基于多阶段BOLD-fMRI数据的脑卒中康复期运动功能研究

发布时间：2018-01-02 13:25

本文关键词：基于多阶段BOLD-fMRI数据的脑卒中康复期运动功能研究　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：脑卒中可能会对患者的运动功能造成伤害,患者的康复常伴随着神经网络结构和功能重塑。基于血氧水平依赖(Blood oxygen level dependent,BOLD)的功能磁共振成像(Functional magnetic resonance imaging,fMRI)作为一种强有力的技术手段能够对大脑活动进行高空间分辨率成像,已被广泛地应用于脑卒中康复过程中神经功能研究。本研究基于任务相关的fMRI实验,通过对脑卒中患者康复的长时程观察来研究病人大脑功能的可塑性变化。我们采集到19个皮质脊髓束受损的脑卒中病人在三个阶段的BOLD-fMRI数据,即急性期(2周以内),恢复期(1~3个月)及恢复后期(大于3个月),其中包含11例仅基底节区域损伤的卒中病人。我们研究了被试在康复不同阶段执行健侧手和患侧手任务时脑功能活动的变化,并提取了相关脑激活水平参数,包括:激活体积、激活强度和加权的侧边性指数(Weighted lateral index,wLI)等,同时,分析了这些参数与患者临床行为学评分,Fugl-Meyer评分的相关性。得到以下结果:(1)皮质脊髓束受损脑卒中患者:在急性期和恢复期,在被试患手运动时,大脑活动呈现双侧激活,但是到恢复后期,脑功能活动逐渐向患侧转移。这种与康复相关的脑功能活动偏侧化现象可以解释为健侧对患侧运动功能损伤的一种补偿机制。做患侧手运动时,在急性期和恢复后期,主运动区以及恢复期的前运动区和丘脑的激活参数与Fugl-Meyer评分呈显著的正相关,M1的wLI与FuglMeyer评分呈显著的正相关,患侧M1在急性期的激活强度与行为学评分有显著相关性。患侧的PM,健侧的丘脑的激活强度和激活体积都与行为学评分在恢复期有显著相关性;急性期患侧M1的激活强度与恢复期评分有显著相关性。恢复期小脑的wLI、患侧小脑的激活体积均与恢复后期和恢复期Fugl-Meyer评分之差有显著的负相关性。在恢复期,双侧扣带回的激活强度或激活体积都与恢复后期与恢复期评分之差有显著正相关性。同时,恢复期扣带回的wLI与恢复后期的评分有显著相关性。(2)病灶位于基底节区域的脑卒中患者:大脑激活分布与所有病人结果相似。在恢复期阶段,当被试执行患侧手运动任务时,健侧扣带回的激活体积,患侧丘脑的激活体积和激活强度都与Fugl-Meyer评分有显著的相关性;小脑的wLI指数与Fugl-Meyer评分呈显著负相关;扣带回恢复期的wLI与两个时期Fugl-Meyer评分之差呈显著正相关。这项实验结果体现出大脑上面的这些区域的活动对脑卒中康复可能有预测功能。本文的结果可能表明,脑卒中后大脑对运动功能的控制会受到影响,健侧脑在脑卒中后不同阶段发挥不同程度的补偿作用,导致大脑激活向健侧转移,激活强度、激活体积和wLI三个参数与FuglMeyer评分在不同阶段具有显著相关性,其结果具有潜在的临床预测价值.
[Abstract]:Stroke may cause injury to the patient's motor function. Rehabilitation is often accompanied by neural network structure and functional remodeling. Blood oxygen level dependent is based on the level of blood oxygen. Bod) functional magnetic resonance imaging. As a powerful technique, fMRI can perform high spatial resolution imaging of brain activity. This study is based on task-related fMRI experiments. The plasticity of brain function in patients with stroke was studied by long-term observation of rehabilitation. We collected BOLD-fMRI data of 19 stroke patients with corticospinal tract damage at three stages. . That is, the acute stage is within 2 weeks, the recovery period is 1 ~ 3 months) and the later stage of recovery (more than 3 months). We studied the changes of brain function during the different stages of rehabilitation of the healthy hand and the affected hand, and extracted the relevant brain activation level parameters. Including: activation volume, activation intensity and weighted lateral index (weighted lateral index), etc. The correlation between these parameters and the Fugl-Meyer score was analyzed. The following results were obtained: acute and convalescent in patients with corticospinal tract injury stroke. At the time of hand movement, brain activity showed bilateral activation, but at the late stage of recovery. Brain functional activity is gradually transferred to the affected side. This phenomenon of lateralization of brain function related to rehabilitation can be explained as a compensation mechanism for the damage of contralateral contralateral motor function. The activation parameters of the main motor area and the anterior motor area and thalamus were positively correlated with the Fugl-Meyer score in the acute stage and the late stage of recovery. There was a significant positive correlation between wLI and FuglMeyer score in M1, and there was a significant correlation between the activation intensity of M1 and behavioral score in the acute phase of the affected side, and PM in the affected side. The activation intensity and volume of the thalamus in the healthy side were significantly correlated with the behavioral score in the convalescent stage. The activation intensity of M1 in the acute stage was significantly correlated with the recovery score. WLI in the cerebellum of the convalescent stage. There was a significant negative correlation between the activation volume of the affected cerebellum and the Fugl-Meyer score in the later stage of recovery and the recovery stage. The activation intensity or volume of bilateral cingulate gyrus was positively correlated with the difference between recovery and recovery score. WLI of cingulate gyrus in convalescent stage was significantly correlated with the score at the later stage of recovery. 2) Stroke patients whose lesions were located in the basal ganglia region: the distribution of cerebral activation was similar to that of all patients. The activation volume of the contralateral cingulate gyrus and the activation volume and intensity of the affected thalamus were significantly correlated with the Fugl-Meyer score when the subjects performed the task of hand movement. The wLI index of cerebellum was negatively correlated with Fugl-Meyer score. There was a significant positive correlation between the difference between wLI and Fugl-Meyer scores in the recovery of cingulate gyrus. The results showed that the activities of these areas above the brain might predict the recovery of stroke. The results of this paper may indicate. The control of cerebral motor function will be affected after stroke. The contralateral brain plays a compensatory role in different stages after stroke, resulting in brain activation transfer to the healthy side and activation intensity. Activation volume and wLI were significantly correlated with FuglMeyer scores at different stages, and the results had potential clinical predictive value.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

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