肌萎缩侧索硬化症吞咽功能及影像学的相关研究

发布时间：2018-03-25 20:34

本文选题：肌萎缩侧索硬化　切入点：吞咽造影　出处：《广州中医药大学》2015年硕士论文

【摘要】：目的：初步探讨吞咽造影检查及影像学在肌萎缩侧索硬化(ALS)检查中的应用价值及ALS患者的吞咽造影功能总分及影像学与患者临床资料之间的相关性。方法：在广东省中医院神经四科的肌萎缩侧索硬化症住院患者中选取17例具有不同诊断级别的肌萎缩侧索硬化症患者,其中包括确诊的肌萎缩侧索硬化症(10例)、很可能的肌萎缩侧索硬化症(4例)、可能的肌萎缩侧索硬化症(3例)的患者,分别进行吞咽造影检查,将患者吞咽造影的结果与其临床资料之间进行相关性分析。同时选取54例具有不同诊断级别的肌萎缩侧索硬化症患者,包括确诊(21例)、很可能(22例)、可能(11例)的患者,并选取23名健康体检的志愿者作为健康对照。分别行磁共振弥散张量成像(DTI)扫描,测量各感兴趣区(ROI)的平均扩散系数(ADC)和各向异性系数(FA),分析两组间ADC和FA的差异,并对肌萎缩侧索硬化症组患者ADC值及FA值与临床资料的相关性进行分析。结果：相关分析显示吞咽造影总分与体重指数呈正相关(r=0.031,P0.05),与年龄、起病方式、病程、病情进展速度、诊断级别、ALS功能评分、ALS球部功能评分等临床资料之间没有相关性。与健康对照组比较,肌萎缩侧索硬化症患者大脑脚、内囊后肢区的ADC值升高(P0.05),大脑脚、内囊后肢及中央前回区的FA值降低(P0.05)；相关分析显示肌萎缩侧索硬化症患者内囊后肢的ADC值与诊断级别呈负相关(r=-0.289,P0.05),与上运动神经元损伤评分呈正相关(r=0.304,P0.05)；大脑脚及内囊后肢的FA值与诊断级别呈正相关(r=0.394, P0.05; r=0.547, P 0.01),与上运动神经元损伤评分呈负相关(r=-0.301, P0.05; r=-0.653, P0.01)。结论：吞咽造影检查可以客观的发现肌萎缩侧索硬化症患者存在的吞咽功能障碍,吞咽造影检查对于评估肌萎缩侧索硬化症患者的吞咽功能具有重要意义。DTI可客观定量评估肌萎缩侧索硬化症患者锥体束的损伤情况,在肌萎缩侧索硬化症的诊断中具有重要的辅助价值。
[Abstract]:Objective: to explore the application value of swallowing angiography and imaging in the examination of amyotrophic lateral sclerosis (ALS) and the correlation between the total functional score of swallowing and imaging and the clinical data of patients with ALS. Among the inpatients with amyotrophic lateral sclerosis in four departments of neurology, 17 patients with amyotrophic lateral sclerosis with different diagnostic levels were selected. These include 10 cases of amyotrophic lateral sclerosis, 4 cases of amyotrophic lateral sclerosis and 3 cases of possible amyotrophic lateral sclerosis. The correlation between the results of swallowing angiography and clinical data was analyzed. At the same time, 54 patients with amyotrophic lateral sclerosis with different levels of diagnosis were selected, including 21 patients diagnosed with amyotrophic lateral sclerosis, probably 22 patients with dysphagia and 11 patients with amyotrophic lateral sclerosis. 23 healthy volunteers were selected as healthy controls. The average diffusion coefficient (ADC) and anisotropic coefficient (FAA) of ADC and FA were measured by magnetic resonance diffusion-diffusion imaging (DTI) scan in each region of interest. The difference of ADC and FA between the two groups was analyzed. The correlation between ADC value, FA value and clinical data in patients with amyotrophic lateral sclerosis was analyzed. Results: correlation analysis showed that the total score of swallowing angiography was positively correlated with body mass index (BMI), and had a positive correlation with age, onset mode, course of disease and the speed of disease progression. There was no correlation between the clinical data such as ALS functional score and ALS ball function score. Compared with the healthy control group, the ADC value of the cerebral foot and the posterior limb area of the internal capsule increased in the patients with amyotrophic lateral sclerosis. The FA value of the posterior limb of the internal capsule and the precentral gyrus decreased (P 0.05). The correlation analysis showed that the ADC value of the posterior limb of the internal capsule in the patients with amyotrophic lateral sclerosis was negatively correlated with the diagnostic grade, and positively correlated with the injury score of the superior motor neuron. The FA value of the posterior limb was positively correlated with the diagnostic grade (P 0.05, r = 0.547, P 0.01), and negatively correlated with the injury score of the upper motor neuron (P 0.05). Conclusion: the swallowing examination can objectively find the dysphagia in the patients with amyotrophic lateral sclerosis. Swallowing angiography is of great significance in evaluating the swallowing function of patients with amyotrophic lateral sclerosis. DTI can objectively and quantitatively evaluate the damage of pyramidal tract in patients with amyotrophic lateral sclerosis. It has important auxiliary value in the diagnosis of amyotrophic lateral sclerosis.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R744.8

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