基于功能磁共振成像的有氧训练对阿尔茨海默病患者干预作用的研究

发布时间：2018-03-24 21:05

本文选题：轻度认知障碍　切入点：有氧训练操　出处：《南京医科大学》2017年博士论文

【摘要】：第一部分有氧训练对轻度认知障碍患者干预作用的研究目的:通过静息态fMRI研究,评估一套专门编制的中等强度有氧训练操对轻度认知障碍(MCI)患者的干预作用。方法:本研究将38例MCI患者按照随机数字表法随机分为训练组(19例)和对照组(19例)。训练组接受3个月的有氧训练操,对照组仅接受健康宣教。两组受试者在入组时及3个月干预结束时均接受认知功能量表评分和静息态功能磁共振(fMRI)评估。静息态fMRI采用低频振幅(ALFF)分析方法。结果:经过3个月的有氧训练操干预后,训练组简易精神状态评分(MMSE)、蒙特利尔认知评估量表(MoCA)、韦氏逻辑记忆及符号数字模式测试评分与干预前基线水平相比差异有统计学意义(p0.05),同时训练组韦氏逻辑记忆评分变化值与对照组韦氏逻辑记忆评分变化值相比差异也有统计学意义(p0.05)。对照组3个月后所有认知功能评分与基线水平相比差异均无统计学意义(p0.05)。静息态fMRI数据分析提示训练组3个月后的双侧额颞叶、内嗅、前扣带回及海马旁皮层较训练前广泛性ALFF值增高,而对照组3个月后的仅右侧颞叶和后扣带回皮层小范围的ALFF值较前增高。结论:有氧训练操能有效提高MCI患者的认知功能。静息态fMRI为MCI患者有氧训练的有效性评价提供了一种敏感可行的量化方法。第二部分有氧训练对阿尔茨海默病患者干预作用的研究目的:通过静息态fMRI研究,评估一套专门编制的中等强度有氧训练操对轻度阿尔茨海默病(AD)患者的干预作用。方法:本研究将40例轻度AD患者按照随机数字表法随机分为训练组(20例)和对照组(20例)。训练组接受3个月的有氧训练操,对照组仅接受健康宣教。两组受试者在入组时及3个月干预结束时均接受认知功能量表评分和静息态fMRI评估。静息态fMRI采用低频振幅(ALFF)分析方法。结果:经过3个月的有氧训练操干预后,训练组MMSE量表、连线测试A与干预前基线水平相比差异有统计学意义(p0.05);对照组3个月后所有认知功能评分与基线水平相比差异均无统计学意义(p0.05);两组3个月与基线水平的变化值也均无统计学意义(p0.05)。静息态tMRI数据分析提示训练组3个月后的左侧额叶、左前扣带回、右侧顶叶及右侧中央前后回皮层ALFF值较训练前显著增高;对照组3个月后的双侧小脑、左侧颞叶、右侧额叶及右前扣带回皮层ALFF值较入组时减低。结论:有氧训练操能适度地提高轻度AD患者的认知功能。静息态fMRI为轻度AD患者有氧训练的有效性评价提供了一种敏感可行的量化方法。第三部分基于静息态fMRI的有氧训练在阿尔茨海默病患者中的初步机制研究目的:通过静息态fMRI研究,探讨有氧训练操对阿尔茨海默病患者的干预作用机制。方法:本研究将选取的17例AD患者随机分为训练组(9例)和对照组(8例)。训练组接受3个月的有氧训练操,对照组仅接受健康宣教。同时获取两组患者在入组时和3个月后的fMRI数据,分别进行低频振幅(ALFF)分析和脑功能网络分析。结果:训练组3个月后的双侧前额叶、前扣带回皮层ALFF值及脑网络介数中心度(BC)值较训练前增高,且3个月后训练组的BC值较对照组增高,差异有统计学意义(p0.05);进一步根据网络的核心节点分布情况发现,训练后网络的核心节点呈现出双侧分布,有异于训练前的偏侧分布。结论:有氧训练可有效增强关键脑区自发活动水平及全脑信息传递效率,促进脑网络结构重组及对侧大脑半球代偿,进而有助于AD患者认知功能的恢复。
[Abstract]:The first part of study on the effect of aerobic exercise intervention in patients with mild cognitive impairment: by resting state fMRI study, a special assessment of moderate intensity aerobic exercise on Preparation of mild cognitive impairment (MCI) intervention patients. Methods: in this study, 38 cases of MCI patients according to randomly divided into the training group (19 cases) and control group (19 cases). The training group received 3 months of aerobic exercise, the control group received health education. The two groups of subjects at baseline and 3 months at the end of the intervention received cognitive function scores and resting state functional magnetic resonance (fMRI). Evaluation of resting state fMRI by low frequency amplitude (ALFF) analysis method. Results: after 3 months of aerobic exercise intervention training group, the mini mental state score (MMSE), Montreal cognitive assessment scale (MoCA), Wechsler Memory and logic symbols in digital mode test scores before and after intervention There are significant differences compared to the baseline level (P0.05), at the same time training group Wechsler logical memory score changes value and group Wechsler logical memory score changes the control value compared to the difference was statistically significant (P0.05). The control group after 3 months all the cognitive function scores from baseline compared differences were not statistically significant (P0.05) analysis. That training group after 3 months of bilateral frontotemporal and entorhinal resting state fMRI data, anterior cingulate and parahippocampal cortex compared with that before the training, wide ALFF value increased, while the control group after 3 months only right temporal lobe and the posterior cingulate cortex, small range of ALFF value higher than before. Conclusion: aerobic exercise training can improve the cognitive function of MCI patients. The resting fMRI for MCI patients is effective evaluation of aerobic training provides a quantitative sensitive and reliable method. The second part of aerobic training on the role of intervention in patients with Alzheimer's disease Objective: To study the resting state fMRI, a special assessment of moderate intensity aerobic exercise on the preparation of mild Blzheimer's disease (AD) intervention patients. Methods: 40 cases of mild AD patients were randomly divided into training group (20 cases) and control group (20 cases). The training group received 3 months of aerobic exercise, the control group received health education. The two groups of subjects at baseline and 3 months at the end of the intervention received cognitive function scores and resting state fMRI assessment. The resting state fMRI by low frequency amplitude (ALFF) analysis method. Results: after 3 months of aerobic exercise intervention training group, MMSE scale, A connection test before and after the intervention at baseline compared to the difference was statistically significant (P0.05); the control group after 3 months of all cognitive scores compared with the baseline levels showed no significant difference (P0.05); the two group of 3 months with the baseline water The change values were not statistically significant (P0.05). The analysis showed that the left frontal training group after 3 months of resting state tMRI data, left anterior cingulate gyrus, right parietal lobe and right back after the central cortex ALFF was significantly increased compared with before training; the control group 3 months after bilateral cerebellum, left temporal lobe, right frontal lobe and right anterior cingulate cortex ALFF value decreased in the group. Conclusion: aerobic exercise can moderately improve cognitive function in patients with mild AD. The resting state fMRI of mild AD patients, evaluation of the effectiveness of aerobic training provides a quantitative sensitive and reliable method. The third part based on resting state fMRI objective to study the preliminary mechanism in patients with Alzheimer's disease through aerobic training: a resting state fMRI study, to explore the mechanism of aerobic training exercise intervention on patients with Alzheimer's disease. Methods: This study selected 17 cases of AD patients were randomly divided into training group ( 9 cases) and control group (8 cases). The training group received 3 months of aerobic exercise, the control group received health education. At the same time to obtain fMRI data at baseline and after 3 months of the two groups of patients, respectively, low-frequency amplitude (ALFF) analysis and analysis of brain functional network. Results: the training group after 3 months of bilateral prefrontal, anterior cingulate cortex and brain ALFF value network betweenness centrality (BC) value and the value increased compared with before training, the training group BC was higher than those in control group after 3 months, the difference was statistically significant (P0.05); according to the distribution of the core nodes of the network. Now, after training the core node of the network showed bilateral distribution, different from the side before the training distribution. Conclusion: aerobic training can effectively enhance the level of spontaneous activity of key brain region and whole brain information transmission efficiency, network structure and to promote brain hemisphere compensatory, and thus contribute to the cognitive function in patients with AD Recovery.

【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;R749.16

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