伴中央颞区棘波儿童良性癫痫行为学及静息态功能磁共振成像研究

发布时间：2018-03-28 03:23

本文选题：伴中央颞区棘波儿童良性癫痫　切入点：静息态功能磁共振　出处：《川北医学院》2014年硕士论文

【摘要】：目的：评估伴中央颞区棘波儿童良性癫痫（BECT）的认知功能，采用静息态功能磁共振（fMRI）成像技术，观察BECT默认模式脑网络（DMN）特征及其功能连接的改变，初步探讨BECT认知功能改变、DMN特征及认知功能改变与fMRI功能连接之间的相关性，以期从脑网络角度为BECT临床诊疗及病理生理机制的探寻提供相关依据。方法：收集27例符合诊断标准的患者为BECT组，以及18位健康志愿者为正常对照组，其中BECT组分为服药组（n=13例）及未服药组（n=14例）。采用中国修订韦氏儿童智力量表（WISC），对所有儿童行智力测定，得出言语智商（VIQ）、操作智商（PIQ）及总智商（FSIQ）。采用SPSS13.0软件包进行统计分析，采用独立样本t检验及单因素方差分析的统计学方法，计量资料以x±s表示。所有被试在3.0T磁共振环境下采集静息态fMRI数据，数据分析以后扣带回（PCC）为种子点，采用基于感兴趣区（ROI）功能连接的分析方法，观察BECT的DMN特征及其功能连接的改变。最后以功能连接降低的脑区及ROI为种子点取其Z分数值，分别与BECT组WISC评分结果行相关性分析。结果：（一）WISC测试结果：1.BECT组儿童在常识、分类、算术、词汇、理解、填图、排列、积木、拼图、编码分测验中得分明显低于正常对照组儿童，差异有统计学意义（p0.01）；2.BECT组儿童VIQ、PIQ及FSIQ均低于正常对照组，差异有统计学意义（p0.01）；3.服药组、未服药组儿童VIQ、PIQ及FSIQ均低于正常对照组，差异有统计学意义（p0.01），但服药组、未服药组儿童VIQ、PIQ及FSIQ相比，差异无统计学意义（p0.05）。（二）fMRI数据方面，27例BECT组中5例被试因检查时过度头动而被淘汰，正常对照组3位因头动过大被淘汰。fMRI功能连接研究结果：1.以PCC为种子点，利用基于ROI的DMN模式网络分析所有被试，正相关区域主要位于前扣带回，楔前叶，双侧角回，内侧前额叶皮层，额上回，颞下回皮层，小脑，尾状核。负相关区域主要位于辅助运动区，中扣带回，双侧顶下叶，脑岛，额中叶，顶下小叶，双侧舌回，右侧枕下叶，额下叶；2.比较DMN之间的差异显示，与正常对照组相比，BECT组与PCC功能连接降低的脑区为右中扣带回，楔前叶，即与种子区临近的脑区有连接降低，BECT组与PCC功能连接增加的脑区为双侧额上回，右侧额中回；3.在未服药组、服药组及正常对照组行两两之间的DMN网络差异比较表明，与正常对照组相比，未服药组与PCC功能连接降低的脑区为楔前叶，，右中扣带回，即与种子区临近的脑区有连接降低，与PCC功能连接增加的脑区为双侧额上回，右侧额中回；与正常对照组相比，服药组与PCC功能连接降低的脑区为楔前叶，左颞中回，与PCC功能连接增加的脑区为右侧额上回，旁中央小叶；与服药组相比，未服药组功能连接降低的脑区为小脑后叶、右侧尾状核、楔前叶、中央后回、左侧中央旁小叶，功能连接增强的脑区为额叶内侧回、左侧中额叶。（三）基于ROI的DMN网络内部节点间功能连接分析结果显示，BECT组相比于正常对照组，其DMN网络连接更稠密。（四）认知功能改变与fMRI功能连接之间的相关性分析结果：1.BECT组DMN中功能连接显著降低的两个脑区即楔前叶（Precuneus）、右侧中扣带回（R.MCC）的连接（Z分数值）与BECT的VIQ、PIQ及FSIQ具有显著正相关关系。2.基于ROI间的DMN功能连接与BECT组WISC评分行相关性分析，两者总体呈负相关关系。结论： 1. BECT患儿VIQ、PIQ及FSIQ降低，其存在一定程度的认知功能损害。 2.服药组与未服药组VIQ、PIQ及FSIQ相比，差异无统计学意义（p0.05），推测其认知功能损害可能是BECT的前兆症状或伴随症状。 3.以PCC为种子点的功能连接分析方法能在BECT患者中获得自发稳定的低频振荡信号和DMN连接图。 4. BECT组获得的DMN脑区与既往研究的脑区基本一致，但BECT的DMN脑区范围更广，可能是由癫痫疾病间接地影响了儿童的生理发育周期，或系癫痫直接导致儿童大脑网络连接异常，导致DMN重新分布。 5. BECT内部功能连接改变可能造成DMN集成功能变化，其可能源自BECT儿童神经发育异常或者大脑结构功能方面的重组，从而导致其认知功能损害。 6. BECT患儿的DMN内部功能连接更加朝向一个规则化网络发展，可能不利于患儿功能脑区的发育完善，引起大脑网络调控紊乱，从而导致神经心理行为学的异常。
[Abstract]:Objective: To evaluate with centrotemporal spikes in children with benign epilepsy (BECT) cognitive function by resting state functional magnetic resonance imaging (fMRI), observe the BECT default mode network (DMN) and its characteristics of brain functional connectivity changes, preliminary study of the cognitive function of BECT, the correlation between DMN features and the changes of cognitive function and fMRI function the connection between, in order to provide relevant basis to explore from the brain network angle of BECT clinical diagnosis and pathophysiological mechanisms.
Methods: a total of 27 cases of BECT group, and 18 healthy volunteers as normal control group, the BECT group was divided into treatment group (n=13 cases) and treatment group (n=14 cases). The China Wechsler Intelligence Scale for children (WISC), were determined for all children for intelligence, the verbal intelligence quotient (VIQ), operation (PIQ) and total IQ IQ (FSIQ). SPSS13.0 software was used for statistical analysis, using statistical methods analysis of variance independent sample t test and single factor, measurement data with x + s. All of the subjects in resting state fMRI data acquisition in 3.0T magnetic resonance environment. Data analysis after the cingulate (PCC) as the seed points, the region of interest (ROI) based on the analysis of functional connectivity, DMN features and functions of BECT. The change of the observation of connected brain areas decreased and ROI as seed points from the Z value, WISC and BECT group respectively. The results were analyzed by correlation.
Results: (1) WISC test results: 1.BECT group of children in the common sense, classification, arithmetic, vocabulary, comprehension, mapping, arrangement, building blocks, puzzles, encoding the test score is significantly lower than the normal control group, the difference was statistically significant (P0.01); 2.BECT group of children VIQ, PIQ and FSIQ were lower than the normal control group, the difference was statistically significant (P0.01); the 3. drug group, unmedicated group of children with VIQ, PIQ and FSIQ were lower than the normal control group, the difference was statistically significant (P0.01), but the medication group, unmedicated group of children with VIQ, compared with PIQ and FSIQ, the difference was not statistically significant (P0.05) (two) fMRI data. In 27 cases, there were 5 cases in group BECT were examined by excessive head motion was eliminated, the normal control group had 3 big head was eliminated.FMRI functional connectivity results: 1. using PCC as the seed point, use the DMN network model ROI analysis based on all subjects, is mainly located in the anterior region buckle Back, bilateral precuneus, angular gyrus, medial prefrontal cortex, superior frontal gyrus, inferior temporal gyrus, cerebellum, caudate nucleus. Negative correlation areas are mainly located in the supplementary motor area, middle cingulate gyrus, bilateral inferior parietal lobe, insula, frontal lobe, inferior parietal lobule, bilateral lingual gyrus, right occipital lobe, frontal leaves; show differences between 2. DMN, compared with the normal control group, BECT group and PCC brain areas is lower, right cingulate gyrus, precuneus, brain area near the area are connected with seed reduced, BECT group and PCC brain areas increased bilateral superior frontal gyrus, right frontal gyrus; 3. in the treatment group, treatment group and normal control group the difference between the 22 DMN network shows that compared with the normal control group, untreated group and PCC brain areas decreased as precuneus, right cingulate gyrus, namely brain regions near and seed regions connected to reduce increase, connected with the PCC function Brain regions of bilateral superior frontal gyrus, right middle frontal gyrus; compared with normal control group, drug group and PCC brain areas decreased as precuneus, left middle temporal gyrus, brain regions increased in connection with the PCC function as the right superior frontal gyrus, paracentral lobule; compared with the control group. The brain no medicine group decreased functional connectivity for the posterior lobe of cerebellum, right caudate nucleus, precuneus, posterior central gyrus, left paracentral lobule, brain functional connectivity for the medial frontal gyrus, left middle frontal lobe. (three) the internal nodes of the DMN network ROI function based on the connection analysis results showed that compared to the normal control group, BECT group, the DMN network connection is more densely populated. (four) correlation between the changes of cognitive function and fMRI function of connection between the results of the analysis: two areas of the brain function of 1.BECT in the DMN group significantly reduced the connection of the precuneus (Precuneus), right cingulate gyrus (R.MCC) connection (Z score) and BECT VIQ P. There was a significant positive correlation between IQ and FSIQ..2. based on ROI was associated with the correlation analysis of WISC scores in BECT group, and there was a negative correlation.
Conclusion:
1. BECT children with VIQ, PIQ and FSIQ decreased to a certain degree of cognitive impairment.
2., there was no significant difference in VIQ, PIQ and FSIQ between the two groups (P0.05), suggesting that their cognitive impairment may be a precursor or accompanying symptom of BECT.
3. the functional connection analysis method with PCC as the seed point can obtain spontaneous and stable low frequency oscillating signals and DMN connections in BECT patients.
4., the DMN area obtained from BECT group is basically the same as that of the previous study. However, the DMN brain area of BECT is wider. It may be indirectly affected by epilepsy, or directly lead to the abnormal connection of children brain network, resulting in the redistribution of DMN.
5., changes in internal functional connectivity of BECT may lead to changes in DMN integration function, which can be derived from BECT children's neurodevelopmental abnormalities or brain structural function reorganization, resulting in cognitive impairment.
6., the internal functional connectivity of DMN in children is more directed towards a regular network development. It may not be conducive to the development and improvement of functional brain regions in children, resulting in brain network regulation disorder, which leads to abnormal neuropsychological behavior. BECT

【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

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