轻度认知功能障碍与脑白质弥散张量成像的相关性研究

发布时间：2018-04-25 19:19

本文选题：轻度认知障碍 + 弥散张量成像　；参考：《昆明医科大学》2016年硕士论文

【摘要】：[目的]通过简易智能精神量表(Mini-Mental State Examination, MMSE)以及蒙特利尔认知评估量表(Montreal Cognitive assessment, MoCA)对患者认知功能进行评估,筛查并收集轻度认知功能障碍的患者,并进一步进行磁共振弥散张量成像(Diffusion Tensor Imaging, DTI)检查,分析轻度认知障碍(Mild Cognitive Impairment, MCI)患者脑白质弥散张量成像的影像学改变,为临床早期诊断轻度认知障碍提供客观依据，分析轻度认知障碍患者神经心理学量表评测结果与DTI检查结果的相关性。[方法]收集2015年7月至2016年2月在昆明医科大学第二附属医院干疗三科住院的患者,通过MMSE及MoCA进行筛查评估并根据结果分别纳入轻度认知障碍组和正常对照组；记录患者一般情况,如性别、年龄、受教育年限；同时记录既往史,包括卒中病史及精神病史等,并对不满足条件的患者进行剔除。被纳入的研究对象均进行汉密尔顿抑郁评分量表、日常生活能力量表评分及痴呆量表评分并记录分值,以便进一步进行筛选。最终纳入研究的对象中,轻度认知障碍组共纳入34例,对照组22例,最后对所有入选病例行常规头颅磁共振以及弥散张量成像检查。原始图像在Philips Achieva 3.0 TXS扫描完成后上传到Philips公司提供的Extended MR Workspace 2.6.3.4工作站,重建出FA平滑图像,利用FiberTrak软件包对图像进行后处理重建出FA彩图,以便追踪纤维,方便测量；在T2WI EPI(b=0)的FA图上采用圆形感兴趣区(rigion-of-interest, ROI,大小约20mmm2)对不同脑区白质纤维进行FA值测量。以扫描层面完全匹配的常规T1WI和T2WI序列作为解剖参考图像。每个ROI测量的纤维束均利用FA彩图及T1WI叠加技术追踪同束纤维在其连续层面的上下层面取值,3个值求得的算术均数为最终结果。最后应用应用SPSS17.0统计学软件对所有数据进行统计分析。[结果]比较分析轻度认知障碍组及对照组整体情况,发现性别、年龄、受教育年限没有统计学差异,(P0.05),轻度认知障碍组MMSE、MoCA得分均低于对照组,两组比较具有统计学意义(P0.01),而轻度认知障碍组]HDRS评分高于正常对照组,差异有统计学意义(p0.05)。在各认知域得分情况方面,轻度认知障碍组MMSE各认知域得分均低于正常对照组,其中定向力、注意与计算力以及临摹图形具有统计学差异(P0.05),而定记忆力能力具有显著差异(P0.01)。轻度认知障碍组MoCA各项认知域得分均低于正常对照组,除视空间与执行以及命名得分无统计学差异外,注意与计算力、语言能力、抽象思维、记忆力及定向能力具有统计学意义(P0.05),其中记忆力、定向力及注意与计算力具有显著统计学差异(P0.01)。轻度认知障碍组患者与正常对照组相比,左侧额叶白质、顶叶白质、右侧颞叶白质、枕叶白质及胼胝体压部白质的FA值之间无统计学差异(p0.05)。而MCI组右侧额叶FA值(0.335±0.068)、左侧颞叶白质FA值(0.391±0.032)及胼胝体膝部FA值(0.658±0.053)均较NC组相应部位FA值低,且两组间比较均具有统计学意义(p0.05)；把MCI组和NC组比较有统计学意义的FA值和MoCA量表中的认知域在进行典型相关分析,结果发现右侧额叶白质FA值与注意与计算力R值为0.332,左侧颞叶白质FA值与记忆力R值为0.456,胼胝体膝部FA值与记忆力R值为0.429,p值均小于0.05,具有统计学意义。是把MCI组和NC比较有差异的FA值和MMSE量表中认知域进行典型相关分析,结果发现只有右侧额叶白质FA值与注意与计算力R为0.342,p值小于0.05,具有统计学意义。[结论]轻度认知障碍患者相对认知功能正常人可能更容易合并有抑郁障碍。轻度认知障碍患者记忆力障碍可能与左侧颞叶白质及胼胝体膝部白质的损害相关,注意与计算力的障碍可能与右侧额叶白质损害有关。脑白质病变可导致认知功能障碍,磁共振弥散张量成像检查可为早期诊断MCI提供客观依据,即表现为相应损害脑区白质的FA值降低。
[Abstract]:[Objective] to evaluate the cognitive function of patients through the simple intelligent mental scale (Mini-Mental State Examination, MMSE) and the Montreal cognitive assessment scale (MoCA), to screen and collect patients with mild cognitive impairment and to carry out magnetic resonance diffusion tensor imaging (Diffusion Tensor Imagi). Ng, DTI) examination, analysis of the imaging changes of white mass diffusion tensor imaging in patients with Mild Cognitive Impairment (MCI), to provide an objective basis for early diagnosis of mild cognitive impairment, and to analyze the correlation between the evaluation of neuropsychological scale and the results of DTI examination in patients with mild cognitive impairment. [Methods] collect 7 2015. The patients who were hospitalized at the Second Affiliated Hospital of Kunming Medical University from January to February 2016 were screened by MMSE and MoCA and were included in the mild cognitive impairment group and the normal control group according to the results. The patient's general condition, such as sex, age, years of education, and history of stroke, including history and spirit of stroke, were recorded. The patients who were not satisfied were eliminated. The subjects were included in the Hamilton depression scale, the daily living ability scale score and the Dementia Scale score and record scores for further screening. Among the subjects of the study, 34 cases were included in the group of light degree cognitive impairment and 22 cases in the control group. After the Philips Achieva 3 TXS scan, the original image was uploaded to the Extended MR Workspace 2.6.3.4 workstation provided by the Philips company, the FA smooth image was reconstructed, and the FA color image was rebuilt by the FiberTrak software package to reconstruct the FA color map. Tracking fiber, convenient measurement; using circular interest zone (rigion-of-interest, ROI, size about 20mmm2) on the T2WI EPI (b=0) FA map to measure the FA value of white matter fibers in different brain regions. The conventional T1WI and T2WI sequences that are completely matched at the scanning level are used as the anatomical reference images. The value of the same bundle fiber at the upper and lower levels of the continuous layer was traced and the arithmetic average of the 3 values was the final result. Finally, all the data were analyzed with SPSS17.0 statistics software. [results] the overall situation of the mild cognitive impairment group and the control group was compared and analyzed, and the gender, age, and the number of years of education were found to have no statistics. The scores of MMSE and MoCA in the mild cognitive impairment group were all lower than those in the control group (P0.05), and the two groups were statistically significant (P0.01), while the]HDRS score in the mild cognitive impairment group was higher than that of the normal control group (P0.05). In the cognitive domains, the scores of the cognitive domains of the mild cognitive impairment group were all lower than those of the normal group (P0.05). There were statistically significant differences (P0.05) between the attention and the computational force and the copying pattern (P0.01). The scores of MoCA in the mild cognitive impairment group were lower than those in the normal control group, and the attention and computational power, language ability, and the language ability, were not significantly different from the visual space and the execution and naming scores. Abstract thinking, memory and orientation had statistical significance (P0.05), of which memory, orientation and attention had significant statistical differences (P0.01). Patients with mild cognitive impairment were compared with normal control group, left frontal lobar white matter, parietal white matter, right lateral temporal white matter, occipital white matter and FA of corpus callosum pressure white matter. There was no statistical difference (P0.05). The FA value of the right frontal lobe in group MCI (0.335 + 0.068), the FA value of white matter in the left temporal lobe (0.391 + 0.032) and the FA value of the corpus callosum (0.658 + 0.053) were lower than those of the NC group, and the two groups were statistically significant (P0.05). The FA values and MoCA scales were compared between the MCI and NC groups. Canonical correlation analysis was carried out. The results showed that the FA value of the right frontal lobe white matter and the R value of attention and calculation were 0.332, the FA value of white matter in the left temporal lobe and the memory R value were 0.456, the FA value of the genu of the corpus callosum and the memory R value was 0.429, the p value was less than 0.05, and was statistically significant in the FA values and MMSE scales which were different between the MCI and NC. The domain was canonical correlation analysis. The results showed that only the FA value of the right frontal lobe white matter and the attention and calculation force R were 0.342 and the p value was less than 0.05. [Conclusion] the patients with mild cognitive impairment may be more likely to be associated with depressive disorder. The memory impairment in patients with mild cognitive impairment may be associated with left temporal white matter. The impairment of white matter in the genu of the corpus callosum may be related to the impairment of the right frontal lobes. Brain white matter can lead to cognitive impairment. Magnetic resonance diffusion tensor imaging can provide an objective basis for the early diagnosis of MCI, that is, the reduction of the FA value of the white matter in the brain region.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R749.1

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