视神经脊髓炎患者视觉皮层亚区结构和功能连接的损害

发布时间：2018-04-23 16:21

本文选题：视神经脊髓炎 + 视觉皮层亚区　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:视神经脊髓炎(neuromyelitis optica,NMO)的静息态功能磁共振及结构磁共振成像的研究发现视觉皮层存在显著的结构和功能的损害,但是精确到视觉亚区水平的结构和功能变化及其与NMO患者临床特征之间的关系目前尚不明确。本实验招募较大样本量的NMO患者,联合脑灰质体积(grey matter volume,GMV)分析及静息态功能连接(resting-state functional connectivity,rs FC)分析,旨在探究NMO患者视觉皮层亚区水平结构和功能连接改变特征及评价其对患者临床残疾程度的预测价值。材料与方法:本次实验招募了符合Wingerchuk诊断标准的37名NMO患者(32名女性和5名男性)及42名健康志愿者(37名女性和5名男性),两组受试者之间的年龄、性别、教育年限相匹配,使用GE Discovery MR750 3.0T磁共振扫描仪对所有受试者分别进行了3D高分辨率T1WI结构像和静息态功能磁共振成像扫描,并对每位NMO患者用扩展残疾状态量表(expanded disability status scale,EDSS)进行临床残疾程度评分。1.用基于Matlab的软件DPARSFA(Data Processing Assistant for Resting-State f MRI Advanced Edition)、SPM8(Statistical Parametric Mapping)及其插件VBM8分别对功能像和结构像进行预处理。2.定义左右大脑半球各10个视觉亚区,计算各亚区的全脑rs FC及其GMV。3.控制年龄、性别及教育年限,研究NMO患者视觉皮层亚区GMV及rs FC的改变,同时用一般线性模型方法将GMV作为协变量去除来研究GMV的变化对rs FC的结果是否有影响。4.分别将存在显著组间差异脑区的GMV和rs FC值提取出来,与EDSS评分进行偏相关分析,年龄、性别、教育年限作为协变量,统计阈值为p0.05,并经过多重比较校正。结果:1.与正常对照相比,NMO患者在双侧V1、V2、V3d、VP和LO及左侧V3A区均有GMV减低。在经典的视觉通路上,相对低级别的视觉亚区相比于相对高级别的视觉亚区GMV的减低更严重。2.不论是否回归GMV,NMO患者在双侧LO和V4v及左侧V2区都表现出rs FC的减低。3.在NMO患者中,双侧V1和LO及左侧V2和V3d区的GMV都与临床残疾程度明显呈负相关且相关的程度与相应亚区在视觉通路的等级明显相关。结论:1.在NMO患者中,相对低级别的视觉亚区表现出更严重的结构损害;2.结构损害不是视觉亚区rs FC改变的唯一影响因素;3.相对低级别视觉亚区的GMV减低对临床残疾程度具有最高的预测价值。
[Abstract]:Objective: the study of resting functional magnetic resonance (fMRI) and structural magnetic resonance imaging (SMR) of neuromyelitis optica (NMOA) revealed significant structural and functional damage in the visual cortex. However, the changes of structure and function at the visual subarea level and their relationship with the clinical features of NMO patients are unclear. In this study, we recruited a large sample of NMO patients, combined with grey matter volume analysis and resting-state functional connectivity rsFCanalysis. The purpose of this study was to investigate the changes of the horizontal structure and functional connections of visual cortex in patients with NMO and to evaluate their predictive value in clinical disability. Materials and methods: 37 NMO patients (32 females and 5 males) and 42 healthy volunteers (37 females and 5 males) who met the Wingerchuk diagnostic criteria were recruited in this study. The age, sex, education years of the two groups were matched. GE Discovery MR750 3.0T magnetic resonance scanner was used to perform 3D high-resolution T1WI structure image and resting functional magnetic resonance imaging respectively, and each NMO patient was evaluated with expanded disability status scale EDSS. The software DPARSFA(Data Processing Assistant for Resting-State f MRI Advanced mapping (SPM8 Statistical Parametric Mapping) and its plug-in VBM8 are used to preprocess the functional image and the structure image respectively. 2. Ten visual subregions of the left and right hemispheres were defined, and the whole brain RsFC and GMV.3 were calculated. The changes of GMV and RsFC in visual cortex of NMO patients were studied by controlling age, sex and years of education, and GMV was removed as a covariable by general linear model to study whether the changes of GMV had an effect on the results of RsFC. 4. The values of GMV and RsFC in brain regions with significant differences were extracted, and the partial correlation analysis was carried out with EDSS scores. Age, sex and years of education were used as covariables, the statistical threshold was p0.05, and was corrected by multiple comparisons. The result is 1: 1. Compared with the normal controls, the GMV was decreased in both V1V2V2V3dU and Lo and the left V3A region in the patients with NMO. In the classical visual pathway, the decrease of GMV in the relatively low level visual subregion is more serious than that in the relatively high level visual subregion. RsFC decreased in both Lo and V4v and left V2 regions in patients with NMO with or without GMVV regression. In patients with NMO, the GMV of bilateral V1 and Lo and left V2 and V3D were negatively correlated with the degree of clinical disability, and the degree of correlation was significantly correlated with the grade of the corresponding subregion in the visual pathway. Conclusion 1. In patients with NMO, the relatively lower visual subareas showed more severe structural damage. Structural damage is not the only factor affecting the changes of RsFC in the visual subarea. The reduction of GMV in the lower visual subarea has the highest predictive value for clinical disability.
【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;R744.52

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