应用功能磁共振研究单侧颞叶癫痫患者警觉功能的影响因素

发布时间：2018-03-16 10:02

本文选题：颞叶癫痫　切入点：静息态功能磁共振　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:越来越多的证据表明颞叶癫痫(temporal lobe epilepsy,TLE)患者的癫痫活动并不是单一来源,常常涉及广泛的大脑网络。病灶病变不仅仅局限于颞叶,还常伴随顶叶、额叶、小脑、丘脑及边缘系统的其他脑区的脑功能改变,导致认知功能损害,如记忆、语言、警觉、执行等。本研究应用静息态功能磁共振(rest-station functional magnetic resonance imaging,rs-f MRI)和神经心理学测试方法探讨颞叶癫痫患者警觉网络损害及其相关影响因素。资料与方法:收集44例单侧TLE患者和32例健康对照者的静息态f MRI数据、注意网络测试(Attention Network Test,ANT)的结果和TLE患者的临床资料,并对左侧TLE患者、右侧TLE患者与健康对照组的警觉相关脑网络进行组内分析及组间比较,提取TLE患者背外侧前额叶脑区功能连接值作为因变量,以可能影响TLE患者警觉功能的相关影响因素作为自变量,进行多因素线性回归分析。结果:1.右侧TLE组与对照组相比,在右侧颞中回、右侧颞极、左侧额上回、左颞下回FC增加;在右侧楔叶、左侧颞中回、左侧楔叶、左侧楔前叶及小脑脑区FC减低。2.左侧TLE组与对照组相比,在左侧颞中回,左内侧额上回FC增加;在右侧枕中回、顶叶、额极,双侧海马脑区FC减低。3.与右侧TLE组相比较,左侧TLE组在左侧海马FC连接值降低,其余脑区均无统计学差异。4.TLE组与对照组相比,固有警觉平均反应时间延长(Reaction Time,RT)(TLE组:661.44±73.23 VS对照组:603.18±85.12,t=3.198,P=0.002)、位相性警觉RT延长(TLE组:628.71±79.55 VS对照组:555.30±78.43,t=3.995,P=0.000),警觉效应时间减少(TLE组:32.73±24.33 VS对照组:47.88±17.87,t=-2.983,P=0.004),差异均有统计学意义。5.多因数线性回归分析显示不同的发作类型(t=2.254,P=0.030)和脑电图痫性放电(t=2.158,P=0.037),差异有统计学意义。结论:1.TLE患者警觉脑网络功能连接完整性受到破坏。2.右侧TLE患者和左侧TLE患者均存在负性调控脑区和正性调控脑区缺失,提示TLE患者警觉网络损害的脑功能基础。3.左侧TLE患者警觉功能损害在左侧海马更为严重。4.TLE患者警觉效率网络、固有警觉和位相性警觉均存在损害。5.TLE患者发作类型和存在痫性放电可能与警觉功能的损害有关。
[Abstract]:Objective: there is growing evidence that epileptic activity in patients with temporal lobe epilepsyTLEs is not a single source and often involves extensive brain networks. The lesion is not limited to the temporal lobe, but is often associated with parietal, frontal, cerebellar, and parietal lobes. Changes in brain function in the thalamus and other brain regions of the limbic system, leading to cognitive impairment such as memory, language, alertness, In this study, resting fMRI rest-station functional magnetic resonance imagingrs-f MRIs and neuropsychological tests were used to investigate the alertness network damage and its related factors in patients with temporal lobe epilepsy. Data and methods: 44 patients with unilateral TLE were collected. Rest f MRI data of 32 healthy controls, Pay attention to the results of Network test and clinical data of TLE patients, and make intra-group analysis and comparison of alertness related brain networks in left TLE patients, right TLE patients and healthy controls. The functional connections of the dorsolateral prefrontal cortex were extracted as dependent variables in patients with TLE, and multivariate linear regression analysis was carried out using the related factors that might affect the alertness of TLE patients. Results: 1. The right TLE group was compared with the control group. FC increased in right middle temporal gyrus, right temporal pole, left superior frontal gyrus, left inferior temporal gyrus, decreased FC in right cuneiform lobe, left middle temporal gyrus, left cuneiform lobe, left anterior cuneate lobe and cerebellar area. FC of left medial superior frontal gyrus increased, FC decreased in right middle occipital gyrus, parietal lobe, frontal pole and bilateral hippocampal area. Compared with right TLE group, left TLE group decreased FC junction value in left hippocampus. There was no statistical difference in the other brain regions. 4. The TLE group was compared with the control group. The average reaction time of the TLE group was prolonged. The average reaction time was prolonged in the TLE group: 661.44 卤73.23 vs control group: 603.18 卤85.12VS control group: 603.18 卤85.12VS control group: 603.18 卤85.12VS control group, and the phase alertness RT prolongation of the TLE group: 628.71 卤79.55VS control group: 555.30 卤78.43t 3.995P0. 000, and the alertness effect time decreased by the TLE group: 32.73 卤24.33VS control group: 47.88 卤17.87t- 2.983P0. 004, the difference was significant. The analysis showed that there were significant differences in different seizure types (2.254) and electroencephalogram (EEG) in epileptic discharge (2.158%). Conclusion: 1. TLE patients are aware that the integrity of functional connections of brain network is damaged. There are negative regulation in patients with right TLE and patients with left TLE. Lack of brain and positive regulatory brain regions, The results suggest that the brain function of TLE patients with alertness network damage is more serious in left hippocampus than in left TLE patients. 4. TLE patient alert efficiency network. Both inherent alertness and positional alertness may be related to the impairment of alertness. 5. The type of seizure and epileptic discharge in TLE patients may be related to the impairment of alertness function.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R742.1

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