基于静息态功能磁共振探讨高压氧治疗脑外伤后认知功能障碍的机制研究

发布时间：2018-03-12 08:15

本文选题：高压氧治疗　切入点：脑外伤　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：第一部分脑外伤后认知功能障碍的DMN网络研究目的:采用静息态功能磁共振成像(rs-fMRI)技术结合独立成分分析(ICA)方法探讨脑外伤后认知功能障碍患者的DMN网络的改变。方法:将40例符合纳入标准的脑外伤后认知功能障碍患者(TBI组)和30例健康对照组(NC组)进行量表评定和静息态功能磁共振的扫描。使用GIFT软件分离出DMN网络,再用DPABI对网络进行单样本t检验,最后对两组予两独立样本t检验,比较NC组和TBI组两组间DMN网络图像的差异。结果:与NC组比较,TBI组aDMN的左前额皮质外侧部(BA6、44)、PC-R(BA7、18)、左梭状回(BA36)和pDMN的右额上回背外侧(BA9)、右扣带回中部(BA32)、PC-R(BA5)、左顶下小叶(BA40)区域在DMN网络中功能连接显著降低。TBI组aDMN的 MPFC-L(BA45、47)、ACC-R(BA32)、右颞中回(BA21、37)、右海马(BA27、30)和pDMN的MPFC(BA10、47)、左枕中回(BA19)区域在DMN网络中功能连接显著增强。结论:脑外伤后认知功能障碍患者DMN网络中PCC/PC、前额叶背外侧、梭状回、顶下小叶等区域的功能连接降低可能是直接影响认知功能的因素。MPFC、ACC、颞中回、海马、枕中回等区域的功能连接增强可能是在早期的脑外伤患者中出现了一种功能代偿。第二部分高压氧治疗脑外伤后认知障碍的DMN网络研究目的:大量研究表明高压氧能够改善脑外伤后的认知功能,但其对改善脑外伤后认知功能的中枢机制尚不清楚。课题通过对入组志愿者进行量表评定,证实高压氧作用。同时,观察高压氧治疗前后脑功能的变化,从而推断高压氧治疗改善脑外伤后认知功能的中枢效应机制。方法:招募合格脑外伤认知障碍患者,根据随机数字法分为高压氧组(HBO组)和非高压氧组(NHBO组),HBO组予HBO治疗+常规认知康复+常规外科治疗,NHBO组予常规认知康复+常规外科治疗。两组志愿者治疗前后均予临床量表评定和功能磁共振扫描。利用DPABI软件对两组志愿者的DMN网络图像分别进行治疗前后配对t检验。根据图像的差异探索高压氧治疗的中枢机制。结果:与治疗前相比,治疗后MMSE、MoCA均升高。且高压氧组较非高压氧组效果更好。HBO组中,治疗后较治疗前功能连接增强的有:左内侧额上回(BA10)、右颞中回(BA21/22)、PCC-L(BA23)、右岛叶(BA47)、左/右舌回(BA17、18);功能连接降低的有:右额上回(BA10)、额上回眶部(BA11)、右梭状回(BA19)、右顶下小叶(BA39)、左枕叶(BA18/37)、右辅助运动区(BA6)。结论:1、高压氧治疗能够改善脑外伤后认知障碍患者的认知功能,与常规认知康复训练有机的结合更有利于恢复。2、高压氧治疗能够改善脑外伤后认知功能障碍的中枢机制可能是HBOT促进PC/PCC、额叶、颞叶等节点在DMN网络中功能连接。
[Abstract]:Part I: DMN Network study on Cognitive dysfunction after brain injury objective: to investigate the changes of DMN network in patients with cognitive impairment after brain injury using resting functional magnetic resonance imaging (fMRI) technique combined with independent component analysis (ICA). Methods: 40 patients with cognitive impairment after traumatic brain injury and 30 healthy controls were assessed with the scale and the rest functional magnetic resonance imaging (fMRI). The DMN network was separated by GIFT software. Then DPABI is used to carry out a single sample t test for the network, and finally two groups of independent samples t test are given. Results: compared with NC group, the difference of DMN network images between NC group and TBI group. Results: compared with NC group, the left prefrontal cortex lateral part of aDMN in aDMN group was compared with that in the control group. The left frontal cortex of aDMN was 44.The left fusiform gyrus (BA36) and the right suprafrontal gyrus dorsolateral gyrus (BA9), the right cingulate gyrus (BA32), the right cingulate gyrus (BA32), and the left inferior parietal lobules (BA40) were compared with those in the NC group. The functional connections of MPFC-LBA447, right middle temporal gyrus, right middle temporal gyrus, right hippocampus, right hippocampus, BA2730) and pDMN's MPFC-LBA45, BA19) were significantly increased in the DMN network. Conclusion: DMN in patients with cognitive impairment after traumatic brain injury is significantly enhanced. The functional connections of MPFC-LBA447 and left occipital gyrus BA19) in patients with cognitive impairment after traumatic brain injury are significantly enhanced in the DMN network (P < 0.05). Conclusion: in patients with cognitive impairment after traumatic brain injury, the functional connections of MPFC-LBA447, right middle temporal gyrus, right hippocampus, and pDMN are significantly increased. PCC / PC in the network, dorsolateral prefrontal lobe, Decreased functional connections in areas such as fusiform gyrus, inferior parietal lobule, etc., may be the factors directly affecting cognitive function. The enhancement of functional connections in areas such as the middle occipital gyrus may be a kind of functional compensation in early brain trauma patients. Part 2 DMN network study of hyperbaric oxygen in the treatment of post-traumatic cognitive impairment objective: a large number of studies have shown that high blood pressure is present in patients with post-traumatic cognitive impairment. Oxygen can improve cognitive function after brain injury. However, its central mechanism for improving cognitive function after brain injury is not clear. The subjects were assessed by the volunteers in the study to confirm the effect of hyperbaric oxygen. At the same time, the changes of brain function were observed before and after hyperbaric oxygen treatment. Therefore, the mechanism of central effect of hyperbaric oxygen therapy on the improvement of cognitive function after brain injury was inferred. Methods: qualified patients with cognitive impairment of brain injury were recruited. According to the random number method, the HBO group was divided into hyperbaric oxygen group (HBO group) and non hyperbaric oxygen group (NHBO group). The HBO group was given conventional cognitive rehabilitation routine surgical treatment and the NHBO group received conventional cognitive rehabilitation routine surgical treatment before and after treatment. The DMN network images of the two groups of volunteers were tested by paired t test before and after treatment with DPABI software. The central mechanism of hyperbaric oxygen therapy was explored according to the difference of the images. :: compared with pre-treatment, MMSE MoCA increased after treatment, and the effect of hyperbaric oxygen group was better than that of non-hyperbaric oxygen group. The enhanced functional connections after treatment were: left medial superior frontal gyrus BA10, right middle temporal gyrus 21 / 22 PCC-LT BA23, right insular lobes BA47, left / right lingual gyrus BA1718; functional connections decreased in right superior frontal gyrus BA10, suprafrontal gyrus orbit, right fusiform gyrus 19, right inferior parietal lobules BA39. Occipital lobes BA18 / 37, right auxiliary motor area BA6. Conclusion: hyperbaric oxygen therapy can improve the cognitive function of patients with cognitive impairment after brain injury. Combined with conventional cognitive rehabilitation training, hyperbaric oxygen therapy can improve cognitive dysfunction after traumatic brain injury. The central mechanism of hyperbaric oxygen therapy may be that HBOT promotes the functional connection of PC-PCC, frontal lobe and temporal lobe in DMN network.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15;R445.2

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