儿童屈光参差性弱视立体视觉中枢区激活的fMRI研究

发布时间：2018-03-15 18:26

本文选题：儿童　切入点：屈光参差性弱视　出处：《兰州大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：本研究采用血氧水平依赖性功能性磁共振成像(Blood oxygen level dependent-function magnetic resonance imaging, BOLD-fMRI)技术,研究屈光参差性弱视儿童在规范弱视训练前后,立体视觉映射的脑皮层的功能变化,确定儿童屈光参差性弱视临床治疗的真正终点。方法：初诊屈光参差性弱视患儿11例(男6例,女5例),年龄5.5～11岁,平均(8.6±3.35)岁。将被试分为5.5～7岁组和8-11岁组；所有被试均为远视性弱视,中心凹注视；屈光参差范围3.0D～6.0D；均为右利手；所有被试无眼部及神经系统疾患；MRI检查时排除由视网膜至外侧膝状体核间的疾病。试验前充分矫正屈光不正；规范化弱视训练后1周、2周及4周时复查fMRI。实验数据由SIEMENS MAGNETOM Verio3T磁共振扫描系统获取。视觉刺激呈现采用脑功能视听觉刺激系统(SAMRTEC,SA-9900)。任务设计程序均采用E-Prime2.0软件编写。刺激模式采用对比度接近80%的随机点立体图像,患儿采用佩戴红蓝眼镜获得双眼立体视觉。采用组块式(blocks)设计,由激活状态(activation state)和控制状态(control state)组成,分别是交替的随机点立体图像与固定于屏幕中央的黑色“+”图标。试验数据导入一台64位操作系统工作站,进行离线处理。采用基于MATLAB7.12.0.635(The MathWorks, Inc.)的SPM8(Statistical Parametric Mapping)软件包进行数据分析。高斯平滑的半高宽度(Full-width at half maximum, FWHM)为6mm。采用随机效应法分别获得各组脑皮层激活的矩阵数据,对被试治疗前及治疗后1周、2周及4周时相应脑皮层激活范围的差异进行自身前后配对t检验(阈值设定为P0.001时具有统计学意义,未多重矫正)。结果：1.当设定P值为0.05,激活范围阈值为6个体素时,两年龄组间大脑皮层激活无显著差异；2.自身前后对照分析结果显示,各治疗阶段较前具有显著地激活差异,主要集中在双侧枕叶(BA18)、舌回(BA17)、枕中回(BA19)及双侧顶上小叶(BA7),以右枕叶(BA18)最显著；1周时双侧枕中回(BA19)小面积激活；2周时左侧顶上小叶(BA7)与双侧顶叶(BA40)小面积激活；4周后左侧顶上小叶(BA7)激活；3.治疗2~4周时,脑皮层视功能区的增进幅度滞后于随机点立体视。结论： 1.儿童屈光参差性弱视对与立体觉相关脑皮层的功能损害严重,短期内恢复困难。 2.屈光参差性弱视治疗的效果在一定程度上取决于患儿对疾病的认识与配合程度。 3.脑皮层视功能区的功能重建速度滞后于临床上广泛应用的随机点立体视锐度的恢复速度。因此,随机点立体视觉检查无法全面评价弱视治疗效果。 4.伴随立体视觉的建立,视皮层的中枢激活由双侧枕叶向顶叶等多个脑功能区延伸。
[Abstract]:Objective: to study the cortical function of anisometropia amblyopia before and after normal amblyopia training by using blood oxygen level dependent-function magnetic resonance imaging (BOLD-fMRI) technique in children with anisometropic amblyopia before and after standardized amblyopia training. To determine the true end point of clinical treatment for anisometropic amblyopia in children. Methods: eleven children with anisometropia amblyopia (6 males and 5 females, mean age: 8.6 卤3.35) were divided into 5. 5 + 7 years old group and 8-11 years old group, all of them were hyperopic amblyopia and central foveal fixation. The range of anisometropia was 3.0 DX 6.0D, all of them were right-handed. All subjects were excluded from retinal to lateral geniculate nucleus in MRI examination of ocular and nervous system diseases. After 1 week, 2 weeks and 4 weeks after normal amblyopia training, fMRI was reexamined. The experimental data were obtained by SIEMENS MAGNETOM Verio3T magnetic resonance scanning system. Visual stimuli were presented by brain functional audiovisual stimulation system SAMRTECS SA-99000.The task design programs were all compiled by E-Prime2.0 software. The stimulation mode was random dot stereoscopic images with a contrast of nearly 80%. Binocular stereoscopic vision was obtained by wearing red and blue glasses. A block block design was used, which consisted of activation state and control state. They were alternately random dot stereoscopic images and black "icon" fixed in the center of the screen. The test data is imported into a 64-bit operating system workstation, Off-line processing. The data were analyzed by SPM8(Statistical Parametric Mapping software package based on MATLAB7.12.0.635(The MathWorks (Inc.). Gao Si's smooth half-width Full-width at half maximum (FWHM) was 6mm. the matrix data of cortical activation in each group were obtained by random effect method. The difference of activation range of cerebral cortex before treatment and 1 week and 4 weeks after treatment was compared with self-matched t test (the threshold was set to P0.001 with statistical significance and no multiple correction). Results: 1.When the value of P was 0.05 and the threshold of activation range was 6 individuals, there was no significant difference in cerebral cortex activation between the two age groups. It was mainly concentrated in bilateral occipital lobes (BA18), lingual gyrus (BA17), middle occipital gyrus (BA19) and bilateral superior parietal lobules (BA7). The right occipital lobe was the most significant (BA19) in bilateral occipital middle gyrus at 1 week) and in left superior parietal lobules (BA7) and bilateral parietal lobe (BA40) at 2 weeks. BA7) activated 3. 4 weeks after treatment, The enhancement of visual function area of cerebral cortex lags behind that of stereopsis of random dots. Conclusion:. 1. The anisometropia amblyopia in children has serious damage to the cortical function associated with stereosensory, and it is difficult to recover in a short time. 2. The effect of anisometropia amblyopia depends on the understanding and cooperation of children. 3. The speed of functional reconstruction in visual functional area of cerebral cortex lags behind that of restoration of stereopsis acuity of random spot, which is widely used in clinic, therefore, random dot stereopsis can not fully evaluate the effect of amblyopia treatment. 4. With the establishment of stereo vision, the central activation of visual cortex extends from bilateral occipital lobe to parietal lobe.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R778

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