of different exercise subtypes in patients with Parkinson disease in the resting state functional magnetic resonance linkage. Methods: resting state fMRI data of 77 PD patients and 29 healthy controls (HC) were collected. PD group was divided into tremor type (TD) 43 cases and postural instability gait type PIGD (34 cases) according to the unified Parkinson's Disease Rating Scale (UPDRS) score. The data were analyzed by the method of degree centrality (DC). The changes of functional connectivity of brain nodes in different subtypes of Parkinson patients were observed. The covariance analysis (ANCOVA) and Post-Hoc t test were used for comparison between groups. Results: compared with HC, TD-PD patients with bilateral thalamus, bilateral caudate nucleus, the DC value increased; bilateral fusiform gyrus, bilateral hippocampus, parahippocampal gyrus, left orbitofrontal gyrus (left orbital frontal gyrus, left orbital frontal gyrus), left superior frontal gyrus, left insula, left putamen, right lateral temporal gyrus, right superior frontal gyrus decreased DC; PIGD-PD compared with HC, right superior parietal lobule, left thalamus / DC value increased; the left front / rear central gyrus and left paracentral lobule, left occipital gyrus, left supramarginal gyrus, bilateral motor areas, bilateral cingulate DC value decreased TD-PD compared with PIGD-PD;, bilateral cuneus, left precuneus, bilateral calcarine and surrounding cortex, bilateral supplementary motor area, left precentral gyrus, left paracentral lobule DC value increased; the left orbitofrontal gyrus, gyrus, left dorsolateral frontal gyrus of left frontal DC values decreased. Pearson correlation analysis showed that TD score was negatively correlated with the DC value of left putamen, left fusiform gyrus, left hippocampus and left parahippocampal gyrus, and no significant positive brain region was found. The PIGD score was negatively correlated with the left temporal gyrus and the left temporal gyrus, and no significant positive brain region was found in the left auxiliary motor area and the left temporal gyrus. Conclusion: the default node network of brain areas related to the decreased DC there are two subtypes of PD patients, PD patients with different subtypes of resting functional connectivity network node has a specific attribute change function network node with TD-PD connection properties change mainly in the basal ganglia and thalamus nerve loop related brain regions, and PIGD-PD the patients mainly reflects the brain areas related to sports network, visual processing network etc.. Resting state functional magnetic resonance imaging based on voxel degree centrality functional connectivity analysis provides a new research method for exploring the potential pathogenesis of PD in different subtypes of sports. The third part change freezing of gait in patients with Parkinson's disease brain activity and functional connectivity in the resting state fMRI connection: the purpose of the local consistency and brain function based on the characteristics of observation: freezing of gait in patients with Parkinson's disease of resting state functional magnetic resonance brain activity in local consistency and functional connectivity, and explore the pathological mechanism of nerve freezing gait. Methods: resting state fMRI data of 30 PD patients and 16 healthy controls (HC) were collected. According to the frozen gait Rating Scale (FOGQ), the PD group was divided into PD and frozen gait patients (FOG (+) PD), 14 cases and PD without frozen gait patients (FOG (- PD)) 16 cases. Local consistency (ReHo) analysis was used to analyze the data and observe the changes of brain function in patients with or without frozen gait. At the same time, the foot bridge nucleus (PPN) was selected as seed point, and seed correlation analysis was used to get the whole PD.
【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R445.2;R742.5

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