复发缓解型多发性硬化患者在视觉结构中的功能连接及结构连接的研究

发布时间：2018-11-19 18:36

【摘要】：目的：应用静态功能连接磁共振(functional connectivity MRI,fcMRI)、弥散张量成像-纤维束示踪(diffusion tensor imaging-fiber tractograph,DTI-FT)磁共振技术对复发-缓解型多发性硬化(relapsing remitting multiple sclerosis,RRMS)患者及正常人进行初级视觉皮层（V1）的静息态功能连接与初级视觉皮层及视放射结构连接研究，探讨RRMS患者视觉功能相关区域的功能与结构的特征性改变以及两者间的相互关系。方法：收集2011.6-2013.12临床确诊的RRMS患者及性别、年龄及受教育程度相匹配的健康志愿者各20例。所有被试行3.0T磁共振颅脑扫描，获取用于影像诊断的常规图像及后处理功能图像包括血氧水平依赖信号及弥散张量成像。记录RRMS患者的病程、并进行临床预后参数扩展残疾量表、进步式听觉累加测试及修正的疲劳影响尺度评估。运用DPARSF、SPM8、REST、TrackVis、DTI-Studio等软件对数据进行预处理和后处理，并分别获得RRMS组和对照组（healthy controls，HCs）的初级视觉皮层功能连接数据、初级视觉皮层及视放射DTI参数（FA值、ADC值、λ∥及λ⊥），对所得数值进行组间两样本及相关性统计学分析，差异阈值设为P 0.05。结果： 1、RRMS患者MFIS得分及EDSS得分均高于正常对照组，PASAT得分低于正常对照组。 2、与HCs相比，RRMS组V1与右侧顶下小叶（brodmann’s area40，BA40）、右侧额中回（BA46）及右侧小脑与V1的功能连接明显减弱（P 0.05，经AlphaSim校正）；而与双侧前扣带回（BA32）与V1的功能连接明显增强（P 0.05，经AlphaSim校正）。 3、与HCs相比，RRMS组患者初级视觉皮层ADC值明显升高（t=3.056，P=0.004），λ∥明显升高（t=2.523，P=0.016），λ⊥明显升高（t=2.523，P=0.005），患者组视放射的FA值显著降低（t=-2.405，P=0.021）。 4、RRMS患者组初级视觉皮层的ADC值与病程存在正相关性（r=0.539，P=0.014），λ∥与病程存在正相关性（r=0.514，P=0.020），λ⊥与病程存在正相关性（r=0.497，P=0.026）。RRMS患者组初级视觉皮层与视放射FA值之间无明显相关性（P0.05）。 5、RRMS患者组功能连接异常脑区右侧额中回与RRMS组初级视觉皮层λ⊥值呈负相关（r=-0.453，P=0.045），右侧小脑半球（后叶）与初级视觉皮层λ∥（r=0.551，，P=0.012）、λ⊥（r=0.513，P=0.021）及ADC值（r=-0.559，P=0.010）呈正相关。结论： 1、RRMS患者初级视觉皮层的结构和功能连接存在异常，可能与患者存在潜在的视空间工作记忆功能障碍有关。 2、RRMS患者初级视觉皮层和视放射均存在结构的损伤；两者间损伤程度无相关性，提示初级视觉皮层与视放射之间的病理改变过程可能是独立的。 3、RRMS患者中，病程越长，大脑初级视觉皮层灰质微观结构损伤程度越明显；且初级视觉皮层的结构改变与初级视觉皮层异常功能连接相关，推测初级视觉皮层结构损害可能影响了视觉功能连接。
[Abstract]:Objective: to evaluate the application of static functional connective magnetic resonance (functional connectivity MRI,fcMRI) and diffusion-Zhang Liang imaging with tracer (diffusion tensor imaging-fiber tractograph,DTI-FT (diffusion tensor imaging-fiber tractograph,DTI-FT) in the treatment of relapse-remission multiple sclerosis (relapsing remitting multiple sclerosis,). The resting functional connections of primary visual cortex (V1) with primary visual cortex and visual radiation structure were studied in RRMS patients and normal subjects. Objective: to investigate the characteristic changes of function and structure of visual function related regions in patients with RRMS and the relationship between them. Methods: 20 patients with RRMS and 20 healthy volunteers with matched gender, age and education were collected from June to December 2011. All 3.0T MRI craniocerebral scans were used to obtain conventional images and post-processing functional images for imaging diagnosis, including blood oxygen level dependent signals and diffused Zhang Liang imaging. The course of RRMS was recorded, and the clinical prognostic parameters were evaluated by extended disability scale, progressive auditory cumulative test and modified fatigue impact scale. DPARSF,SPM8,REST,TrackVis,DTI-Studio and other software were used to preprocess and post-process the data. The primary visual cortex functional connection data, the primary visual cortex and visual radiation DTI parameters (FA) of the RRMS group and the control group (healthy controls,HCs) were obtained, respectively. The values of ADC, 位 / and 位 ~ (-) were analyzed by two samples and correlation statistical analysis. The threshold of difference was set as P0.05. Results: 1 the scores of MFIS and EDSS in RRMS patients were higher than those in the normal control group, and the PASAT scores were lower than those in the normal control group. 2Compared with HCs, the functional connections between V1 and right inferior parietal lobule (brodmann's area40,BA40), right middle frontal gyrus (BA46) and right cerebellum with V1 were significantly decreased in RRMS group (P 0.05, corrected by AlphaSim). The functional connection between the anterior cingulate gyrus (BA32) and V1 was significantly enhanced (P 0.05, corrected by AlphaSim). 3Compared with HCs, the ADC value of primary visual cortex in RRMS group was significantly higher than that in RRMS group (t = 3.056, P ~ (0.004), 位 _ (1) / (t _ (2.523) P _ (0. 016), 位 _ () was significantly increased (t _ (2.523) P ~ (0. 005). The FA value of visual radiation in the patients group was significantly lower than that in the control group (t = -2.405, P = 0.021). 4There was a positive correlation between the ADC value of the primary visual cortex and the course of disease in RRMS group (r = 0.539P0. 014), a positive correlation between 位 / and the course of the disease (r = 0. 514), and a positive correlation between the ADC value of the primary visual cortex and the course of disease (r = 0. 497, r = 0. 497). There was no significant correlation between FA value of primary visual cortex and visual radiation (P0.05) in group P ~ (0.026). 5There was a negative correlation between the right middle frontal gyrus in the right frontal gyrus and the primary visual cortex in the RRMS group (r = 0.453P ~ (0.045). The right cerebellar hemisphere (posterior lobe) and the primary visual cortex 位 / (r ~ (0.551P) 0.012) were found in the right cerebellar hemisphere (P < 0.05). There was a positive correlation between ADC value (r = 0.513, P = 0.021) and ADC value (r = 0.559, P = 0.010). Conclusion: 1 the abnormal structure and functional connection of primary visual cortex in RRMS patients may be related to the potential visual spatial working memory dysfunction. 2There were structural damage in primary visual cortex and visual radiation in RRMS patients, but there was no correlation between them, suggesting that the pathological process between primary visual cortex and visual radiation might be independent. 3 in RRMS patients, the longer the course of disease, the more obvious the microstructural damage of gray matter in the primary visual cortex of brain. The structural changes of the primary visual cortex were related to the abnormal functional connections of the primary visual cortex, which suggested that the damage of the primary visual cortex structure might affect the visual functional connections.
【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】：R445.2;R744.51

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