【正文】 單位代碼： 10369 2014屆同等學(xué)力申請(qǐng)碩士學(xué)位論文基于局部一致性算法的周圍性面癱針刺治療靜息態(tài)磁共振成像研究THE STUDY OF RESTINGSTATE FMRI BASED ON REGIONAL HOMOGENEITY IN PERIPHERAL FACIAL PARALYSIS BEFORE AND AFTER ACUPUNCTURE TREATMENT學(xué) 科 專 業(yè) 中西醫(yī)結(jié)合臨床 研 究 方 向 腦功能成像 導(dǎo) 師 李傳富 主任醫(yī)師 碩 士 生 劉 軍 平 論文完成單位 安徽中醫(yī)藥大學(xué) 91目錄中文摘要 1ABSTRACT 5英文縮略詞表 9前言 12材料與方法 151研究對(duì)象 152 器材和設(shè)備 183 實(shí)驗(yàn)步驟 194 實(shí)驗(yàn)設(shè)計(jì)與數(shù)據(jù)采集 205 靜息態(tài)fMRI數(shù)據(jù)處理 216 局部一致性(Regionalhomogeneity, ReHo)分析 237統(tǒng)計(jì)學(xué)分析 24結(jié)果 251 組內(nèi)分析結(jié)果 252 組間分析結(jié)果 31討論 421 傳統(tǒng)醫(yī)學(xué)對(duì)周圍性面癱的認(rèn)識(shí) 422現(xiàn)代醫(yī)學(xué)對(duì)周圍性面癱的認(rèn)識(shí) 43 43 44 453對(duì)針灸治療周圍性面癱的認(rèn)識(shí) 45 45 464fMRI在該項(xiàng)研究機(jī)制中的運(yùn)用 47 47 48（restingstate fMRI） 49 靜息態(tài)fMRI技術(shù)分析方法的選擇 505針刺治療周圍性面癱患者不同病程腦功能影像的分析 52 52 53結(jié)論 63問題與展望 64參考文獻(xiàn) 66附錄一知情同意書 76附錄二 腦功能磁共振研究信息采集表 79綜述 80攻讀碩士期間已發(fā)表和錄用的論文 92個(gè)人簡介 93致謝 94基于局部一致性算法的周圍性面癱針刺治療靜息態(tài)磁共振成像研究中文摘要目的 以周圍性面癱患者為載體, 功能磁共振成像為技術(shù)手段，利用局部一致性分析方法，研究在靜息狀態(tài)下周圍性面癱患者臨床針刺治療不同病程狀態(tài)下的腦區(qū)局部一致性（ReHo）變化特點(diǎn)，探討針刺治療周圍性面癱的可能中樞整合機(jī)制。方法（1） 選取實(shí)驗(yàn)組47人，按病程（duration data,DD）及HouseBrackmann面癱分級(jí)分為面癱早期未治療組、面癱針刺治療后期組、面癱針刺治療治愈組（以下簡稱面癱早期組、后期組及治愈組），在靜息狀態(tài)下進(jìn)行BoldfMRI檢查；囑受試者在整個(gè)掃描過程中，全身尤其是頭部保持靜止，并盡可能避免心理活動(dòng), fMRI的主要參數(shù)為：TR/TE/FA 3000ms/30ms/90176。，F(xiàn)OV 192mm 192 mm，SL mm， mm，分辨率6464，；實(shí)驗(yàn)數(shù)據(jù)采用AFNI軟件分析處理，采用局部一致性(ReHo)方法分析靜息狀態(tài)下的BoldfMRI數(shù)據(jù)，采用單樣本t檢驗(yàn)組內(nèi)分析及Monte Carlo模擬閾值校正方法得出組內(nèi)分析結(jié)果(P=, α≤)，對(duì)周圍性面癱患者不同病程狀態(tài)下（面癱早期組、后期組及治愈組）的腦區(qū)局部一致性（ReHo）進(jìn)行分析； （2） 選取健康志愿者32人，在靜息狀態(tài)下進(jìn)行BoldfMRI檢查；掃描參數(shù)與周圍性面癱患者相同；實(shí)驗(yàn)數(shù)據(jù)采用AFNI軟件分析處理，采用局部一致性(ReHo)方法分析靜息狀態(tài)下的BoldfMRI數(shù)據(jù)，采用單樣本t檢驗(yàn)組內(nèi)分析及Monte Carlo模擬閾值校正方法得出組內(nèi)分析結(jié)果(P=, α≤)，對(duì)健康對(duì)照者腦區(qū)局部一致性（ReHo）進(jìn)行分析。（3） 周圍性面癱患者臨床針刺治療不同病程狀態(tài)（面癱早期組、后期組及治愈組）與健康對(duì)照者之間的全腦局部一致性（ReHo）進(jìn)行對(duì)比研究，采用兩樣本t檢驗(yàn)進(jìn)行組間分析及Monte Carlo模擬閾值校正方法確定ReHo存在顯著性差異的腦區(qū)，得出組間分析結(jié)果(P=, α≤)，探究靜息態(tài)下周圍性面癱患者臨床針刺治療不同病程狀態(tài)下腦區(qū)局部一致性（ReHo）的變化。結(jié)果（1） 靜息態(tài)fMRI數(shù)據(jù)的組內(nèi)分析（p=，α≤）結(jié)果顯示面癱早期組、后期組及治愈組局部一致性（ReHo）增強(qiáng)的腦區(qū)廣泛，與健康對(duì)照組相似，且主要位于后扣帶回及相鄰的楔前葉和前額葉，與靜息狀態(tài)默認(rèn)模式網(wǎng)絡(luò)（DMN）一致。（2） 組間對(duì)比分析（p，α≤）得出周圍性面癱臨床針刺治療不同病程狀態(tài)（面癱早期組、后期組及治愈組）與健康對(duì)照組的分析結(jié)果，組間分析經(jīng)過Monte Carlo多重比較閾值校正（p=，α≤）顯示有顯著性差異，表現(xiàn)為：1) 面癱早期組比健康對(duì)照組Reho增高的腦區(qū)：右側(cè)額上回、右側(cè)額中回、右側(cè)額下回、右側(cè)前扣帶回、左側(cè)楔前葉、左側(cè)后扣帶回、左側(cè)顳上回 ；面癱早期組比健康對(duì)照組Reho降低的腦區(qū)：右側(cè)顳下回。2) 面癱后期組比健康對(duì)照組Reho增強(qiáng)的腦區(qū)：左側(cè)SII、左側(cè)顳上回、左側(cè)額上回、左側(cè)中央旁小葉、左側(cè)楔葉、左側(cè)楔前葉、左側(cè)后扣帶回、右側(cè)額下回；面癱后期組比健康對(duì)照組Reho降低的腦區(qū)：無。3) 面癱治愈組比健康對(duì)照組Reho增強(qiáng)的腦區(qū)：左側(cè)楔前葉、左側(cè)梭狀回、左側(cè)鉤回；面癱治愈組比健康對(duì)照組Reho降低的腦區(qū)：無。結(jié)論（1） 面癱早期組ReHo增高的區(qū)域分布在左右大腦半球，但到了面癱后期組，ReHo增高的區(qū)域分布集中在左側(cè)大腦半球，治愈組的ReHo異常區(qū)域減少，但仍然分布在左側(cè)大腦半球，治療前后存在著一個(gè)動(dòng)態(tài)的變化過程，提示了左側(cè)大腦半球的代償作用；（2） 周圍性面癱患者臨床針刺治療不同病程狀態(tài)（面癱早期組、后期組及治愈組）腦區(qū)的ReHo明顯增高，與健康志愿者相比有顯著差異，且多位于運(yùn)動(dòng)前區(qū)（額上回、額中回）、輔助運(yùn)動(dòng)區(qū)（中央旁小葉），默認(rèn)模式網(wǎng)絡(luò)（楔前葉、PCC）、ACC、SII、楔葉及顳上回，僅在面癱早期組右側(cè)顳下回ReHo減低，治愈組與健康志愿者有顯著差異的腦區(qū)明顯減少；（3） 大腦皮層運(yùn)動(dòng)前區(qū)（PMA）、輔助運(yùn)動(dòng)區(qū)(SMA)很可能是周圍性面癱患者靜息狀態(tài)下腦功能重組及代償?shù)年P(guān)鍵區(qū)域,也是針刺治療周圍性面癱患者重要的調(diào)制和關(guān)鍵代償區(qū)域。（4） 靜息狀態(tài)下周圍性面癱患者腦區(qū)也同樣存在默認(rèn)模式網(wǎng)絡(luò)（DMN），并存在異常，針刺誘導(dǎo)默認(rèn)模式網(wǎng)絡(luò)發(fā)生改變，可能也是針刺治療周圍性面癱的內(nèi)在機(jī)制之一；（5） 周圍性面癱患者針刺治療可能是通過同側(cè)大腦半球的代償、運(yùn)動(dòng)前區(qū)及輔助運(yùn)動(dòng)區(qū)的激活，以及其它腦區(qū)神經(jīng)元的活動(dòng)來協(xié)同整合完成的。關(guān)鍵詞 周圍性面癱；功能性磁共振成像，局部一致性；針刺；腦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 paralysis.Methods:(1) According to the course of the disease(durationdata, DD) and HouseBrackmann paralysis grading for facial paralysis, the study performed on 47 righthanded left side peripheral facial paralysis, whom were divided into the early group, the later group and the recovered group(part of 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 GREEPI sequence (TR/TE/FA=3000ms/30ms/90176。, SL , spacing , FOV 192mm x 192mm, resolution 64 x 64). Images were processed using the AFNI software program and themethod of ReHo was used to analyze theBoldfMRI datain the resting state. One sample ttest group analysis and threshold correction with Monte Carlo simulation for the results of the group analysis. The level of significance was thresholded at P and α≤. The ReHo map ofperipheral facial paralysis patients in the different pathological stages was analyzed.(2) The study was performed on 32 righthanded healthy adult volunteers. The functional data were acquired in the resting state. Thescanningparameters were the same as the patients withperipheral facial paralysis. Images were processed using the AFNI software program and themethod of ReHo was used to analyze theBoldfMRI datain the resting state. One sample ttest group analysis and threshold correction with Monte Carlo simulation for the results of the group analysis. The level of significance was thresholded at P and α≤. The ReHo map of the normal group was analyzed.(3) To pare the difference of ReHo between healthy adult volunteers and leftperipheral facial paralysis in the different pathological stages (the early group, the later group and the recovered group) before and after acupuncture treatment, two sample ttest group analysis for the different brain areas and threshold correction with Monte Carlo simulation. The level of significance was thresholded at P and α≤ for the grouppared analysis. The change of the 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 increased 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 pared leftperipheral facial paralysis in the different pathological stages (the early group, the later group and the recovered group) with the normal group, it had remarkable difference after threshold correction with Monte Carlo simulation（p=, α≤）. List as follows:1) Group parison between the early grou