复发缓解型多发性硬化患者海马功能和结构的MRI研究

发布时间：2018-03-21 08:16

本文选题：多发性硬化　切入点：海马　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：联合静息态功能连接（resting-statefunctionalconnectivity，RSFC）、局部一致性（regional homogeneity，ReHo）和弥散张量成像纤维束示踪（diffusiontensor imaging fiber tracking，DTI-FT）技术，分析复发缓解型多发性硬化(relapsingremitting multiple sclerosis，，RRMS)患者海马与全脑功能连接、局部功能连接和结构的改变，通过分析海马内源性功能活动、结构和患者认知功能的相关性，探究RRMS患者海马改变的可能机理。方法：招募24例RRMS患者与24名性别、年龄及受教育程度相匹配的健康志愿者进行3.0T磁共振颅脑扫描，获取常规磁共振（magnetic resonance imaging，MRI）图像、血氧水平依赖信号功能磁共振图像（functional MRI，fMRI）及DTI-FT数据。数据分析主要包括：(1)使用静息态数据处理助手基于MATLAB平台对静息态fMRI数据进行预处理，REST软件提取双侧海马为感兴趣区，进行种子为基础的全脑功能连接分析，ReHo方法用于计算海马内部的局部功能连接；（2）Diffusion Toolkit软件、Track Vis软件提取双侧海马区DTI参数（ADC值、FA值）。所有受试者接受临床评分量表评估（EDSS、PASAT、MFIS）。RRMS与正常对照组（healthy controls，HCs）的一般情况、临床评分及海马区DTI相关参数（ADC值、FA值）使用SPSS软件进行组间两样本t检验，RSFC及ReHo值使用SPM8软件进行组间两样本t检验，患者组临床评分量表、RSFC异常区域、ReHo异常区域、DTI参数两两间进行Pearson相关性分析。结果：（1）RRMS患者MFIS得分(t=11.7, P=0.001)及EDSS得分均高于HCs，PASAT得分低于HCs（t=3.449, P=0.001）。（2）与HCs比较，RRMS患者左侧海马与左侧海马旁回（brodmann area36，BA36）功能连接减弱，与左后侧小脑、右侧额中回（BA9）、右侧额下回（BA47）、右侧缘上回(BA40)功能连接增强；右侧海马与左后侧小脑功能连接增强（P 0.05，经AlphaSim校正，体素85）。（3）与HCs比较，RRMS患者左侧海马头部、尾部ReHo减弱（P 0.05，经AlphaSim校正，体素10）。（4）与HCs比较，RRMS患者左侧海马ADC值升高(t=3.147, P=0.004)，FA值减低(t=3.544,P=0.001)；HCs及RRMS患者组海马ADC值与FA值存在明显负性相关。（5）左侧海马功能连接异常脑区中右侧额中回与临床量表PASAT得分（r=0.473, P=0.019）、左侧海马ADC值（r=-0.502, P=0.012）及FA值（r=0.477,P=0.019）均存在相关性，右侧缘上回与左侧海马ADC值（r=-0.506，P=0.012）存在负性相关。左侧海马ADC值（r=-0.481, P=0.017）、FA值（r=0.438, P=0.032）与PASAT得分分别存在负性、正性相关。结论：（1）RRMS患者海马区存在与全脑和局部的异常功能连接，且异常功能连接与认知功能相关。（2）RRMS患者海马存在结构异常，且呈现左侧大脑半球偏侧化改变，左侧海马结构损害与认知功能相关。（3）左侧海马结构改变与左侧海马异常功能连接右侧额中回、缘上回存在相关性，海马结构改变影响了海马功能连接，进而影响患者正常认知功能，可能是造成RRMS患者认知功能改变的机理之一。
[Abstract]:Objective: to study the hippocampal and global functional junctions in patients with relapsed multiple sclerosis (relapsing multiple sclerosis) using resting-statefunctive connectivity (RSFCs), regional homogeneity imaging (ReHoA) and diffusive Zhang Liang imaging fiber tracer imaging fiber tracking- DTI-FT- (DTI-FTT-FTIR) technique in patients with recurrent and remission multiple sclerosis (MS), and to analyze the functional connections between the hippocampus and the whole brain in patients with recurrent and remission multiple sclerosis (MS). By analyzing the correlation among endogenous functional activity, structure and cognitive function of patients with RRMS, the possible mechanism of hippocampal changes was explored. Methods: 24 patients with RRMS and 24 healthy volunteers matched with sex, age and education were recruited to perform 3.0T MRI brain scan, and routine magnetic resonance imaging images were obtained. Blood oxygen level dependent signal functional MRI of MRI) and DTI-FT data. Data analysis mainly includes: 1) using rest data processing assistant to preprocess resting fMRI data based on MATLAB platform and rest software to extract bilateral hippocampus as regions of interest. Seed-based global brain functional junction analysis was used to calculate the local functional junctions in the hippocampus. The track Vis software was used to extract bilateral hippocampal DTI parameters. All subjects received the clinical score scale. To assess the general status of EDSS PASAT MFISN. RRMS and healthy controls (HCs), Clinical score and DTI related parameters of hippocampus were evaluated by SPSS software and SPM8 software were used to carry out t-test of two samples between groups, and SPM8 software was used to test t-test of two samples between groups. The correlation of Pearson parameters in abnormal area of RSFC and abnormal area of ReHo was analyzed. Results the scores of MFIS and EDSS in the patients with RMS were higher than those in the patients with EDSS (P < 3.449, P < 0.001), and the scores of EDSS were higher than those of the patients with RMS (P < 0.001), and the scores of EDSS were significantly higher than those of the patients with RMS (P < 0.01). (2) compared with HCs, the functional connections of left hippocampal and left parahippocampal gyrus (Brodmann area36, BA36) decreased, and increased with left posterior cerebellum, right middle frontal gyrus, right inferior frontal gyrus, right inferior frontal gyrus, right superior margin gyrus, and right superior margin gyrus. The right hippocampus and left posterior cerebellar functional junction were enhanced P 0.05, corrected by AlphaSim. (3) compared with HCs, the left hippocampal head and tail ReHo of RRMS patients were attenuated P 0.05, corrected by AlphaSim. (4) compared with HCs, the ADC value of left hippocampus in RMS patients increased 3.147, the FA value decreased 3.544% in RRMS group and the ADC value in hippocampus in RRMS group was negatively correlated with FA value. (5) the right middle frontal gyrus in the left hippocampal functional junction was correlated with the PASAT scores (r = 0.473, P = 0.019), the ADC value of the left hippocampus (r = 0.502, P = 0.012) and the FA value (r = 0.477n, P = 0.019). There was a negative correlation between the right superior margin gyrus and the left hippocampal ADC value (r = 0.506). The left hippocampal ADC value was 0.481.The left hippocampal ADC value was 0. 438, P = 0. 032) and the PASAT score was positively correlated with that of the left hippocampal ADC value (P = 0. 017, P = 0. 038, P = 0. 032). Conclusion the hippocampal area of RRMS patients with RRMS has abnormal functional connections with the whole brain and local areas, and the abnormal functional connections are related to cognitive function. There were abnormal hippocampal structure in RRMS patients, and the left cerebral hemispheres were lateralized. The damage of left hippocampus structure was related to cognitive function. 3) the changes of left hippocampal structure and left hippocampal abnormal function connect right middle frontal gyrus and supramarginal gyrus. The changes of hippocampal structure affect the functional connection of hippocampus, and then affect the normal cognitive function of the patients. It may be one of the mechanisms of cognitive function change in patients with RRMS.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.51;R445.2

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