【作者】 张娟；

【导师】 彭德昌；

【作者基本信息】 南昌大学 ， 影像医学与核医学（专业学位）， 2021， 硕士

【摘要】 目的:本研究采用基于体素-镜像同伦功能连接（voxel-mirrored homotopic connectivity,VMHC）方法,探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者双侧大脑半球功能协调性的改变,为揭示COPD患者认知功能障碍潜在的神经病理机制提供新的理论依据。材料及方法:本课题组在南昌大学第一附属医院呼吸科招募了19位确诊的稳定期COPD患者（平均年龄:62.7±5.9岁）;选择与之相匹配（包括年龄、性别和受教育年限）的健康志愿者20例（平均年龄60.8±6.3岁）作为对照组（Healthy control,HC）。所有被试均接受静息态功能磁共振（rs-f MRI）检查并进行动脉血气分析、肺功能检测及神经认知评估。计算基于体素的镜像同伦连接（VMHC）和基于种子点的功能连接,统计比较两组的组间差异,与动脉血气分析、肺功能及认知功能评分行相关分析。结果:（1）COPD患者的Sa O₂（P=0.008）、Pa O₂（P<0.001）、FVC（P<0.001）、FEV₁（P<0.001）、FEV₁/FVC（P<0.001）较HC组明显减低,而Pa CO₂较HC组升高（P<0.001）。COPD患者在Mo CA（P<0.001）认知评估量表中总分低于HC组,其中命名（P=0.026）、视空间和执行（P=0.012）及记忆测试（P<0.001）这几项认知领域评分也低于HC组。（2）与HC组相比,COPD患者双侧颞上回的VMHC值显著降低,未检测到VMHC值增加的大脑区域。（3）以VMHC异常脑区作为种子点的功能连接分析显示COPD患者颞上回与全脑多个脑区功能连接存在异常,主要涉及默认网络、视觉网络及感觉网络。（4）相关性分析表明颞上回及部分异常脑区功能连接系数与FEV₁、Sa O₂呈正相关,与Pa CO₂、语言、抽象、记忆功能、Mo CA总分呈负相关。结论:稳定期COPD患者存在双侧半球间信息交流和整合障碍,双侧颞上回的半球间协调功能受损及其与多个脑区间的功能连接异常可能是其认知功能障碍的神经病理学基础。更多还原

【Abstract】 Objective:This study used the method of voxel-mirrored homotopic connectivity（VMHC）to explore the coordinated changes in bilateral brain function in patients with chronic obstructive pulmonary disease（COPD）,thereby understanding possible pathophysi-ological evidence of the pathogenesis of cognitive impairment in patients with COPD.Materials and methods:The research group recruited 19 stable COPD patients（an average age of 62.7±5.9 year）and 20 healthy control groups（an average age of 60.8±6.3 year）matched with their age,gender and number of years of education by the department of aspiration in the First Affiliated Hospital of Nanchang University.Subjects in both groups underwent resting functional magnetic resonance imaging（f MRI）,arterial blood gas analysis,pulmonary function detection and neurocognitive assessment.The resting-state f MRI image is obtained after preprocessing and VMHC calculation The VMHC values of whole brain voxels were obtained by statistical analysis and calculation.Obtain the abnormal VMHC value brain regions between COPDs group and HCs group through statistical analysis operation.Then the abnormal brain regions were selected as seed points to analyze the functional connections of the whole brain.Finally,evaluate the correlation between the brain regions with altered functional connection coefficient and the arterial blood gas analysis,lung function index and cognitive function score in COPD patients.Results:（1）Pa O₂（P<0.001）,Sa O₂（P=0.008）,FVC（P<0.001）,FEV₁（P<0.001）,and FEV₁/FVC（P<0.001）in COPD patients were significantly lower than that in the HC group,while Pa CO₂ was higher than that in the HC group（P<0.001）.The total scores of COPD patients in the Mo CA（P<0.001）cognitive assessment scales was lower than those in the HC group,and the scores in the Mo CA scale naming（P=0.026）,visual space and execution（P=0.012）and memory tests（P<0.001）were also lower than those in the HC group.（2）Compared with the healthy control group,the VMHC value of bilateral superior temporal gyrus of COPD patients were significantly reduced,and no higher VMHC value was detected.（3）The functional connection analysis using the abnormal VMHC value brain area as the seed point shows that there are abnormal functional connections between the superior temporal gyrus and several brain regions of the whole brain in patients with COPD.（4）Correlation analysis showed that the functional connectivity coefficient between the superior temporal gyrus and several brain regions was positively correlated with FEV₁,Sa O₂,and negatively correlated with Pa CO₂,the total Mo CA score,language,abstract,memory.Conclusion:There are abnormal functional coordination between bilateral hemispheres and abnormal functional connectivity of multiple brain regions in stable COPD patients,and the functional connectivity abnormalities correlated with lung function index,arterial blood gas analysis and cognitive function score,which might provide new pathophysiological evidence for further understanding the potential mechanism of cognitive impairment in COPD patients.更多还原