【最新版】基于局部一致性算法的周围性面瘫针刺治疗_静息态磁共振成像研究毕业论文设计.doc
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1、(此文档为word格式,下载后您可任意编辑修改!) 单位代码: 10369 2014届同等学力申请硕士学位论文基于局部一致性算法的周围性面瘫针刺治疗静息态磁共振成像研究THE STUDY OF RESTING-STATE FMRI BASED ON REGIONAL HOMOGENEITY IN PERIPHERAL FACIAL PARALYSIS BEFORE AND AFTER ACUPUNCTURE TREATMENT学 科 专 业 中西医结合临床 研 究 方 向 脑功能成像 导 师 李传富 主任医师 硕 士 生 刘 军 平 论文完成单位 安徽中医药大学 目录中文摘要1ABSTRACT
2、5英文缩略词表9前言12材料与方法151研究对象152 器材和设备183 实验步骤194 实验设计与数据采集205 静息态fMRI数据处理216 局部一致性(Regionalhomogeneity, ReHo)分析237统计学分析24结果251 组内分析结果252 组间分析结果31讨论421 传统医学对周围性面瘫的认识422现代医学对周围性面瘫的认识432.1对该病病因病机的认识432.2周围性面瘫的诊断和分型442.3周围性面瘫的影像学检查453对针灸治疗周围性面瘫的认识453.1现代医家对针灸治疗该病的认识453.2周围性面瘫及针灸治疗机制的既往fMRI研究464fMRI在该项研究机制中的
3、运用474.1Bold-fMRI技术的原理474.2Bold-fMRI成像技术的特点和优势484.3静息态功能性磁共振(resting-state fMRI)494.4 静息态fMRI技术分析方法的选择505针刺治疗周围性面瘫患者不同病程脑功能影像的分析525.1面瘫患者静息态脑功能默认网络的存在525.2静息状态下针刺治疗面瘫患者大脑皮层的功能重组53结论63问题与展望64参考文献66附录一知情同意书76附录二 脑功能磁共振研究信息采集表79综述80攻读硕士期间已发表和录用的论文92个人简介93致谢94中文摘要目的 以周围性面瘫患者为载体, 功能磁共振成像为技术手段,利用局部一致性分析方法,
4、研究在静息状态下周围性面瘫患者临床针刺治疗不同病程状态下的脑区局部一致性(ReHo)变化特点,探讨针刺治疗周围性面瘫的可能中枢整合机制。方法(1) 选取实验组47人,按病程(duration data,DD)及House-Brackmann面瘫分级分为面瘫早期未治疗组、面瘫针刺治疗后期组、面瘫针刺治疗治愈组(以下简称面瘫早期组、后期组及治愈组),在静息状态下进行Bold-fMRI检查;嘱受试者在整个扫描过程中,全身尤其是头部保持静止,并尽可能避免心理活动, fMRI的主要参数为:TR/TE/FA 3000ms/30ms/90,FOV 192mm 192 mm,SL 3.0 mm,层间距0.75
5、 mm,分辨率6464,每3.0秒可获得间隔为0.75mm的覆盖全脑的36层图像;实验数据采用AFNI软件分析处理,采用局部一致性(ReHo)方法分析静息状态下的Bold-fMRI数据,采用单样本t检验组内分析及Monte Carlo模拟阈值校正方法得出组内分析结果(P=0.005, 0.05),对周围性面瘫患者不同病程状态下(面瘫早期组、后期组及治愈组)的脑区局部一致性(ReHo)进行分析; (2) 选取健康志愿者32人,在静息状态下进行Bold-fMRI检查;扫描参数与周围性面瘫患者相同;实验数据采用AFNI软件分析处理,采用局部一致性(ReHo)方法分析静息状态下的Bold-fMRI数据
6、,采用单样本t检验组内分析及Monte Carlo模拟阈值校正方法得出组内分析结果(P=0.005, 0.05),对健康对照者脑区局部一致性(ReHo)进行分析。(3) 周围性面瘫患者临床针刺治疗不同病程状态(面瘫早期组、后期组及治愈组)与健康对照者之间的全脑局部一致性(ReHo)进行对比研究,采用两样本t检验进行组间分析及Monte Carlo模拟阈值校正方法确定ReHo存在显著性差异的脑区,得出组间分析结果(P=0.005, 0.05),探究静息态下周围性面瘫患者临床针刺治疗不同病程状态下脑区局部一致性(ReHo)的变化。结果(1) 静息态fMRI数据的组内分析(p=0.005,0.05)
7、结果显示面瘫早期组、后期组及治愈组局部一致性(ReHo)增强的脑区广泛,与健康对照组相似,且主要位于后扣带回及相邻的楔前叶和前额叶,与静息状态默认模式网络(DMN)一致。(2) 组间对比分析(p0.005,0.05)得出周围性面瘫临床针刺治疗不同病程状态(面瘫早期组、后期组及治愈组)与健康对照组的分析结果,组间分析经过Monte Carlo多重比较阈值校正(p=0.005,0.05)显示有显著性差异,表现为:1) 面瘫早期组比健康对照组Reho增高的脑区:右侧额上回、右侧额中回、右侧额下回、右侧前扣带回、左侧楔前叶、左侧后扣带回、左侧颞上回 ;面瘫早期组比健康对照组Reho降低的脑区:右侧颞下
8、回。2) 面瘫后期组比健康对照组Reho增强的脑区:左侧SII、左侧颞上回、左侧额上回、左侧中央旁小叶、左侧楔叶、左侧楔前叶、左侧后扣带回、右侧额下回;面瘫后期组比健康对照组Reho降低的脑区:无。3) 面瘫治愈组比健康对照组Reho增强的脑区:左侧楔前叶、左侧梭状回、左侧钩回;面瘫治愈组比健康对照组Reho降低的脑区:无。结论(1) 面瘫早期组ReHo增高的区域分布在左右大脑半球,但到了面瘫后期组,ReHo增高的区域分布集中在左侧大脑半球,治愈组的ReHo异常区域减少,但仍然分布在左侧大脑半球,治疗前后存在着一个动态的变化过程,提示了左侧大脑半球的代偿作用;(2) 周围性面瘫患者临床针刺治疗
9、不同病程状态(面瘫早期组、后期组及治愈组)脑区的ReHo明显增高,与健康志愿者相比有显著差异,且多位于运动前区(额上回、额中回)、辅助运动区(中央旁小叶),默认模式网络(楔前叶、PCC)、ACC、SII、楔叶及颞上回,仅在面瘫早期组右侧颞下回ReHo减低,治愈组与健康志愿者有显著差异的脑区明显减少;(3) 大脑皮层运动前区(PMA)、辅助运动区(SMA)很可能是周围性面瘫患者静息状态下脑功能重组及代偿的关键区域,也是针刺治疗周围性面瘫患者重要的调制和关键代偿区域。(4) 静息状态下周围性面瘫患者脑区也同样存在默认模式网络(DMN),并存在异常,针刺诱导默认模式网络发生改变,可能也是针刺治疗周围
10、性面瘫的内在机制之一;(5) 周围性面瘫患者针刺治疗可能是通过同侧大脑半球的代偿、运动前区及辅助运动区的激活,以及其它脑区神经元的活动来协同整合完成的。关键词 周围性面瘫;功能性磁共振成像,局部一致性;针刺;脑ABSTRACTObjective:To analyze the changes of regional homogeneity by puncturing at the acupoints on the involved meridian and explore the central mechanisms of patients with peripheral facial para
11、lysis.Methods:(1) According to the course of the disease(durationdata, DD) and House-Brackmann paralysis grading for facial paralysis, the study performed on 47 right-handed left side peripheral facial paralysis, whom were divided into the early group, the later group and the recovered group(part of
12、 the patients participated inMRI scan many times). The functional data were acquired in the resting state. Keeping resting state in the experiment, particularly the head. The functional data were acquired by a GRE-EPI sequence (TR/TE/FA=3000ms/30ms/90, SL 3.0mm, spacing 0.75mm, FOV 192mm x 192mm, re
13、solution 64 x 64). Images were processed using the AFNI software program and themethod of ReHo was used to analyze theBold-fMRI datain the resting state. One sample t-test group analysis and threshold correction with Monte Carlo simulation for the results of the group analysis. The level of signific
14、ance was thresholded at P 0.005 and 0.05. The ReHo map ofperipheral facial paralysis patients in the different pathological stages was analyzed.(2) The study was performed on 32 right-handed healthy adult volunteers. The functional data were acquired in the resting state. Thescanningparameters were
15、the same as the patients withperipheral facial paralysis. Images were processed using the AFNI software program and themethod of ReHo was used to analyze theBold-fMRI datain the resting state. One sample t-test group analysis and threshold correction with Monte Carlo simulation for the results of th
16、e group analysis. The level of significance was thresholded at P 0.005 and 0.05. The ReHo map of the normal group was analyzed.(3) To compare the difference of ReHo between healthy adult volunteers and left-peripheral facial paralysis in the different pathological stages (the early group, the later
17、group and the recovered group) before and after acupuncture treatment, two sample t-test group analysis for the different brain areas and threshold correction with Monte Carlo simulation. The level of significance was thresholded at P 0.005 and 0.05 for the group-compared analysis. The change of the
18、 ReHo map of peripheral facial paralysis patients before and after acupuncture treatment was analyzed.Results: (1) The group analysis of left side peripheral facial paralyses with resting state fMRI data showed in the early group, the later group and the recovered group the ReHo of the brain area in
19、creased widely, similar to the normal group, and mainly located in the posterior cingulate, precuneus and the prefrontal cortex, which is consistent with the Default Mode Network (DMN);(2) To compared left-peripheral facial paralysis in the different pathological stages (the early group, the later g
20、roup and the recovered group) with the normal group, it had remarkable difference after threshold correction with Monte Carlo simulation(p=0.01, 0.05). List as follows:1) Group comparison between the early group and the normal group: The brain areas of increased Reho were found in right superior fon
21、tal gyrus, right superior medial gyrus, right inferior fontal gyrus, right anterior cingulate, left precuneus, left posterior cingulate, left superior temporal gyrus and the brain areas of decreased Reho were found in right inferior temporal Gyrus;2) Group comparison between the later group and the
22、normal group: The brain areas of increased Reho were found in left SII, left superior temporal gyrus, left superior frontal gyrus, left paracentral lobule, left cuneus, left precuneus, right inferior frontal gyrus, left posterior cingulate; and the brain areas of decreased Reho were none ;3) Group c
23、omparison between the recovered group and the normal group: The brain areas of increased Reho were found in left precuneus, left fusiform gyrus, left uncus; and the brain areas of decreased Reho were none.Conclusions:(1) In the early group of facial paralysis, the brain areas of increased Reho was d
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