应用静息态功能磁共振成像对急性脑梗死后脑心综合征患者脑功能的研究

发布时间：2018-04-18 10:24

  本文选题：急性脑梗死 + 脑心综合征　； 参考：《河北医科大学》2017年硕士论文

【摘要】：目的:急性脑缺血可导致原来没有心脏疾患的患者发生心脏损害,严重者可发生心肌损伤甚至猝死,机制尚不清楚。本研究利用静息态功能性磁共振成像(resting-state functional magnetic resonance imaging,rs-fMRI)技术研究评价急性脑梗死后脑心综合征(brain heart syndrome,BHS)患者脑区定位及机制。方法:搜集符合入选标准的急性脑梗死后脑心综合症(brain heart syndrome,BHS)患者16例(男性14例,女性2例,平均年龄52.2±13.4岁)纳入实验组。选择与实验组年龄、性别和教育程度相匹配的急性脑梗死患者20例(男性17例,女性3例,平均年龄56.5±11.1岁)作为对照组。实验组及对照组均无脑外伤、脑出血、脑梗死、脑肿瘤、精神疾病及重大心血管疾病史,无吸烟、酗酒、非法药物滥用病史。采用Philips Achieva3.0T X-series磁共振扫描仪及8通道相控阵头部正交线圈,在静息状态下行血氧水平依赖磁共振脑功能成像。采用REST v1.6软件包、DPARSF v2.0软件包基于Matlab R2009a软件平台对实验数据进行预处理、统计分析和结果显示。数据排除标准:(1)头动校正过程中检测到的头动平移超过1mm或头动旋转超过1°;(2)空间标准化过程中检测到的图像配准不理想的数据。人口统计学变量及临床资料的统计分析运用SPSS 21.0统计分析软件。两组年龄、受教育程度和NISSH评分均服从正态分布,采用独立样本t检验,P0.05有统计学意义。采用四格表Fisher确切概率法比较两组性别构成比的差异性,P0.05有统计学意义。结果:1两组间的人口统计学变量(性别、年龄、受教育程度)差异无显著统计学意义(P0.05),临床资料(NISSH评分)差异有显著统计学意义(P0.05)。2与对照组相比较,BHS组ALFF值显著增强的脑激活区:右侧丘脑、右侧桥脑、右侧扣带回、胼胝体、左侧补充运动区、左侧中央旁小叶、左侧楔前叶、左侧枕上回、左侧枕中回、左侧小脑前叶、左侧小脑后叶。3与对照组相比较,BHS组ALFF值显著减弱的脑激活区:脑干、左侧脑岛、右侧眶部额上回、左侧额中回、左侧颞中回颞极。结论:1 BHS患者梗死灶远隔部位脑区激活增强,表明BHS的发生诱发并加重了脑梗死后远隔效应的产生(神经机能联系失能),这可能是导致患者进展性脑梗死或预后不良的原因之一。2 BHS的发生与脑干及边缘系统(主要是岛叶皮质)支配心脏活动的相关脑区的损伤密切相关。3 Rs-fMRI在评价急性脑梗死后脑心综合征患者脑区定位及机制和预测急性脑梗死后脑心综合症的发生具有潜在的应用价值。
[Abstract]:Objective: acute cerebral ischemia may lead to cardiac damage in patients without heart disease, and myocardial injury or sudden death in severe cases. The mechanism is not clear.In this study, resting-state functional magnetic resonance imagingrs-fMRI technique was used to evaluate the localization and mechanism of brain heart in patients with cerebral heart syndrome after acute cerebral infarction.Methods: sixteen patients (14 males and 2 females, mean age 52.2 卤13.4 years) with brain heart syndrome after acute cerebral infarction were enrolled in the study group.Twenty patients (male 17, female 3, mean age 56.5 卤11.1 years) with acute cerebral infarction matched with age, sex and education level of the experimental group were selected as the control group.There were no history of brain injury, cerebral hemorrhage, cerebral infarction, brain tumor, mental illness and major cardiovascular disease, no smoking, alcohol abuse and illegal drug abuse in the experimental group and the control group.Philips Achieva3.0T X-series magnetic resonance scanner and 8-channel phased array head quadrature coil were used to perform brain function imaging with oxygen level dependent magnetic resonance imaging in resting state.The experimental data are preprocessed with REST v1.6 software package and DPARSF v2.0 software package based on Matlab R2009a software platform. The statistical analysis and the result show.Data exclusion Standard: 1) the detected head motion translation exceeds 1mm or the head rotation is more than 1 掳/ 2) in the process of spatial standardization, the image registration is not ideal.The demographic variables and clinical data were analyzed by SPSS 21. 0 software.The age, education level and NISSH score of the two groups were all taken from normal distribution, using independent sample t test (P0.05) had statistical significance.It was statistically significant to compare the difference of sex composition ratio between the two groups by using Fisher exact probability method.Results the demographic variables between the two groups (sex, age,There was no significant difference in educational level (P 0.05). There was a significant difference in clinical data (P 0.05%). The activation areas of ALFF in the right thalamus, the right pontine, the right cingulate gyrus, the corpus callosum were significantly enhanced in the right thalamus, the right pontine, the right cingulate gyrus, and the corpus callosum, compared with those in the control group.In the left supplementary motor area, the left paracentral lobules, the left precuneal lobe, the left superior occipital gyrus, the left middle occipital gyrus, the left anterior cerebellar lobe, the left posterior cerebellar lobe, the brain activation areas in which the ALFF values of the BHS group were significantly reduced compared with those of the control group: brain stem, left cerebral island.Right orbital superior frontal gyrus, left middle frontal gyrus, left middle temporal gyrus temporal pole.Conclusion the activation of brain in the distant region of infarct was enhanced in patients with 1 BHS.It is suggested that the occurrence of BHS induces and exacerbates the generation of distant effect after cerebral infarction (neurologic dysfunction, which may be one of the causes of progressive cerebral infarction or poor prognosis. 2. 2 BHS) and brainstem and limbic system.(mainly the insular cortex) the injury of the brain region innervating cardiac activity is closely related to the location and mechanism of cerebral area in patients with cerebral heart syndrome after acute cerebral infarction and the prediction of cerebral heart syndrome after acute cerebral infarction.It has potential application value.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R743.33;R541

【参考文献】

中国期刊全文数据库 前1条

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