首发儿童青少年精神分裂症静息态磁共振研究

发布时间：2018-05-13 04:15

本文选题：精神分裂症 + 儿童青少年　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景精神分裂症是一种高遗传度、高异质性的大脑功能紊乱性疾病。临床以其精神活动与所处的环境不相协调为特征,有慢性化和衰退倾向,病情波动难于预测,许多症状如自杀、被害妄想、命令性幻听等的出现严重影响患者自身、家人与社会的安全,甚至给人民生命和国家财产造成巨大损失。儿童青少年精神分裂症(childhood and adolescence schizophrenia)起病于18岁前,与成年起病的患者比较,神经发育异常更明显,临床症状更不典型,治疗效果及预后更差。越来越多的研究发现精神分裂症患者存在脑结构异常,包括脑室扩大、皮层及皮层下萎缩。本课题组在既往研究中发现首发儿童青少年精神分裂症患者显示类似的异常。关于儿童青少年精神分裂症脑功能相关研究较少,本研究拟通过磁共振成像技术(Magnetic Resonance Imaging,MRI)从结构和功能两个方面进行检测,为儿童青少年精神分裂症病理生理学机制的探索提供线索。目的通过分析首发儿童青少年精神分裂症患者的脑区白质和灰质体积改变及静息态脑功能成像特点,为儿童青少年精神分裂症病理生理学机制的探索提供线索。方法1.研究对象:本研究将选取45例符合《美国精神障碍诊断与统计手册第四版》(Diagnostic and Statistical Manual of Mental Disorder-IV,DSM-IV)诊断标准的首发儿童青少年精神分裂症患者作为病例组,并严格按照性别、年龄、民族和教育程度等配对原则选择39例正常对照者作为健康组。2.结构影像数据的处理及分析:其程序依次为格式重建、空间标准化、图像分割、计算脑体积、平滑等,最后对平滑后的灰、白质体积进行统计分析。应用的软件是Matlab(The Math Works,Inc.,Natick,Massachusetts)平台下,基于SPM8(Statistical Parametric Mapping,http://www.fil.ion.ucl.ac.uk/spm)软件下的子工具包VBM8(voxel-based morphometry.dbm.neuro.uni-jena.de/vbm/)及REST(RS-fMRI Data Analysis Toolkit,http://www.restfmri.net)软件包。3.脑功能成像及分析:采用3.0T功能磁共振成像系统对所有研究对象进行血氧水平依赖性的静息态功能磁共振成像(blood oxygenation level dependent resting-state functional Magnetic Resonance Imaging,BOLD-fMRI)检查,对所获取的影像学数据运用DPARSF软件进行预处理后,对符合标准的入组对象运用REST(Resting-State fMRI Data Analysis Toolkit)软件进行分析,得出低频振幅(Amplitude of Low-Frequency Fluctuation,ALFF)改变有统计学意义的脑区。以低频振幅值改变的脑区作为种子点,运用REST软件进行脑功能连接分析,得出种子点与全脑功能连接有统计学意义的脑区。结果1.病例组与健康组之间脑结构比较⑴两组之间脑白质体积比较:和健康组相比,病例组的大脑在左侧额叶、右侧边缘叶、左侧扣带回部位的白质体积显著降低,MNI坐标分别为:x=-27、18、-21,y=12、-9、-18,z=21、39、45;体素分别为:116、411、76;t=-4.4132、-5.0232、-5.2164;Alphasim矫正,矫正后P0.05。⑵两组之间脑灰质体积比较:和健康组相比,病例组的大脑在右侧脑岛、左侧额下回、左侧边缘叶部位的灰质体积显著降低,MNI坐标分别为:x=36、54、0,y=21、18、45,z=3、9、27;体素分别为:42、37、83;t=-5.303、-5.3016、-6.211;Alphasim矫正,矫正后P0.05。2.病例组与健康组之间低频振幅分析及功能连接结果⑴低频振幅分析:和健康组相比,病例组大脑在左侧舌回、左侧颞叶、额叶等部位低频振幅显著降低,MNI坐标分别为:x=0、-54、0,y=-63、-21、-27,z=9、0、69;体素分别为:225、84、143;t=-4.8201、-4.3652、-4.7325;Alphasim矫正,矫正后P0.05。⑵功能连接分析:将低频振幅降低的脑区作为种子点与全脑进行静息态功能连接分析。当左侧舌回(MNI坐标x=0,y=-63,z=9)作为种子点时,病例组显示右颞上回、左颞上回、右脑岛、左额叶、右顶叶与种子点的连接显著低于健康组,MNI坐标分别为:x=66、-51、63、-33、-6,y=-36、-21、-18、-21、-33,z=12、3、9、54、72;体素分别为:123、196、164、158、190;t=-4.586、-4.448、-4.1543、-5.0523、-4.8143;FDR矫正P0.05。当左侧颞叶(MNI坐标x=-54,y=-21,z=0)作为种子点时,病例组显示右枕叶、右额内侧回、左顶叶、左额叶、右额上回与种子点的连接显著低于健康组,MNI坐标分别为:x=12、6、-39、-45、12,y=-36、54、-18、-18、6,z=78、-3、12、60、66;体素分别为:8589、622、346、464、157;t=-6.2086、-4.6238、-5.0948、-4.8746、-4.5463;FDR矫正P0.05。当额叶(MNI坐标x=0,y=-27,z=69)作为种子点时,病例组显示左颞叶、右额中回、左顶叶、右额上回、右扣带回与种子点的连接显著低于健康组,MNI坐标分别为:x=18、39、-54、24、6,y=-51、45、-21、30、-21,z=9、-18、36、45、45;体素分别为:12536、99、510、77、104;t=-5.1981、-4.8179、-3.5712、-4.1543、-3.4971;FDR矫正P0.05。结论1.首发儿童青少年精神分裂症患者脑灰质及白质体积均有显著降低。2.首发儿童青少年精神分裂症患者在静息状态下存在多个脑区的功能连接异常。
[Abstract]:Background schizophrenia is a highly hereditary, highly heterogeneous brain disorder. It is characterized by the lack of coordination between the mental activity and the environment. It has a tendency of chronicity and decline, and the fluctuation of the disease is difficult to predict. Many symptoms such as suicide, delusion, and hallucination have serious influence on the patient, family and family. Social security, even to the people's life and national property caused great loss. Children and adolescent schizophrenia (childhood and adolescence schizophrenia) before the age of 18 years old, compared with adult patients, the neurodevelopmental abnormalities are more obvious, the clinical symptoms are more untypical, the treatment effect and worse prognosis. More and more research found Patients with schizophrenia have abnormal brain structure, including ventricular enlargement, cortical and subcortical atrophy. In our previous study, we found that the onset of schizophrenia in the first children and adolescents showed similar abnormalities. The brain function related to schizophrenia in children and adolescents was less. This study was designed by magnetic resonance imaging (Magnetic Resonance Imaging, MRI), from two aspects of structure and function, provides clues for the pathophysiological mechanism of children and adolescents with schizophrenia. Objective to analyze the changes of white matter and gray matter volume and the resting state brain functional imaging in the brain area of the first children with schizophrenia. The pathophysiological mechanism of cleft disease provides clues. Method 1. subjects: This study will select 45 juvenile schizophrenia patients who are in line with the diagnostic and Statistical Manual of Diagnostic and Statistical Manual of Mental Disorder-IV, DSM-IV). According to the matching principle of sex, age, nationality and education level, 39 normal controls were selected as the data processing and analysis of.2. structure in the health group. The program was in turn in format reconstruction, space standardization, image segmentation, calculation of brain volume, smoothing and so on. Finally, the volume of white matter after smoothing was statistically analyzed. The application software was Matla B (The Math Works, Inc., Natick, Massachusetts) platform based on SPM8 (Statistical Parametric Mapping, http://www.fil.ion.ucl.ac.uk/spm) software package And analysis: the 3.0T functional magnetic resonance imaging system was used to perform resting state functional magnetic resonance imaging (blood oxygenation level dependent resting-state functional Magnetic Resonance Imaging, BOLD-fMRI) for all research subjects, and the obtained imaging data were pretreated with DPARSF software. The REST (Resting-State fMRI Data Analysis Toolkit) software was used to analyze the standard group. The low frequency amplitude (Amplitude of Low-Frequency Fluctuation, ALFF) changed the statistically significant brain area. The brain region, which was changed by the low frequency amplitude value, was used as the seed point, and the brain function connection was analyzed by using the REST software. Compared with the healthy group, the cerebral structure of the 1. cases group and the healthy group was compared with the healthy group. Compared with the health group, the white mass accumulation in the left frontal lobe, the right marginal lobe and the left cingulate gyrus decreased significantly compared with the healthy group, and the MNI coordinates were x=-27,18, -21, y=12, respectively. -9, -18, z=21,39,45; 116411,76; t=-4.4132, -5.0232, -5.2164; Alphasim corrected, and after correction of the volume of gray matter between the two groups of P0.05. 2: compared with the health group, the brain of the case group decreased significantly in the right insula, the left inferior frontal gyrus, and the left margin of the lobe, and the MNI coordinates were x=36,54,0, y=21,18,45, respectively. 3,9,27; voxels were 42,37,83; t=-5.303, -5.3016, -6.211; Alphasim correction. Low frequency amplitude analysis and functional connection results (1) analysis of low frequency amplitude between the P0.05.2. case group and the healthy group after correction: compared with the health group, the low frequency amplitude of the left lingual gyrus, the left temporal lobe, the frontal lobe and other parts of the case group decreased significantly, and the MNI coordinates were x, respectively: X =0, -54,0, y=-63, -21, -27, z=9,0,69; the voxels were 225,84143; t=-4.8201, -4.3652, -4.7325; Alphasim correction, and after corrective P0.05. 2 functional connection analysis: the brain area of low frequency amplitude reduced as seed point and whole brain resting state function connection analysis. Case group showed when the left tongue gyrus was used as seed point. Right temporal gyrus, left temporal gyrus, right brain Island, left frontal lobe and right parietal lobe were significantly lower than those of the healthy group. The MNI coordinates were x=66, -51,63, -33, -6, y=-36, -21, -18, -21, -33, z=12,3,9,54,72, respectively. 1, z=0) as the seed point, the case group showed that the right occipital lobe, right medial frontal gyrus, left parietal lobe, left frontal lobe, right upper frontal gyrus and seed points were significantly lower than those of the healthy group, and the MNI coordinates were x=12,6, -39, -45,12, y=-36,54, -18, -18,6, z=78, -3,12,60,66, respectively: 8589622346464157; t=-6.2086, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238, -4.6238 When the frontal lobe (MNI coordinates x=0, y=-27, z=69) was used as seed point, the case group showed that the left temporal lobe, right middle frontal gyrus, left parietal lobe, right upper frontal gyrus, right cingulate gyrus and seed point were significantly lower than those of the healthy group, and the MNI coordinates were x=18,39, -54,24,6, y=-51,45, -21,30, -21, z=9, MNI, respectively. .8179, -3.5712, -4.1543, -3.4971, and P0.05. correction of P0.05. conclusion 1. the cerebral gray matter and white matter volume of children with schizophrenia in the first episode of children and adolescents significantly decreased the function connection of multiple brain areas in the resting state of children with schizophrenia in the resting state.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R749.3

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