化瘀通络合剂对脑小血管病致认知功能障碍的功能网络研究

发布时间：2018-01-16 23:28

本文关键词：化瘀通络合剂对脑小血管病致认知功能障碍的功能网络研究　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：脑小血管病(Cerebral small vessel disease,CSVD)其常见的临床表现有认知功能损害(Cerebral small vascular cognitive Impairment,CSVCI)、腔隙综合症、步态平衡障碍、情绪低落等。研究表明CSVD是血管性认知功能障碍(vascular cognitive Impairment,VCI)及年龄相关性认知功能减低最主要的病因,但由于其起病比较隐匿,进展相对缓慢,临床症状往往不是很典型,因此CSVD容易被人忽视,一旦进展为血管性痴呆(Vascular dementia,VaD)后会严重影响患者生活质量,同时给家庭社会造成严重的经济负担。虽然目前尚无有效药物能逆转其最终发展为血管性痴呆,但可根据其危险因素进行早期干预治疗,延缓其发展进程。结合前期研究成果表明,化瘀通络合剂具有“化瘀生新以通络”的功效,能促进脑梗死后血管新生,有促进脑缺血组织的血循环及改善神经功能缺损的疗效；能改善脑小血管病所致认知功能障碍。本课题应用静息态功能磁共振观察化瘀通络合剂对大脑各功能区激活的影响,进一步探讨化瘀通络合剂改善认知功能的可能的机制。方法：按照纳入标准和排除标准入组了40例脑小血管病患者,体检健康者15例作为空白组,将40例患者按照就诊的时间顺序随机分为治疗组和对照组,每组各20例。治疗组除了接受常规的基础药物治疗和康复治疗外,予以口服化瘀通络合剂1瓶／天,共干预1月,对照组只接受常规的药物治疗和康复治疗,健康空白组不做任何治疗。治疗组、对照组和空白组在治疗后30天行静息态功能性磁共振成像检查(functional Magnetic Resonance Imaging,fMRI),三组治疗前均使用蒙特利尔认知评估表(Montreal Cognitive Assessment,MoCA)进行总体认知功能评定。选取双侧后扣带回(posterior cingulate cortex,PCC)为感兴趣区,利用脑功能数据辅助处理软件(Data processing assistant forresting-state fMRI,DPARSF)和统计参数图软件(Statistical parametric mapping,SPM)对数据进行预处理,采用REST软件自带统计工具对组内行单样t检验和对组间行双样本t检验,得到脑功能连接图,观察化瘀通络合剂对治疗后大脑静息态功能连接模式的影响,进一步探讨其改善认知的可能机制。结果：1、与空白组比较,治疗后对照组右侧扣带回与左侧额中回/颞中回/眶部额下回、右侧额下回连接增强,与右侧额中回、海马旁回连接减弱；左侧扣带回与左侧颞叶(颞上回、颞下回)、小脑功能连接增强。2、与空白组比较,治疗后治疗组右侧后扣带回与左侧顶下小叶、右侧枕上回/海马/额下回的功能连接增强,与右侧海马旁回/眶内额上回/内侧额上回/额中回的功能连接减弱：左侧后扣带回与右侧小脑/颞下回/颞上回、左侧颞下回/海马/颞上回/颞中回的功能连接增强,与左侧顶下小叶/内侧额上回/背外侧额上回的功能连接减弱。3、与对照组比较,化瘀通络合剂干预1月后治疗组的MoCA评分显著增高,证明化瘀通络合剂具有改善认知的疗效。结论：化瘀通络合剂有改善脑小血管病致认知功能障碍疗效,其改善认知功能缺损的机制尚不明确。与空白组相比,治疗后治疗组认知改善可能与脑区(如顶下叶、海马、枕叶、部分额颞叶)的功能网络连接增强有关,特别是默认网络连接的增强相关,但由于课题的自身的局限性需进一步研究予以证实。
[Abstract]:Objective: cerebral small vessel disease (Cerebral small vessel disease, CSVD) the clinical manifestations are common cognitive impairment (Cerebral small vascular cognitive Impairment, CSVCI), lacunar syndrome, gait disorder balance, such as depression. Research shows that CSVD is a vascular cognitive impairment (vascular cognitive, Impairment, VCI) and age related cognitive function to reduce the main cause, but because of its onset is hidden, the relatively slow progress, clinical symptoms are not typical, so CSVD can easily be ignored, once the progress of vascular dementia (Vascular dementia, VaD) will seriously affect the quality of life of patients, and caused serious economic burden to family and society. Although there is no effective drug that can reverse the final development of vascular dementia, but early intervention according to the risk factors, delaying the development process. Preliminary research results show that Huayutongluo decoction has "Tongluo Huayu health new to" effect, can promote angiogenesis after cerebral infarction, cerebral ischemia can promote blood circulation and improve nerve function defect curative effect; can improve cerebral small vessel disease caused by cognitive dysfunction. The application of resting state functional magnetic resonance effects of removing blood stasis the activation of the Tongluo mixture of each functional area of the brain, to further explore the Huayutongluo mixture to improve cognitive function mechanisms. Methods: according to the inclusion and exclusion criteria included 40 cases of patients with cerebral small vessel disease, health examination in 15 cases as control group, 40 cases of patients in clinic were randomly divided into time the treatment group and control group, 20 cases in each group. The treatment group in addition to accept conventional drug treatment and rehabilitation treatment, treated with Huayu Tongluo mixture of 1 bottles per day, a total of January intervention, control Group only received drug therapy and routine rehabilitation, the healthy control group without any treatment. The treatment group, control group and the control group in 30 days after treatment of resting state functional magnetic resonance imaging (functional Magnetic Resonance Imaging, fMRI), the three groups before treatment were using Montreal cognitive assessment (Montreal Cognitive Assessment. MoCA) for the assessment of cognitive function. The overall selection of bilateral posterior cingulate (posterior cingulate, cortex, PCC) for the region of interest, the auxiliary processing software using functional brain data (Data processing assistant forresting-state fMRI, DPARSF) and statistical parametric mapping software (Statistical parametric, mapping, SPM) to preprocess the data, with statistical tools for group within one sample t test and the differences between the two sample t test using REST software, get the connection diagram of the brain function, observation of blood stasis Tongluo mixture after treatment of brain dead Effect of resting state functional connectivity pattern, to further explore the possible mechanism of cognitive improvement. Results: 1, compared with the control group, the control group after treatment right cingulate gyrus and left frontal gyrus / middle temporal gyrus / orbital frontal gyrus, right inferior frontal gyrus and enhanced connection, right middle frontal gyrus, parahippocampal gyrus connection decreased; left cingulate gyrus and left temporal lobe (temporal gyrus, inferior temporal gyrus, cerebellum) increased functional connectivity of.2, compared with the control group, after treatment, right posterior cingulate and left inferior parietal lobule, right occipital gyrus / hippocampus / inferior frontal gyrus increased functional connectivity, and the right side of the parahippocampal gyrus / orbital superior frontal gyrus / medial frontal gyrus / back function frontal weakening connection: the left posterior cingulate cortex and right cerebellum / inferior temporal gyrus / superior temporal gyrus, left inferior temporal gyrus / hippocampus / superior temporal gyrus / back temporal connection enhancement, connected with the left inferior parietal lobule / medial frontal gyrus / dorsolateral frontal gyrus function .3 decreased, compared with the control group, Huayu Tongluo mixture intervention in January after the MoCA score of treatment group increased significantly, that of Huayutongluo decoction has curative effect to improve cognition. Conclusion: Huayutongluo Decoction improve the curative effect of cognitive dysfunction caused by cerebral small vessel disease, improve the cognitive impairment mechanism is not clear. Compared with blank control group. After treatment, cognitive improvement may be associated with brain regions (e.g., parietal lobe, occipital lobe, hippocampus, part of frontotemporal enhancement is related to the function of network connection), especially enhance the default network connectivity, but due to limitations need to be confirmed further research on the topic of their own.

【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】：2016
【分类号】：R277.7

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