CAJ | 학술논문

目的应用基于体素形态测量学(VBM)技术检测脑瘫患儿粗大运动功能相关的脑灰质结构,探讨脑瘫相关脑机制.方法回顾性分析2012年10月至2013年12月于安徽医科大学第一附属医院就诊的40例脑瘫患儿资料.其中男26例、女14例,平均年龄(3.6±2.0)岁,对其进行粗大运动功能分级(GMFCS)和全脑3D结构像扫描.利用VBM 5对全脑容积进行分割,获得脑灰质、脑白质、脑脊液容积.在Matalab 7.1环境下运行SPM 5,采用相关分析法分析GMFCS与全脑灰质容积相关性.结果 GMFCS与灰质容积成显著正相关性的脑区主要有左颞中回(Z=3.57)及颞下回(Z=3.40)、右侧丘脑及豆状苍白球(Z=3.36)、左侧丘脑及豆状苍白球(Z=2.76)、左缘上回(Z=3.14)、左楔前叶(Z=3.00)、右背外侧额上回(Z=3.08)、右枕上回及枕中回(Z=2.84)(P均＜0.005);成负相关性脑区主要有左眶部额中回及前扣带回(Z =3.28、3.02)、左内侧额上回(Z=3.19)、左尾状核(Z=3.04、2.94、2.92)、左侧小脑(Z=2.94)、右侧小脑(Z=2.97)、左侧海马旁回(Z=3.94)、右侧海马旁回(Z=3.43、3.00)、左侧岛叶(Z=3.50)、右侧岛叶(Z=3.41、3.80)、左侧舌回(Z=3.37)、右侧舌回(Z=3.30)、左后扣带回(Z=2.73)、左枕中回(Z=2.92)及右颞中回(Z=3.05)(P均＜0.005).结论基于VBM研究发现脑瘫患儿GMFCS与运动、情绪、记忆和默认网络脑灰质结构异常有关.
목적 응용기우체소형태측량학(VBM)기술검측뇌탄환인조대운동공능상관적뇌회질결구,탐토뇌탄상관뇌궤제.방법 회고성분석2012년10월지2013년12월우안휘의과대학제일부속의원취진적40례뇌탄환인자료.기중남26례、녀14례,평균년령(3.6±2.0)세,대기진행조대운동공능분급(GMFCS)화전뇌3D결구상소묘.이용VBM 5대전뇌용적진행분할,획득뇌회질、뇌백질、뇌척액용적.재Matalab 7.1배경하운행SPM 5,채용상관분석법분석GMFCS여전뇌회질용적상관성.결과 GMFCS여회질용적성현저정상관성적뇌구주요유좌섭중회(Z=3.57)급섭하회(Z=3.40)、우측구뇌급두상창백구(Z=3.36)、좌측구뇌급두상창백구(Z=2.76)、좌연상회(Z=3.14)、좌설전협(Z=3.00)、우배외측액상회(Z=3.08)、우침상회급침중회(Z=2.84)(P균＜0.005);성부상관성뇌구주요유좌광부액중회급전구대회(Z =3.28、3.02)、좌내측액상회(Z=3.19)、좌미상핵(Z=3.04、2.94、2.92)、좌측소뇌(Z=2.94)、우측소뇌(Z=2.97)、좌측해마방회(Z=3.94)、우측해마방회(Z=3.43、3.00)、좌측도협(Z=3.50)、우측도협(Z=3.41、3.80)、좌측설회(Z=3.37)、우측설회(Z=3.30)、좌후구대회(Z=2.73)、좌침중회(Z=2.92)급우섭중회(Z=3.05)(P균＜0.005).결론 기우VBM연구발현뇌탄환인GMFCS여운동、정서、기억화묵인망락뇌회질결구이상유관.
Objective To measure gray matter volume of whole brain with voxel-based morphometry (VBM) method and to study brain structures associated with gross motor function.Method Forty children with cerebral palsy were recruited in the authors' hospital from Oct.2012 to Dec.2013 (26 male,14 female cases,average age (3.6 ± 2.0) years).Gross motor function classification system (GMFCS) for children was used to obtain their motor function.The whole-brain three dimensional magnetic resonance imaging (MRI) was performed on a 3.0 T MRI scanner.The data were segmented by VBM 5,and the whole brain volumes of gray matter,white matter and cerebospinal fluid were produced.Correlation analysis was used to analyze the correlation of GMFCS with whole brain volumes using SPM 5 in Matalab 7.1.Result The volume in left meditemporal gyrus (Z =3.57) and inferior temporal gyrus (Z =3.40),right thalamus and pallidum (Z =3.36),left thalamus and pallidum (Z =2.76),left supramarginal gyrus (Z =3.14),left precuneus gyrus (Z =3.00),right dorsolateral superior frontal gyrus (Z =3.08),right superior and medial occipital gyrus (Z =2.84) significantly increased as aggravation of gross motor dysfunction.The volume of the left medial orbitofrontal lobe and anterior cingulate (Z =3.28,3.02),left medial superior frontal gyrus (Z =3.19),left caudate (Z =3.04,2.94,2.92),left cerebellum (Z =2.94),right cerebellum (Z =2.97),left parahippocampal (Z =3.94),right parahippocampal (Z =3.43,3.00),left insula (Z =3.50),right insula (Z =3.41,3.80),left lingual (Z =3.37),right lingual (Z =3.30),left post cingulum (Z =2.73),left midioccipital gyrus (Z =2.92) and right miditemporal gyrus (Z =3.05) significantly reduced as the aggravation of gross motor dysfunction (P all ＜ 0.005).Conclusion GMFCS in children with cerebral palsy is related to abnormalities of brain gray matter structure for motor,emotion,memory and default model network when examined with VBM method.