不同亚型精神分裂症患者静息态脑功能及3D ASL灌注成像对比研究

发布时间：2018-07-11 11:11

本文选题：精神分裂症 + 局部一致性　；参考：《南方医科大学》2017年硕士论文

【摘要】：第一部分不同亚型精神分裂症患者静息态脑功能对比研究目的:通过静息态脑功能局部一致性的方法,研究阳性、阴性症状为主型精神分裂症患者较对照组比较ReHo差异的区域,并探讨差异脑区在精神分裂症患者中的作用,为精神分裂症的发病机制、分型等提供影像学依据。材料与方法:1.研究对象:依据《美国精神疾病诊断与统计学手册-第5版》(DSM-V)精神分裂症诊断标准收集患者,并根据PANSS量表将精神分裂症患者分为阳性组(n=25)和阴性组(n=19),选择年龄、性别及受教育程度较为匹配的正常人作为对照组(n=20)。2.数据采集:采用GE SignaHDXT3.0T超导型磁共振成像仪进行脑功能成像数据,扫描序列包括:常规磁共振序列(T1WI、T2WI及FLAIR)、3D高分辨结构像以及静息态扫描。3.数据预处理:于MATLAB(R2012a)软件平台,采用静息态磁共振处理软件DPARSFA 2.3对所获取的影像数据进行预处理,ReHo方法数据预处理步骤包括:格式转换、剔除前10时间点、时间层校正、头动校正、空间标准化、去线性漂移、滤波以及去除协变量、计算ReHo值以及平滑。头动校正剔除标准设置为x、y、z轴方向平动大于2mm和转动2°。4.统计学分析:采用SPSS 20.0对临床资料进行统计学分析。使用REST软件中One WayANOVA方法对三组ReHo指标进行比较,结果进行AlphaSim校正(P0.01),提取单因素方差分析差异脑区中ReHo值进行post hoc test(Bonferroni校正),得到阴性、阳性组与对照组组间比较的结果,P0.05认为差异有统计学意义。结果:精神分裂症阴性、阳性组与对照组在年龄、性别、受教育年限上无明显统计学差异。阳性组较对照组相比,右侧额上回眶部及左侧颞中回ReHo下降,左侧枕下回、右侧壳核和双侧舌回ReHo增高。而阴性组较对照组相比,左侧小脑、颞下回及右侧壳核ReHo增高,左侧中央后回、右侧额上回眶部ReHo减低。结论:阴性、阳性症状为主的精神分裂症患者较对照组存在广泛的局部一致性异常,包括额叶、颞叶、枕叶、基底节区及小脑等。阳性组、阴性组与对照组相比,ReHo差异的脑区不尽相同,考虑不同亚型精神分裂症患者存在不同的神经病理学差异。其中额叶、壳核功能的异常可能是两种亚型共同的病理生理学改变;枕叶与患者阳性症状相关,而小脑与阴性症状形成有关;颞叶不同亚区、中央后回在精神分裂症发病机制中的作用目前尚不明确。第二部分不同亚型精神分裂症患者3D ASL灌注成像对比研究目的:SPECT、PET/CT方面研究表明精神分裂症患者存在脑部血流灌注差异。本研究采用3D ASL技术,无创性地研究阳性、阴性症状为主型精神分裂症患者脑部血流灌注的改变,探讨不同亚型精神分裂症患者灌注特点以及差异脑区在精神分裂症患者中的作用。方法:1.研究对象:依据《美国精神疾病诊断与统计学手册-第5版》(DSM-V)精神分裂症诊断标准收集患者,并根据PANSS量表将精神分裂症患者分为阳性组(n=25)、阴性组(n=19),选择年龄、性别及受教育程度较为匹配的正常人作为对照组(n=20)。2.数据采集:采用GESignaHDXT3.0T超导型磁共振成像仪进行脑功能成像数据。扫描序列包括:常规磁共振序列(T1WI、T2WI及FLAIR)、3D高分辨结构像以及三维动脉自旋标记成像(3D Arterial Spin Labeling,3D ASL)扫描。3.数据预处理:通过GE Signa HDXT 3.0T扫描仪自带的Functool后处理工作站获得被试的脑血流灌注图。采用SPM 8软件对CBF图进行基于体素的预处理,步骤包括格式转换、配准、分割、空间标准化以及平滑。4.统计学分析:采用SPSS 20.0对临床资料进行统计学分析。阴性、阳性组及对照组预处理之后的CBF图采用SPM 8软件中One Way ANOVA方法进行分析(P0.05),提取clustersize56的体素作为mask,用于精神分裂症亚组与对照组组间比较。两两之间比较采用两样本t检验,统计结果进行AlphaSim校正(P0.05)。结果:精神分裂症阴性、阳性组与对照组在年龄、性别、受教育年限上无统计学差异。阳性组较对照组相比,右侧枕下回、枕中回及左侧颞中回CBF显著增高,而左侧丘脑、双侧额上回CBF降低。阴性组左侧颞中回、右侧枕中回、枕下回及角回灌注增高,左侧壳核、丘脑、楔前叶及右侧尾状核、补充运动区和双侧额上回CBF降低。结论:本实验发现ASL成像可应用于精神分裂症患者脑血流灌注检测,结果也支持既往PET/CT、SPECT发现的精神分裂症额叶、颞叶、枕叶以及基底节区等灌注的异常。此外,阴性、阳性组在血流灌注方面存在差异,推断不同亚型精神分裂症患者存在不同的病理生理学变化,不同区域的灌注改变可能与不同亚型精神分裂症临床表现相关。其中额叶、丘脑的血流灌注改变可能是两组亚型共同的病理生理学改变;楔前叶、角回与阴性症状的发生关系密切;而补充运动区域的作用尚待进一步证实。
[Abstract]:Part 1 Comparison of resting state brain function in different subtypes of schizophrenics Objective: To compare the region of ReHo difference between positive and negative symptomatic schizophrenics compared with the control group by the method of resting state of brain function, and to explore the role of different brain areas in schizophrenic patients and to be schizophrenic. The pathogenesis and classification of the disease provided the basis of imaging. Materials and methods: 1. subjects were collected according to the diagnostic criteria for schizophrenia in the American psychiatric diagnosis and statistics manual Fifth Edition (DSM-V), and the schizophrenic patients were divided into positive group (n=25) and negative group (n=19) according to the PANSS scale, and the age, sex and teaching were selected. The normal people with more matched level as the control group (n=20).2. data acquisition: using the GE SignaHDXT3.0T superconducting magnetic resonance imaging instrument for brain functional imaging data, the scanning sequence includes the conventional magnetic resonance sequence (T1WI, T2WI and FLAIR), the 3D high resolution structure image and the static state scanning.3. data preprocessing: the MATLAB (R2012a) software platform, The rest state magnetic resonance processing software DPARSFA 2.3 is used to preprocess the acquired image data. The ReHo method data preprocessing steps include the format conversion, the elimination of the first 10 time points, the time layer correction, the head motion correction, the space standardization, the de linear drift, the filtering and elimination of the covariance, the calculation of the ReHo value and the smoothness correction culling mark. X, y, Z axis translations were more than 2mm and 2 degrees.4. of rotation: SPSS 20 was used to analyze the clinical data. The One WayANOVA method was used in the REST software to compare the three groups of ReHo indexes, and the AlphaSim correction (P0.01) was carried out. Ferroni correction), the results of negative, positive and control groups were compared, and P0.05 thought the difference was statistically significant. Results: schizophrenia was negative. There was no significant difference between the positive group and the control group in age, sex, and the number of years of education. Compared with the control group, the right side of the upper frontal gyrus and the left temporal gyrus ReHo decreased. The lateral occipital gyrus, right putamen and bilateral lingual gyrus increased ReHo. Compared with the control group, the left cerebellum, the lower temporal gyrus and the right putamen increased ReHo, the left central posterior gyrus, and the right frontal gyrus orbital ReHo decreased. Conclusion: the negative, positive symptoms of schizophrenia patients have extensive local concordance abnormalities, including the frontal lobes, as compared with the control group. Temporal lobe, occipital lobe, basal ganglia and cerebellum. Positive group, negative group compared with control group, the difference of ReHo brain area was different, considering the different neuropathic differences in different subtype schizophrenic patients. The abnormalities of the frontal and putamen function may be the pathophysiological changes of the two subtypes, and the positive symptoms of the occipital lobe and the patients. Correlation, and the cerebellum is related to the formation of negative symptoms; the role of the posterior central temporal lobe in the pathogenesis of schizophrenia is not clear. Second the comparison of 3D ASL perfusion imaging in different subtypes of schizophrenic patients: SPECT, PET/CT studies show that the difference of cerebral blood perfusion in schizophrenic patients In this study, 3D ASL technique was used to study the changes in cerebral blood flow in schizophrenic patients with positive and negative symptoms, and to explore the perfusion characteristics of schizophrenic patients with different subtypes and the role of different brain regions in schizophrenic patients. Methods: 1. subjects: according to the diagnostic and statistical hands of American Psychiatric disorders. The diagnostic criteria of schizophrenia, Fifth Edition > (DSM-V) were collected, and the schizophrenic patients were divided into positive group (n=25) and negative group (n=19) according to the PANSS scale. The age, sex and the normal persons with more matched education were collected as the.2. number of the control group (n=20): the GESignaHDXT3.0T superconducting magnetic resonance imaging instrument was used to perform the brain work. The scanning sequence includes: the conventional magnetic resonance sequence (T1WI, T2WI and FLAIR), the 3D high resolution structure image, and the three-dimensional arterial spin labeling imaging (3D Arterial Spin Labeling, 3D ASL) scan.3. data preprocessing. SPM 8 software preprocessed the CBF map based on voxel, including format conversion, registration, segmentation, spatial standardization, and smooth.4. statistical analysis: SPSS 20 was used for statistical analysis of clinical data. Negative, positive and control groups were pretreated with SPM 8 One Way ANOVA method in SPM 8 software (P0.05). The voxel of clustersize56 was used as mask for the comparison between the subgroup of schizophrenia and the control group. The two sample t test was compared between 22 and the result was AlphaSim correction (P0.05). The result: the schizophrenia was negative. There was no statistical difference between the positive group and the control group in age, sex, and the number of years of education. On the right, the right occipital gyrus, the middle occipital gyrus and the left temporal gyrus CBF increased significantly, while the left thalamus and the bilateral frontal gyrus decreased CBF. The left lateral temporal gyrus, the right occipital gyrus, the lower occipital gyrus and the angular gyrus increased, the left putamen, the thalamus, the anterior lobe of the wedge and the right caudate nucleus, and the CBF decreased in the motor area and the bilateral frontal gyrus. Conclusion: this experiment found ASL into the motor area and bilateral frontal gyrus. Conclusion: this experiment found that the CBF decreased in the motor area and bilateral frontal gyrus. Conclusion: this experiment found ASL into the motor area and bilateral frontal gyrus. The results also supported abnormal perfusion in the frontal lobe, the temporal lobe, the occipital lobe and the basal ganglia found in the PET/CT, SPECT, and the positive groups were different in the blood flow perfusion, and the different pathophysiology of the patients with different subtype schizophrenia had different pathophysiology. Changes in the perfusion changes in different regions may be related to the clinical manifestations of different subtypes of schizophrenia. The changes in the perfusion of the frontal and thalamus may be the common pathophysiological changes in the two subtypes; the anterior lobe, the angular gyrus are closely related to the negative symptoms, and the role of the supplementary exercise area needs to be further confirmed.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R749.3

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