甲状腺激素减低患者静息态脑网络的fMRI研究

发布时间：2018-04-04 13:09

本文选题：功能连接密度　切入点：脑网络　出处：《天津医科大学》2017年硕士论文

【摘要】：目的:甲状腺激素对于人类大脑维持正常的结构及功能起着至关重要的作用。甲状腺激素减低患者常伴发抑郁、焦虑等神经精神症状,但对其机制尚不清楚。本实验应用静息态功能磁共振成像(rest functional magnetic resonance imaging,rs-fMRI)技术基于体素水平(voxel-wise)的功能连接密度(functional connectivity density,FCD)与基于种子点(region of interest,ROI)的全脑功能连接(functional connectivity,FC)相结合的方式来研究甲状腺激素减低患者脑网络的改变,并探讨其与精神神经症状症状及甲状腺激素水平的相关性。材料与方法:我们收集了自2014年6月至2016年8月在天津医科大学总医院核医学科门诊初诊且未行治疗的15例甲减患者(男性1例,女性14例)作为实验组,另选取同期选入的年龄及性别匹配的健康志愿者15例(男性1例,女性14例)为对照组。临床上采集每个被试的空腹静脉血标本以测定其甲状腺激素水平。并使用汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)来测定每个被试的焦虑程度,使用汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)来测定每个被试的抑郁程度。应用GE公司的3.0T核磁共振扫描仪(Discovery MR750,General Electric,Milwaukee,WI,USA)对所有被试进行常规轴位T1WI、T2WI扫描及静息态fMRI扫描,经数据预处理后,使用Linux系统的内部脚本分别得到两组人的全程功能连接密度(globle-FCD)、短程功能连接密度(short-FCD)及长程功能连接密度(long-FCD)图像。然后采用REST(www.restfmri.net)软件自带的统计分析软件对病例组与对照组全程功能连接密度(globle-FCD)、短程功能连接密度(short-FCD)及长程功能连接密度(long-FCD)三组数据分别进行双样本t检验(P0.001,AlphaSim校正),然后分析比较每两组之间具体的差异水平。并以两组间短程功能连接密度存在显著差异的脑区作为感兴趣区,进行全脑功能连接分析,并比较两组间差异。最后使用Pearson相关分析方法分别检验甲减组各个ROI的globle-FCD、short-FCD及long-FCD值与血清甲状腺激素水平、HAMA以及HAMD量表评分的相关性。结果:(1)甲减组与正常对照组相比,在左侧眶部额下回、左侧眶部额中回、左侧三角部额下回全程功能连接密度(globle-FCD)值更高(P0.001,AlphaSim校正)。(2)甲减组与正常对照组相比,在左侧额中回、左侧眶部额下回及左侧眶部额中回短程功能连接密度(short-FCD)值显著减低(P0.001,AlphaSim校正)。(3)甲减组与正常对照组相比,在左侧额中回长程功能连接密度(long-FCD)值更高(P0.001,AlphaSim校正)。(4)左侧额中回与左侧三角部额下回、左侧颞上回颞极、左侧岛叶、左侧扣带回中部、双侧辅助运动区及左侧扣带回前部功能连接增强(P0.001,AlphaSim校正)。(5)应用Pearson相关方法分别分析FCD值与血清FT3、FT4浓度及HAMA、HAMD得分的相关性。Pearson相关分析结果显示:均未发现显著相关性(P0.05)。结论:1.甲状腺激素减低可引起左侧额中回、左侧眶部额下回及左侧眶部额中回局部脑功能连接的异常,导致该区短程功能连接密度减低,提示可能与甲减患者伴发情绪抑郁及认知障碍等神经精神症状有关;2.甲状腺激素降低可引起左侧额中回长程功能连接异常,导致该区长程功能连接密度增高,提示可能与该脑区发挥代偿机制,建立远程连接弥补甲减患者认知及情绪障碍有关;3.甲状腺激素减低可以引起左侧眶部额下回、左侧眶部额中回、左侧三角部额下回全程功能连接密度增高,这说明全程功能连接密度主要受长程功能连接密度结果的影响,也就是代偿机制大于额叶功能连接的局部破坏;4.左侧额中回与默认网络及双侧辅助运动区功能连接增强,提示可能甲减患者不自主运动增多而需要大脑控制网络对其进行更强的控制作用有关。
[Abstract]:Objective: thyroid hormone to the human brain to maintain the normal structure and function plays a vital role. Thyroid hormone decreasing is common in patients with depression, anxiety and other neuropsychiatric symptoms, but the mechanism is not clear. The experimental application of resting state functional magnetic resonance imaging (rest functional magnetic resonance imaging, rs-fMRI) technology voxel level based on (voxel-wise) functional connectivity density (functional connectivity density, FCD) and based on the seed point (region of interest, ROI) of the whole brain functional connectivity (functional connectivity FC) to study the combination of the thyroid hormone changes in patients with impaired brain network, and explore its correlation with mental symptoms and thyroid hormone level. Materials and methods: We collected from June 2014 to August 2016 in the Department of nuclear medicine clinic of General Hospital Affiliated to Tianjin Medical University and not 15 cases of patients with hypothyroidism treatment (male 1 cases, female 14 cases) as the experimental group, 15 cases were selected in selected age and sex matched healthy volunteers (male 1 cases, female 14 cases) as the control group. The clinical subjects collected fasting venous blood samples to determine the thyroid gland hormone level and the use of Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA) to determine the anxiety level of each participant, using Hamilton Depression Scale (Hamilton Depression Scale, HAMD) to determine the degree of depression in each subjects. 3.0T nuclear magnetic resonance scanner using the GE (Discovery MR750, General Electric, Milwaukee WI, USA), all of the subjects were conventional axial T1WI, T2WI scan and resting state fMRI scan after data preprocessing, using Linux system internal scripts were obtained throughout the function of those in the two group (globle-FCD), short-range connection density function Connection density (short-FCD) and long term functional connectivity density (long-FCD) image. Then the REST (www.restfmri.net) software statistical analysis software for the case group and the control group throughout the functional connectivity density (globle-FCD) function, short-range connection density (short-FCD) and long term functional connectivity density (long-FCD) data of the three groups were double sample t test respectively (P0.001, AlphaSim, correction) and then compare the difference of each level between the two groups. And in between the two groups of short-range brain areas there are significant differences in density as regions of interest, for the whole brain functional connectivity analysis, and compare the differences between the two groups. Finally, using Pearson correlation analysis method respectively. Test each ROI hypothyroidism group globle-FCD, short-FCD and long-FCD values and serum thyroid hormone levels, HAMA and HAMD scale correlation. Results: (1) hypothyroidism group compared with normal control group, in The left orbital frontal gyrus, left orbital frontal gyrus, left inferior frontal triangle full functional connectivity density (globle-FCD) was higher (P0.001, AlphaSim correction). (2) hypothyroidism group compared with normal control group, the left middle frontal gyrus, left inferior frontal gyrus and left orbital orbital frontal gyrus short the functional connectivity density (short-FCD) values were significantly lower (P0.001, AlphaSim correction). (3) hypothyroidism group compared with normal control group, in the left frontal gyrus long-range functional connectivity density (long-FCD) was higher (P0.001, AlphaSim correction). (4) back to the left frontal gyrus and left frontal triangle in the left. Superior temporal gyrus temporal pole, left insula, left middle cingulate cortex, bilateral supplementary motor area and left anterior cingulate gyrus increased functional connectivity (P0.001, AlphaSim correction). (5) using Pearson method to analysis the FCD value and the concentration of serum FT3, FT4 and HAMA, the correlation results of.Pearson correlation analysis of HAMD score Display: found no significant correlation (P0.05). Conclusion: 1. thyroid hormone can cause impaired left middle frontal gyrus, abnormal return of brain function connected with the left orbital frontal gyrus and left orbital frontal, leads to the short-range functional connectivity density reduced, suggesting that patients with hypothyroidism with symptoms of depression and cognitive impairment and other neuropsychiatric related; 2. hypothyroidism can cause left middle frontal gyrus long-term functional connectivity abnormalities, leading to the long-range functional connectivity density increased, suggesting that may play a compensatory mechanism and the brain areas, establish a remote connection for cognitive and emotional disorder in patients with hypothyroidism; 3. thyroid hormone decreasing can cause left orbital volume the left orbital gyrus, middle frontal gyrus, left inferior frontal triangle full functional connectivity density increased, indicating that the whole function of connection density is mainly affected by the long-range functional connectivity density results, also The compensatory mechanism is greater than the local failure of frontal lobe functional connectivity. 4., the functional connectivity between the left frontal middle gyrus and the default network and bilateral supplementary motor areas is enhanced, suggesting that the involuntary movements of hypothyroidism patients are increasing, and the control network is required for their stronger control.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R581.2

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