本文選題：卒中 + 運(yùn)動(dòng)性失語癥�。� 參考：《石河子大學(xué)》2017年碩士論文

【摘要】：第一部分基于ReHo的靜息態(tài)BOLD-fMRI在卒中后運(yùn)動(dòng)性失語患者的研究目的:采用ReHo的方法研究卒中后運(yùn)動(dòng)性失語患者(發(fā)病7天內(nèi)和康復(fù)1月后)和無失語患者在靜息狀態(tài)下局部腦區(qū)活動(dòng)的差異,探討腦卒中后運(yùn)動(dòng)性失語患者康復(fù)前后的腦功能區(qū)變化情況。方法:失語組根據(jù)納入標(biāo)準(zhǔn)選取12例卒中后運(yùn)動(dòng)性失語癥患者,男性6例,女性6例,平均年齡57.75±7.71歲,其中6例患者1月后行第二次fMRI檢查,男性4例,女性2例,平均年齡61.5±8.34歲;對(duì)照組10例,男性5例,女性5例,平均年齡59.2±7.08歲。靜息態(tài)數(shù)據(jù)均采用西門子3.0T磁共振掃描儀進(jìn)行掃描獲得,應(yīng)用SPM8和DPARSF軟件對(duì)數(shù)據(jù)預(yù)處理,去除每一位被試的前10個(gè)時(shí)間點(diǎn)以保證數(shù)據(jù)的穩(wěn)定性。數(shù)據(jù)處理包括時(shí)間校正、頭動(dòng)校正、空間標(biāo)準(zhǔn)化、消除線性趨勢(shì)、消除低頻漂移及高頻噪聲。ReHo計(jì)算是采用肯德爾系數(shù)(Kendall's coefficient of concordance,KCC))對(duì)團(tuán)塊(采用27個(gè)體素)進(jìn)行時(shí)間序列變化一致性進(jìn)行度量,得到每個(gè)被試的KCC腦,然后通過對(duì)每個(gè)體素的KCC劃分,把KCC腦進(jìn)行ReHo圖標(biāo)準(zhǔn)化,最后進(jìn)行空間平滑。ReHo統(tǒng)計(jì)分析在REST軟件里完成,對(duì)失語組和對(duì)照組患者分別行配對(duì)和兩樣本t檢驗(yàn),采用Slice Viewer生成激活圖進(jìn)行查看(P0.05,Alphasim校正,體素大小58 voxels)相關(guān)的腦區(qū)激活圖。結(jié)果:本實(shí)驗(yàn)經(jīng)過預(yù)處理,排除2例頭動(dòng)過大的患者,最終得到失語組患者10例;排除3例中途退出和1例頭動(dòng)過大的患者,康復(fù)1月后6例失語組患者行第二次fMRI檢查;對(duì)照組10例。失語組患者(發(fā)病7天內(nèi))ReHO高于對(duì)照組的腦區(qū)有左側(cè)小腦、左側(cè)枕葉和右側(cè)顳中回,ReHO低于對(duì)照組的腦區(qū)有左側(cè)前額葉內(nèi)側(cè)回、左側(cè)額上回、左側(cè)額中回、左側(cè)角回、左側(cè)頂葉、右側(cè)枕葉、右側(cè)角回、右側(cè)緣上回、雙側(cè)頂上小葉和頂下小葉;失語組(康復(fù)1月后)ReHO高于對(duì)照組的腦區(qū)有左側(cè)額下回島蓋部、左側(cè)楔前葉、左側(cè)中央前回、左側(cè)頂上小葉、左側(cè)額中回、右側(cè)海馬旁回和右側(cè)角回,低于對(duì)照組的腦區(qū)有左側(cè)小腦、左側(cè)額上回、左側(cè)內(nèi)囊前肢、右側(cè)額中回、右側(cè)頂葉和雙側(cè)頂下小葉;失語組患者康復(fù)前后對(duì)比的ReHO結(jié)果顯示,相對(duì)失語組(發(fā)病7天內(nèi))患者,激活增高的腦區(qū)為左側(cè)中央前回和左側(cè)頂上小葉。結(jié)論:1、左側(cè)前額葉內(nèi)側(cè)回、左側(cè)額上回、左側(cè)額中回、左側(cè)角回、左側(cè)頂葉、右側(cè)角回、右側(cè)緣上回、右側(cè)枕葉、雙側(cè)頂上小葉和頂下小葉的ReHo 信號(hào)在失語組(發(fā)病7天內(nèi))減低,提示這些腦區(qū)出現(xiàn)了功能改變,可能與大腦局部病灶影響神經(jīng)元的活動(dòng)有關(guān)。2、左側(cè)額下回島蓋部、左側(cè)楔前葉、左側(cè)中央前回、左側(cè)頂上小葉、左側(cè)額中回、右側(cè)海馬旁回和右側(cè)角回的ReHo信號(hào)在失語組康復(fù)1月后增高,在失語恢復(fù)期這些功能腦區(qū)神經(jīng)元活性增高,可能對(duì)語言的恢復(fù)起一定的代償作用。3、對(duì)于卒中后運(yùn)動(dòng)性失語癥患者,急性期出現(xiàn)右側(cè)大腦半球的功能腦區(qū)激活增多,而在恢復(fù)期患者則出現(xiàn)左側(cè)大腦半球病灶周圍未受損腦區(qū)的激活增多,同時(shí)右側(cè)大腦半球的激活減少,這種變化考慮失語后腦功能恢復(fù)機(jī)制是急性期以右側(cè)大腦半球的代償為主,恢復(fù)期以左側(cè)大腦半球病灶周圍未損傷腦區(qū)的功能重組為主,是兩側(cè)大腦半球共同作用的結(jié)果。第二部分基于FC的靜息態(tài)BOLD-fMRI在卒中后運(yùn)動(dòng)性失語患者腦功能可塑性的研究目的:采用種子點(diǎn)功能連接方法分析卒中后運(yùn)動(dòng)性失語患者腦功能區(qū)的功能連接變化,探討運(yùn)動(dòng)性失語患者腦功能區(qū)的可塑性變化機(jī)制。方法:采用第一部分預(yù)處理后的數(shù)據(jù),然后去除協(xié)變量,主要為去除頭動(dòng)、全腦信號(hào)、白質(zhì)信號(hào)和腦脊液對(duì)低頻同步振蕩信號(hào)的影響。根據(jù)第一部分的結(jié)果選擇左側(cè)額中回(LMFG)后部作為感興趣區(qū)(ROI),ROI種子點(diǎn)的坐標(biāo)為MNI(-40,10,55),用REST中的slice viewer生成一個(gè)覆蓋58體素的Mask,然后以ROI中各體素時(shí)間信號(hào)的平均值作為ROI的時(shí)間信號(hào),通過分析ROI與全腦各體素的時(shí)間序列得到Pearson相關(guān)圖。在REST中分別采用單樣本、兩樣本或配對(duì)t檢驗(yàn)進(jìn)行組內(nèi)或組間分析,得到統(tǒng)計(jì)參數(shù)圖疊加到REST軟件中的Slice Viewer的MNI標(biāo)準(zhǔn)模板腦,生成功能連接圖,查看相關(guān)強(qiáng)度的大小。結(jié)果:靜息狀態(tài)下,失語組(發(fā)病7天內(nèi))與LMFG-ROI正相關(guān)的腦區(qū)有右側(cè)額中回、右側(cè)額下回,失語組(發(fā)病7天內(nèi))與 LMFG-ROI負(fù)相關(guān)的腦區(qū)有左側(cè)小腦、左側(cè)扣帶回后部、左側(cè)外囊、左側(cè)島葉、左側(cè)枕葉、左側(cè)頂上小葉;失語組(康復(fù)1月后)與LMFG-ROI正相關(guān)的腦區(qū)有左側(cè)額中回、額下回、左側(cè)額上回、左側(cè)島葉皮質(zhì)、左側(cè)內(nèi)囊,失語組(康復(fù)1月后)與LMFG-ROI負(fù)相關(guān)的腦區(qū)有左側(cè)小腦、右側(cè)顳葉、右側(cè)島葉、右側(cè)中央后回、雙側(cè)扣帶回、雙側(cè)枕葉;與對(duì)照組相比,失語組(發(fā)病7天內(nèi))與LMFG-ROI功能連接增強(qiáng)的腦區(qū)有右側(cè)島葉、右側(cè)額頂葉島蓋部、右側(cè)額下回(三角部、眶部)、右側(cè)顳上回和顳中回、右側(cè)緣上回、右側(cè)角回,功能連接減少的腦區(qū)有左側(cè)扣帶回后部、左側(cè)楔前葉;與對(duì)照組相比,失語組(康復(fù)1月后)與LMFG-ROI功能連接增強(qiáng)的腦區(qū)有左側(cè)尾狀核頭部、左側(cè)額中回和額下回、左側(cè)蒼白球、左側(cè)中央前回和中央后回、左側(cè)島葉,功能連接減少的腦區(qū)有左側(cè)扣帶回后部、左側(cè)小腦、右側(cè)海馬、右側(cè)舌回、右側(cè)枕葉、右側(cè)楔前葉;與失語組(發(fā)病7天內(nèi))患者相比,失語組(康復(fù)1月后)功能連接增強(qiáng)的腦區(qū)有左側(cè)額中回、左側(cè)額頂葉島蓋、左側(cè)中央前回和中央后回,功能連接減低的腦區(qū)有右側(cè)顳上回、右側(cè)顳中回、右側(cè)島葉、右側(cè)緣上回。結(jié)論:1、對(duì)于卒中后運(yùn)動(dòng)性失語癥患者,急性期與LMFG-ROI功能連接正相關(guān)明顯的腦區(qū)在右側(cè)大腦半球,提示這可能是大腦損傷后機(jī)體出現(xiàn)的代償反應(yīng)。2、失語患者康復(fù)1月后與與LMFG正相關(guān)明顯的腦區(qū)主要在病灶周圍未受損腦區(qū),提示功能腦區(qū)的代償機(jī)制出現(xiàn)了轉(zhuǎn)移,與ROI功能連接增強(qiáng)的腦區(qū)從右側(cè)大腦半球轉(zhuǎn)移到左側(cè)大腦半球,考慮左側(cè)半球損傷后失語的恢復(fù)機(jī)制包括急性期右側(cè)半球功能腦區(qū)的代償激活和恢復(fù)期左側(cè)大腦半球病灶周圍未受損腦區(qū)的激活,這也可能是大腦功能恢復(fù)的主要機(jī)制。3、無論是失語急性期還是恢復(fù)期,均出現(xiàn)了左側(cè)扣帶回后部的激活減低,考慮這是卒中后運(yùn)動(dòng)性失語發(fā)生的關(guān)鍵腦區(qū)。
[Abstract]:The first part of the study based on ReHo's resting state BOLD-fMRI in patients with poststroke motor aphasia: the ReHo method was used to study the difference in the local brain activity in the patients with apoplexy aphasia (7 days after the onset and after January) and the silent patients in the resting state. Methods: according to the inclusion criteria, the aphasia group selected 12 patients with poststroke motor aphasia, 6 males and 6 females, with an average age of 57.75 + 7.71 years, of which 6 patients underwent second fMRI examinations after January, 4 men and 2 women, with an average age of 61.5 + 8.34 years, and the control group 10, male 5, female 5, average age and average age. 7.08 years of age. Resting state data are scanned by SIEMENS 3.0T MRI scanner. SPM8 and DPARSF software are used to preprocess data to remove the first 10 time points of each person to ensure the stability of the data. Data processing includes time correction, head motion correction, spatial standardization, elimination of linear trends, low frequency drift and high The frequency noise.ReHo calculation uses the Kendall coefficient (Kendall's coefficient of concordance, KCC) to measure the conformance of the time series change of the mass (using 27 individual elements), get the KCC brain of each test, and then standardize the ReHo diagram of the KCC brain by dividing the KCC of each voxel, and finally carry out the spatial smoothness.ReHo statistical score. In the REST software, the patients were paired with the aphasia group and the control group, and the patients in the control group were paired and two samples t test respectively. The activation map of the Slice Viewer generated activation map was used to examine the brain area activation map (P0.05, Alphasim correction, voxel size 58 voxels). Results: the experiment was pretreated to exclude 2 patients with oversize head, and finally get 10 of the aphasia group. Cases of 3 cases of Midway withdrawal and 1 cases of high head movement were excluded, and second times of fMRI examination were performed in 6 cases of aphasia after January, and 10 cases in the control group. The ReHO in the aphasia group (7 days of onset) was higher than that of the control group with left cerebellum, left occipital lobe and right medial temporal gyrus, and ReHO in the brain area of the control group with the medial frontal gyrus of the left prefrontal lobe and the left upper part of the brain. Gyrus, left frontal gyrus, left angular gyrus, left parietal lobe, right occipital lobe, right angular gyrus, right margin of upper gyrus, bilateral upper lobule and inferior parietal lobule. The aphasia group (after rehabilitation January) was higher than the control group with left inferior frontal gyrus, left anterior cuneate, left precentral gyrus, left superior lobule, left middle frontal gyrus, right parahippocampal gyrus and right side. In the angular gyrus, the cerebral area of the control group had the left cerebellum, the left superior frontal gyrus, the left inner capsule forelimb, the right frontal gyrus, the right parietal lobe and the bilateral inferior parietal lobule. The results of the ReHO in the aphasia group before and after the rehabilitation showed that the relative aphasia group (7 days of onset) activated the higher brain area to the left precentral gyrus and the left superior lobule. Conclusion: 1, left The medial prefrontal gyrus, left superior frontal gyrus, left frontal gyrus, left angular gyrus, left parietal lobe, right angular gyrus, right margin of upper gyrus, right occipital lobe, bilateral apical lobule and inferior lobular ReHo signal decreased in aphasia group (7 days of onset), suggesting that these brain areas were altered and may affect neuronal activity with local lesions of the brain. .2, left inferior frontal gyrus, left anterior lobe, left anterior central gyrus, left parietal gyrus, left parietal lobule, left middle frontal gyrus, right lateral frontal gyrus, right hippocampal gyrus and right angle gyrus, increased in the aphasia group after January. In the aphasia recovery period, the neuronal activity of these functional brain regions increased, which might be a compensatory function of.3 for the recovery of language. In the patients with moderate and posterior motor aphasia, the activation of the functional brain area in the right hemisphere increases in the acute stage, while in the recovery period the activation of the undamaged brain area around the left hemisphere is increased and the activation of the right hemisphere decreases. This change considers the mechanism of the recovery of the brain function after aphasia is in the acute phase of the right brain. The compensatory hemisphere is the main part of the recovery period with the functional reorganization of the undamaged brain regions around the left hemisphere of the cerebral hemisphere, which is the result of the joint action of the bilateral cerebral hemispheres. The second part of the resting state BOLD-fMRI based on FC in the study of the cerebral function plasticity in the patients with motor aphasia after stroke: using the seed point function connection method to analyze the stroke The function connection of the brain functional area of the patients with post motor aphasia was changed to explore the mechanism of the plasticity of the functional area of the motor aphasia. Methods: the first part of the pre processed data was used to remove the covariate, which was mainly to remove the head movement, the whole brain signal, the white matter signal and the cerebrospinal fluid on the low frequency synchronous oscillation signal. In part, the posterior part of the left middle frontal gyrus (LMFG) is selected as the region of interest (ROI), the coordinates of the ROI seed point are MNI (-40,10,55), and a Mask of 58 voxel is generated by slice viewer in REST, and then the mean value of the time signal of each voxel in ROI is used as a ROI time signal, and the time series of the ROI and the whole brain is obtained by analyzing the time series of the whole brain voxel. Arson correlation diagram. In REST, single sample, two sample or paired t test were used to carry out intra group or inter group analysis. The MNI standard template brain of Slice Viewer in REST software was superimposed on the statistical parameter map, and the function connection graph was generated and the relative intensity was examined. Results: in resting state, the aphasia group (7 days of onset) was positively related to LMFG-ROI. The brain area had the right frontal gyrus and the right frontal gyrus, and the aphasia group (7 days after the onset) had the left cerebellum, the left cingulate gyrus, left lateral cingulate, left insula, left occipital lobe, left superior lobule, and the brain area associated with LMFG-ROI in the aphasia group (after January) had the left middle frontal gyrus, the lower frontal gyrus, left upper frontal gyrus, left side, left side, left side, left side, left side, left side, left side, left side of frontal gyrus, left left upper frontal gyrus, left side, left side, left side of the left side, left upper frontal gyrus, left side, left side of the left side, left upper frontal gyrus, left left side, left left upper frontal gyrus, left side, left left side of the brain area The insula cortex, left internal capsule, and aphasia group (after January rehabilitation) had the left cerebellum, right temporal lobe, right Island lobe, right posterior central gyrus, bilateral cingulate gyrus, bilateral occipital lobe, and the brain area with the LMFG-ROI function connection enhanced with the control group, the right frontal parietal insula, right side, right frontal parietal insula, right side, and the right side were compared with the control group. Lower frontal gyrus (triangle, orbital), right superior temporal gyrus and middle temporal gyrus, right margin of upper gyrus, right angular gyrus, left cingulate gyrus and left anterior wedge of the left cingulate cortex. Compared with the control group, the brain area of the aphasia group (after recovery January) has the left caudate nucleus, left middle frontal gyrus and inferior frontal gyrus, and left paleness of the left side of the brain. Ball, left anterior central gyrus and posterior central gyrus, left insula, functional connection reduced brain area with left cingulate gyrus, left cerebellum, right hippocampus, right lingual gyrus, right occipital lobe, right anterior wedge. Compared with aphasia group (7 days of onset), the aphasia group (after January rehabilitation) has the left middle frontal gyrus, left frontal parietal lobe island. The brain areas with lower functional connectivity include right right temporal gyrus, right temporal gyrus, right Island lobe, right margin upper gyrus. Conclusion: 1, in patients with postapoplexy aphasia, acute phase with LMFG-ROI function connection is positively related to the right hemisphere in the brain area, suggesting that this may be the body after brain injury. The present compensatory response.2, after the recovery of the aphasia, after January, the brain region, which is positively related to LMFG, is not damaged in the brain area around the lesion, suggesting that the compensatory mechanism of the functional brain region is transferred. The brain region which is enhanced by the function of the ROI is transferred from the right hemisphere to the left hemisphere, considering the recovery mechanism of the aphasia after the left hemisphere injury. The activation of compensatory activation in the right hemisphere of the right hemisphere and the activation of the undamaged brain area around the left hemisphere of the cerebral hemisphere in the convalescence of the right hemisphere, which may also be the main mechanism for the recovery of brain function,.3, both in the aphasia and in the recovery period, both in the left cingulate gyrus and at the back of the left cingulate gyrus, considering this is a poststroke motor aphasia. The key brain area of birth.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R743.3

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本文編號(hào)：1918253