重型颅脑损伤昏迷患者的损伤评估及预后预测在静息态功能磁共振中的研究
发布时间：2018-10-24 16:43
【摘要】：目的:应用静息态功能磁共振(resting-state functional magnetic resonance imaging,rs-f MRI)成像的低频振幅(Amplitude of Low-Frequency Fluctuation,ALFF)及功能连接(functional connectivity,FC)的方法对重型颅脑损伤昏迷患者进行损伤评估及预测其预后。方法:用静息态功能磁共振对21例重型颅脑损伤昏迷(s TBI)患者的病例组和21例受教育程度、年龄、性别均相匹配的正常对照组进行成像检查,通过软件对数据进行处理及分析,使我们能够得到健康对照组及重型颅脑损伤昏迷患者的大脑的激活图,采用单样本t检验分别分析后扣带回(PCC)在重型颅脑损伤昏迷患者和正常对照组的各自组内的功能连接,从而得到病例组及正常对照组的后扣带回(PCC)同全脑的连接图,我们只选择正连接的激活图,然后取两图的并集做一个默认脑网络的蒙版(MASK)。再采用双样本t检验在蒙版(MASK)内比较健康对照组和病例组之间脑区的低频振幅(ALFF)的差异。根据重型颅脑损伤性昏迷患者的预后情况将病例组分为清醒组及昏迷组,同样采用双样本t检验在蒙版(MASK)内比较清醒组和昏迷组之间脑区的功能连接及低频振幅(ALFF)的差异。最后将重型颅脑损伤昏迷病人后扣带回(PCC)区域内的平均低频振幅(m ALFF)的值同格拉斯哥昏迷评分做相关性分析。结果:重型颅脑损伤性昏迷患者与正常对照组在基于MASK内相比,重型颅脑损伤性昏迷患者的背外侧额上回、前额叶内侧区、左侧额中回、前扣带回、左侧颞回、后扣带回、楔前叶、楔叶、右枕中回、右枕下回、右顶上回区域的低频振幅(ALFF)值明显降低。病例组中的清醒组与昏迷组在基于MASK内相比,在清醒组的额上回内侧区、左侧颞回、前扣带回、楔前叶、后扣带回、顶叶区域的功能连接明显增强。而在其右侧额回、右侧颞回、右侧顶下回区域的低频振幅(ALFF)明显增高。病例组的后扣带回(PCC)的平均低频振幅(m ALFF)同重型颅脑损伤性昏迷患者的GCS评分的高低呈明显正相关r=0.798,P0.0001。结论:在静息态下重型颅脑损伤昏迷(s TBI)患者的默认脑网络仍然存在,但其范围却减小,重型颅脑损伤昏迷(s TBI)患者在静息态下与健康对照组相比多个脑区的低频振幅(ALFF)明显降低,说明了重型颅脑损伤的患者昏迷的原因不只是某个特定脑区自发活动的异常,而是整个默认脑网络的脑区整体自发活动的降低。在病例组中昏迷组相比清醒组的多个脑区的功能连接明显增高,而其余多个脑区低频振幅明显增高。从而揭示了大脑默认网络的脑区功能连接及自发活动的增高与其预后关系密切。病例组后扣带回(PCC)的平均ALFF值同重型颅脑损伤性昏迷患者的GCS评分呈明显正相关,揭示了后扣带回自发活动的强弱与患者昏迷程度的高低密切相关,但与患者的预后关系不太密切。
[Abstract]:Objective: to evaluate the low frequency amplitude (Amplitude of Low-Frequency Fluctuation,ALFF and functional junction (functional connectivity,FC) of resting functional magnetic resonance (resting-state functional magnetic resonance imaging,rs-f MRI) imaging in severe craniocerebral injury coma patients and predict their prognosis. Methods: resting functional magnetic resonance imaging was performed in 21 patients with severe craniocerebral injury coma (s TBI) and 21 normal controls with matched education, age and sex. The data were processed and analyzed by software. So that we can get the activation map of the brain in the healthy control group and the comatose patients with severe craniocerebral injury. The functional connections of the posterior cingulate gyrus (PCC) in the comatose patients with severe craniocerebral injury and the normal control group were analyzed by single sample t-test. So we can get the connection diagram of the posterior cingulate gyrus (PCC) and the whole brain of the case group and the normal control group. We only select the active map of the positive connection, and then take the combination of the two images to make a mask (MASK). Of the default brain network. The difference of low frequency amplitude (ALFF) between healthy control group and case group was compared by double sample t test in masked (MASK). According to the prognosis of severe craniocerebral injury coma patients, the patients were divided into conscious group and coma group. The difference of functional connection and low frequency amplitude (ALFF) between awake group and coma group was also compared by double sample t test in masked (MASK). Finally, the correlation between the mean low frequency amplitude (m ALFF) of the posterior cingulate gyrus (PCC) and the Glasgow coma score in the coma patients with severe craniocerebral injury was analyzed. Results: the patients with severe craniocerebral injury coma were compared with the control group based on MASK. The superior dorsolateral frontal gyrus, medial prefrontal lobe, left middle frontal gyrus, anterior cingulate gyrus, left temporal gyrus, posterior cingulate gyrus were found in severe craniocerebral injury coma patients. The low frequency amplitude (ALFF) of anterior cuneate lobe, cuneiform lobe, right occipital middle gyrus, right inferior occipital gyrus and right superior parietal gyrus decreased significantly. The functional connections in the medial area of superior frontal gyrus, left temporal gyrus, anterior cingulate gyrus, anterior cuneate lobe, posterior cingulate gyrus and parietal lobe were significantly enhanced in the conscious group compared with the coma group based on MASK. The low frequency amplitude of (ALFF) in the right frontal gyrus, right temporal gyrus and right inferior parietal gyrus was significantly increased. The mean low frequency amplitude (m ALFF) of posterior cingulate gyrus (PCC) in the case group was positively correlated with the GCS score of severe craniocerebral injury coma patients (P 0.0001). Conclusion: the default brain network still exists in (s TBI) patients with severe craniocerebral injury, but its range is reduced. The low frequency amplitude (ALFF) of (s TBI) patients with severe craniocerebral injury was significantly lower than that of the healthy control group, indicating that the reason of coma in severe brain injury patients was not only the abnormality of spontaneous activity in a particular brain area. It is a decrease in the overall spontaneous activity of the entire default brain network. In the case group, the functional connections of multiple brain regions in the coma group were significantly higher than those in the awake group, while the low frequency amplitudes in the other multiple brain regions were significantly increased. Therefore, it is revealed that the increase of functional connections and spontaneous activities of the brain's default network is closely related to its prognosis. The average ALFF value of posterior cingulate gyrus (PCC) was positively correlated with the GCS score of severe craniocerebral injury coma patients, which revealed that the intensity of spontaneous activity of posterior cingulate gyrus was closely related to the degree of coma. However, it is not closely related to the prognosis of the patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.15
本文编号：2291943
[Abstract]:Objective: to evaluate the low frequency amplitude (Amplitude of Low-Frequency Fluctuation,ALFF and functional junction (functional connectivity,FC) of resting functional magnetic resonance (resting-state functional magnetic resonance imaging,rs-f MRI) imaging in severe craniocerebral injury coma patients and predict their prognosis. Methods: resting functional magnetic resonance imaging was performed in 21 patients with severe craniocerebral injury coma (s TBI) and 21 normal controls with matched education, age and sex. The data were processed and analyzed by software. So that we can get the activation map of the brain in the healthy control group and the comatose patients with severe craniocerebral injury. The functional connections of the posterior cingulate gyrus (PCC) in the comatose patients with severe craniocerebral injury and the normal control group were analyzed by single sample t-test. So we can get the connection diagram of the posterior cingulate gyrus (PCC) and the whole brain of the case group and the normal control group. We only select the active map of the positive connection, and then take the combination of the two images to make a mask (MASK). Of the default brain network. The difference of low frequency amplitude (ALFF) between healthy control group and case group was compared by double sample t test in masked (MASK). According to the prognosis of severe craniocerebral injury coma patients, the patients were divided into conscious group and coma group. The difference of functional connection and low frequency amplitude (ALFF) between awake group and coma group was also compared by double sample t test in masked (MASK). Finally, the correlation between the mean low frequency amplitude (m ALFF) of the posterior cingulate gyrus (PCC) and the Glasgow coma score in the coma patients with severe craniocerebral injury was analyzed. Results: the patients with severe craniocerebral injury coma were compared with the control group based on MASK. The superior dorsolateral frontal gyrus, medial prefrontal lobe, left middle frontal gyrus, anterior cingulate gyrus, left temporal gyrus, posterior cingulate gyrus were found in severe craniocerebral injury coma patients. The low frequency amplitude (ALFF) of anterior cuneate lobe, cuneiform lobe, right occipital middle gyrus, right inferior occipital gyrus and right superior parietal gyrus decreased significantly. The functional connections in the medial area of superior frontal gyrus, left temporal gyrus, anterior cingulate gyrus, anterior cuneate lobe, posterior cingulate gyrus and parietal lobe were significantly enhanced in the conscious group compared with the coma group based on MASK. The low frequency amplitude of (ALFF) in the right frontal gyrus, right temporal gyrus and right inferior parietal gyrus was significantly increased. The mean low frequency amplitude (m ALFF) of posterior cingulate gyrus (PCC) in the case group was positively correlated with the GCS score of severe craniocerebral injury coma patients (P 0.0001). Conclusion: the default brain network still exists in (s TBI) patients with severe craniocerebral injury, but its range is reduced. The low frequency amplitude (ALFF) of (s TBI) patients with severe craniocerebral injury was significantly lower than that of the healthy control group, indicating that the reason of coma in severe brain injury patients was not only the abnormality of spontaneous activity in a particular brain area. It is a decrease in the overall spontaneous activity of the entire default brain network. In the case group, the functional connections of multiple brain regions in the coma group were significantly higher than those in the awake group, while the low frequency amplitudes in the other multiple brain regions were significantly increased. Therefore, it is revealed that the increase of functional connections and spontaneous activities of the brain's default network is closely related to its prognosis. The average ALFF value of posterior cingulate gyrus (PCC) was positively correlated with the GCS score of severe craniocerebral injury coma patients, which revealed that the intensity of spontaneous activity of posterior cingulate gyrus was closely related to the degree of coma. However, it is not closely related to the prognosis of the patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.15
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