BOLD-fMRI成像技术对rTMS治疗脑梗死后上肢功能障碍的研究

发布时间：2018-03-20 16:48

本文选题：缺血性脑卒中　切入点：BOLD-fMRI　出处：《成都体育学院》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:采用测量患者患侧M1区皮层厚度、fALFF值、ReHo值及功能连接等多模态分析法,研究rTMS对亚急性期脑梗死患者M1区在治疗前后结构和功能的变化,探讨rTMS对患者大脑皮质功能的重塑过程,以期为临床提供可靠的治疗依据。研究方法:选取30例初次患病脑梗死患者(病灶单一,病程10-20天),随机平均分为对照组(采用神经内科药物治疗和一般康复治疗)和实验组(在对照组治疗基础上增加rTMS治疗)。两组均于入院当日和一个疗程后(治疗4周后),进行BOLD-fMRI静息态扫描和UE-FMA评分。其次,运用Freesurfer V.5.1.0软件逐个测量被试者患侧M1区皮层厚度。再次,使用Matlab2009a自带的DPARSFA、REST插件进行静息态fMRI数据处理,计算出全部被试者患侧M1区ReHo值和fALFF值。第四,在治疗后实验组与对照组M1区皮层厚度存在差异的脑区,选取该脑区峰值点MNI坐标为种子点,以半径为5mm球形区域作为ROI,与全脑其他体素进行静息态功能连接分析。最终,将所有被试者性别、年龄、受教育程度作为协变量,运用REST对两组被试者治疗前后Re Ho值、fALFF值以及FC结果进行配对t检验和双样本t检验,分析组间和组内结果差异,以及UE-FMA评分和Re Ho值的相关性。研究结果显示:通过治疗,两组患者M1区皮层厚度均存在增厚的变化,实验组增厚较明显(p0.05);治疗后,两组患者RIO区的ReHo值均较前降低,而实验组降低较对照组明显(P0.05);该区两组患者fALFF值治疗后较治疗前增高,实验组增高明显(P0.05)。RIO与全脑功能连接结果显示,对照组治疗前后ROI与全脑功能连接差异结果在患侧颞中回、颞下回、额上回及额中回等存在连接增强,健侧枕下回、扣带回后部等出现连接减弱;实验组治疗后与治疗前ROI与全脑功能连接差异结果显示患侧颞中回、颞下回出现功能连接增强,患侧中央前回、患侧中央后回及双侧辅助运动区存在功能连接减弱表现;对比实验组与对照组治疗前后差异表明,在小脑及枕叶存在大面积连接减弱的区域。(p0.05,同时运用FDR校正进行cluster水平的校正,p0.05)。ReHo与UE-FMA评分相关分析结果显示:患者患侧Re Ho值与UE-FMA评分呈现正相关。研究结论:(1)通过治疗,实验组和对照组患者患侧M1区皮层厚度较前均有增厚表现、Re Ho值较前均降低、fALFF值较前均增高,而实验组较对照组变化幅度较大。这些结果以及功能连接的结果均证实了随着治疗介入大脑开始从代偿向自我修复转变,同时说明rTMS对脑部结构重塑的起促进作用。(2)患者患侧ReHo值与UE-FMA评分呈现正相关,说明基于ReHo的静息态fMRI技术能够有效评价rTMS的治疗效果,动态观察以及预测患者的恢复情况。(3)采用结构与功能相结合的分析方法观察脑梗死患者M1区变化,是探讨rTMS对于改善患者上肢运动功能恢复机制的有效手段。
[Abstract]:Objective: to study the changes of the structure and function of M1 area in patients with subacute cerebral infarction before and after treatment by measuring the cortical thickness of the affected M1 area and the functional junction and other multimodal analysis methods. To investigate the remodeling process of cerebral cortex function in patients with rTMS in order to provide a reliable basis for clinical treatment. Methods: 30 patients with primary cerebral infarction (single focus) were selected. The course of the disease was 10-20 days and was randomly divided into two groups: the control group (treated with neuromedical therapy and general rehabilitation) and the experimental group (the treatment group was treated with rTMS on the basis of the control group). Both groups were treated on the day of admission and after one course of treatment (treatment). After 4 weeks, BOLD-fMRI rest scanning and UE-FMA score were performed. Secondly, Freesurfer V.5.1.0 software was used to measure the cortical thickness of M1 area of the affected side of the subjects one by one. Thirdly, the rest fMRI data were processed by using the rest plug-in of Matlab2009a's own DPARSFAP, and the ReHo and fALFF values of M1 region of all the subjects were calculated. 4th. After treatment, the cerebral regions with different cortical thickness in M1 region of the experimental group and the control group were selected as seed points, and the spherical area with a radius of 5 mm was used as the seed point, and the rest functional connection analysis was carried out with other voxels in the whole brain. The sex, age and education level of all subjects were used as covariables. Re Ho and FC results were matched t test and double sample t test before and after treatment with REST. The difference of results between groups and within groups was analyzed. The correlativity of UE-FMA score and ReHo value. The results showed that the cortical thickness of M1 area was thickened in both groups, the thickening of experimental group was more obvious (p 0.05), the ReHo value of RIO area in both groups was lower than that in the former group after treatment. The fALFF value of the two groups was higher than that of before treatment, and that of the experimental group was significantly higher than that of the control group. The results of functional connection between ROI and the whole brain in the experimental group showed that the difference between the ROI and the whole brain function before and after treatment was in the middle temporal gyrus of the affected side. The connection of inferior temporal gyrus, superior frontal gyrus and middle frontal gyrus was enhanced, the connection of contralateral inferior occipital gyrus and posterior cingulate gyrus was weakened. The functional junctions in the infratemporal gyrus, precentral gyrus of the affected side, postcentral gyrus of the affected side and bilateral auxiliary motor area were enhanced, and the differences between the experimental group and the control group before and after treatment were compared. In the cerebellum and occipital lobe, there is a large area of weakened junction. The FDR correction was used to correct the cluster level. The correlation analysis between ReHo and UE-FMA score showed that there was a positive correlation between the ReHo value of the affected side of the patient and the UE-FMA score. Conclusion: 1) through treatment, there is a positive correlation between the ReHo value of the affected side of the patient and the UE-FMA score. The cortical thickness of M1 region in the experimental group and the control group was thicker than that of the former. The re Ho value decreased and the fALFF value increased compared with the former. These results, as well as the results of functional junctions, confirmed that the brain began to shift from compensation to self-repair as treatment intervened. At the same time, it was suggested that the ReHo value of the affected side was positively correlated with the UE-FMA score in the patients with rTMS, and that the resting fMRI technique based on ReHo could effectively evaluate the therapeutic effect of rTMS. Dynamic observation and prediction of recovery in patients with cerebral infarction using structural and functional analysis method to observe the changes of M1 area in patients with cerebral infarction is an effective means to explore the mechanism of rTMS in improving the recovery of upper limb motor function in patients with cerebral infarction.
【学位授予单位】：成都体育学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R743.33

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