本文選題：急性腦梗死 + 腦心綜合征　； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:急性腦缺血可導致原來沒有心臟疾患的患者發(fā)生心臟損害,嚴重者可發(fā)生心肌損傷甚至猝死,機制尚不清楚。本研究利用靜息態(tài)功能性磁共振成像(resting-state functional magnetic resonance imaging,rs-fMRI)技術研究評價急性腦梗死后腦心綜合征(brain heart syndrome,BHS)患者腦區(qū)定位及機制。方法:搜集符合入選標準的急性腦梗死后腦心綜合癥(brain heart syndrome,BHS)患者16例(男性14例,女性2例,平均年齡52.2±13.4歲)納入實驗組。選擇與實驗組年齡、性別和教育程度相匹配的急性腦梗死患者20例(男性17例,女性3例,平均年齡56.5±11.1歲)作為對照組。實驗組及對照組均無腦外傷、腦出血、腦梗死、腦腫瘤、精神疾病及重大心血管疾病史,無吸煙、酗酒、非法藥物濫用病史。采用Philips Achieva3.0T X-series磁共振掃描儀及8通道相控陣頭部正交線圈,在靜息狀態(tài)下行血氧水平依賴磁共振腦功能成像。采用REST v1.6軟件包、DPARSF v2.0軟件包基于Matlab R2009a軟件平臺對實驗數(shù)據(jù)進行預處理、統(tǒng)計分析和結果顯示。數(shù)據(jù)排除標準:(1)頭動校正過程中檢測到的頭動平移超過1mm或頭動旋轉超過1°;(2)空間標準化過程中檢測到的圖像配準不理想的數(shù)據(jù)。人口統(tǒng)計學變量及臨床資料的統(tǒng)計分析運用SPSS 21.0統(tǒng)計分析軟件。兩組年齡、受教育程度和NISSH評分均服從正態(tài)分布,采用獨立樣本t檢驗,P0.05有統(tǒng)計學意義。采用四格表Fisher確切概率法比較兩組性別構成比的差異性,P0.05有統(tǒng)計學意義。結果:1兩組間的人口統(tǒng)計學變量(性別、年齡、受教育程度)差異無顯著統(tǒng)計學意義(P0.05),臨床資料(NISSH評分)差異有顯著統(tǒng)計學意義(P0.05)。2與對照組相比較,BHS組ALFF值顯著增強的腦激活區(qū):右側丘腦、右側橋腦、右側扣帶回、胼胝體、左側補充運動區(qū)、左側中央旁小葉、左側楔前葉、左側枕上回、左側枕中回、左側小腦前葉、左側小腦后葉。3與對照組相比較,BHS組ALFF值顯著減弱的腦激活區(qū):腦干、左側腦島、右側眶部額上回、左側額中回、左側顳中回顳極。結論:1 BHS患者梗死灶遠隔部位腦區(qū)激活增強,表明BHS的發(fā)生誘發(fā)并加重了腦梗死后遠隔效應的產(chǎn)生(神經(jīng)機能聯(lián)系失能),這可能是導致患者進展性腦梗死或預后不良的原因之一。2 BHS的發(fā)生與腦干及邊緣系統(tǒng)(主要是島葉皮質)支配心臟活動的相關腦區(qū)的損傷密切相關。3 Rs-fMRI在評價急性腦梗死后腦心綜合征患者腦區(qū)定位及機制和預測急性腦梗死后腦心綜合癥的發(fā)生具有潛在的應用價值。
[Abstract]:Objective: acute cerebral ischemia may lead to cardiac damage in patients without heart disease, and myocardial injury or sudden death in severe cases. The mechanism is not clear.In this study, resting-state functional magnetic resonance imagingrs-fMRI technique was used to evaluate the localization and mechanism of brain heart in patients with cerebral heart syndrome after acute cerebral infarction.Methods: sixteen patients (14 males and 2 females, mean age 52.2 鹵13.4 years) with brain heart syndrome after acute cerebral infarction were enrolled in the study group.Twenty patients (male 17, female 3, mean age 56.5 鹵11.1 years) with acute cerebral infarction matched with age, sex and education level of the experimental group were selected as the control group.There were no history of brain injury, cerebral hemorrhage, cerebral infarction, brain tumor, mental illness and major cardiovascular disease, no smoking, alcohol abuse and illegal drug abuse in the experimental group and the control group.Philips Achieva3.0T X-series magnetic resonance scanner and 8-channel phased array head quadrature coil were used to perform brain function imaging with oxygen level dependent magnetic resonance imaging in resting state.The experimental data are preprocessed with REST v1.6 software package and DPARSF v2.0 software package based on Matlab R2009a software platform. The statistical analysis and the result show.Data exclusion Standard: 1) the detected head motion translation exceeds 1mm or the head rotation is more than 1 擄/ 2) in the process of spatial standardization, the image registration is not ideal.The demographic variables and clinical data were analyzed by SPSS 21. 0 software.The age, education level and NISSH score of the two groups were all taken from normal distribution, using independent sample t test (P0.05) had statistical significance.It was statistically significant to compare the difference of sex composition ratio between the two groups by using Fisher exact probability method.Results the demographic variables between the two groups (sex, age,There was no significant difference in educational level (P 0.05). There was a significant difference in clinical data (P 0.05%). The activation areas of ALFF in the right thalamus, the right pontine, the right cingulate gyrus, the corpus callosum were significantly enhanced in the right thalamus, the right pontine, the right cingulate gyrus, and the corpus callosum, compared with those in the control group.In the left supplementary motor area, the left paracentral lobules, the left precuneal lobe, the left superior occipital gyrus, the left middle occipital gyrus, the left anterior cerebellar lobe, the left posterior cerebellar lobe, the brain activation areas in which the ALFF values of the BHS group were significantly reduced compared with those of the control group: brain stem, left cerebral island.Right orbital superior frontal gyrus, left middle frontal gyrus, left middle temporal gyrus temporal pole.Conclusion the activation of brain in the distant region of infarct was enhanced in patients with 1 BHS.It is suggested that the occurrence of BHS induces and exacerbates the generation of distant effect after cerebral infarction (neurologic dysfunction, which may be one of the causes of progressive cerebral infarction or poor prognosis. 2. 2 BHS) and brainstem and limbic system.(mainly the insular cortex) the injury of the brain region innervating cardiac activity is closely related to the location and mechanism of cerebral area in patients with cerebral heart syndrome after acute cerebral infarction and the prediction of cerebral heart syndrome after acute cerebral infarction.It has potential application value.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R743.33;R541

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