重复经颅磁刺激与帕金森病的局部一致性的研究(硕士)

重复经颅磁刺激与帕金森病的局部一致性的研究(硕士)(论文13000字)
中文摘要
目的: 帕金森病是中老年人中较常见的神经系统退行性疾病，在中国有较高的发病率和致残率。目前以药物治疗为主，但药物及手术治疗均有一定的局限性。本研究旨在探讨rTMS治疗前后帕金森病患者的脑功能区内ReHo值的改变及其可能的病理生理机制；研究高频rTMS治疗帕金森病运动障碍的疗效。
方法：根据纳入及排除标准，收集原发性PD患者17例，其中强直-少动型11例。在rTMS治疗前后完成fMRI扫描，UPDRS评分和MMSE评分。然后在Matlab2016a平台上用DPARSFD进行ReHo值的预处理，用SPSS 22处理相关数据结果。
结果: ①rTMS治疗前后患者的UPDRS II/III以及运动相关总分下降，且差异存在统计学意义，在强直-少动型PD亚组中结果一致，而MMSE评分未见明显变化；②相比治疗前，PD患者在rTMS治疗后左侧扣带回旁旁区、右侧颞上回后区、右侧距状裂皮质以及左侧小脑的ReHo值增高；而右侧扣带回旁、右侧扣带回前区及后区和左侧扣带回后区皮层的ReHo值降低。
结论:本研究发现，帕金森病患者经过高频的rTMS治疗后运动症状有明显的改善，强直-少动型亚型的症状也有明显改善。相比治疗前，患者脑区内ReHo的差异可能提示高频的rTMS治疗方案可能激活了PD的视空间功能和左侧扣带回旁区，在运动传导通路中产生了可能产生了兴奋作用，而在DMN中可能产生相关的抑制作用。具体机制可能与视觉传导通路，皮质-小脑回路以及皮层下纹状体－小脑回路等存在相关性。
关键词:帕金森病 局部一致性 重复经颅磁刺激 静息态功能核磁共振 运动皮层

Abstract
Objective: Parkinson's disease is a degenerative disease of the central nervous system,which is common in the middle-aged and elderly people.It has a high rate of morbidity and disability in China.Medicine is the most important way to relieve symptoms,while both drug and surgery have limitations.Our aim is to obtain the difference of ReHo value, before and after rTMS treatment.Then we will analyze the related causes and detect the possible pathophysiological mechanisms;We also aim to verify of the efficacy of high frequency rTMS for movement disorder in patients.
METHODS: According to the inclusion and exclusion criteria,Seventeen patients diagnosed with PD participated in the study. We complete an rs-fMRI before and after rTMS, as well as the UPDRS scores and MMSE scores in patients. Then Matlab2016a, DPARSFD, and SPSS 22 were used to obtain the final data and images.
Results: The UPDRS II/III and motor-related total scores were decreased after 5Hz rTMS treatment, the difference was statistically significant,as well as in the  Akinetic-rigid’s group. There was an opposite result in the MMSE score. Compared to the data obtained before rTMS, we found that there is an increased ReHo in the paracingulate gyrus(L),posterior division of the right superior temporal gyrus(R),left cerebellar and the right intracalcarine cortex. There is a decrease in ReHo value in the right paracingulate gyrus, right anterior division of cingulate gyrus, right posterior division of cingulate gyrus, and left posterior division of the cingulate gyrus.
Conclusion:We found that high-frequency rTMS may significantly improve motor behavior in PD patients and the Akinetic-rigid’s group. Compared to ReHo results without rTMS, we saw a difference in the patient's different brain areas,which implies rTMS may promote the visual pathway,the left paracingulate gyrus and the motor conduction pathway,as well as inhibiting the DMN.The main mechanism might be the change in the visual pathway, cortico-cerebellar circuit, and subcortical striatum-cerebellar circuit.
Keywords:Parkinson’s disease;Regional homogeneity;repetitive Transcranial Magnetic Stimulation,resting-state functional magnetic resonance imaging,motor cortex.

目录
致谢    Ⅰ
中文摘要    Ⅱ
Abstract    Ⅲ
目次
1 引言    1
1.1 帕金森病概述    1
1.2 静息态功能核磁共振    2
1.3 rTMS治疗原理及在 PD方面的应用    3
1.3.1 rTMS概述    3
1.3.2 rTMS分类    3
1.3.3 rTMS治疗运动障碍的基本原理    4
1.3.4 rTMS治疗PD运动症状的研究进展    5
2.实验部分    6
2.1 研究对象    6
2.2 研究设备    6
2.3 研究方法及过程    6
3．结果    8
3.1 UPDRS评分结果    8
3.2 亚组结果    9
3.3 ReHo值改变    10
3.4 MMSE评分结果    11
4.讨论    11
4.1 rTMS治疗PD运动症状结果分析    11
4.2 局部一致性分析    12
5 结论    14
参考文献    16