弥散张量成像在痉挛型脑性瘫痪中的应用

目的：通过头颅磁共振弥散张量成像技术（DTI）并结合脑性瘫痪（CP）患儿粗大运动评估（GMFM）的测定来探讨其对脑瘫患儿运动功能转归的应用价值。方法选取痉挛型脑瘫患儿65例作为研究组,正常儿童16例作为对照组,应用GMFM评价患儿粗大运动功能。对受试儿童进行DTI检查,测量各组患儿主要白质纤维束部分各向异性（ FA）。结果各个部位的FA值与GMFM-88值存在正相关性,均存在统计学意义,其中内囊后肢相关性明显（r＝0．455）。结论粗大运动功能障碍与脑内广泛白质纤维束损伤有关,以内囊后肢部位最明显。 FA值的高低一定程度上反映运动功能的发育情况,DTI在评价痉挛性脑瘫运动功能方面有较高的应用价值。     

轻度认知功能障碍患者后扣带回的磁共振扩散张量成像研究

目的 应用磁共振DTI分析轻度认知功能障碍（MCI）患者后扣带回脑白质各向异性分数（FA）值的变化,探讨DTI对轻度认知障碍的诊断价值.方法 选择观察组MCI患者与对照组健康志愿者各18例,应用GE Signa Excite 1.5 T 核磁共振系统进行头颅DTI检查,分别测量2组后扣带回、海马旁回及内囊后肢脑白质的FA值,比较2组测量结果.结果 观察组双侧后扣带回脑白质FA值显著低于对照组,差异有统计学意义（P〈0.05）;2组海马旁回、内囊后肢及胼胝体膝部FA值比较差异无统计学意义（P〉0.05）.结论 DTI作为早期诊断MCI的无创性检查手段,对早期干预及提高患者生存质量具有重要意义.     

认知量表联合颅脑磁共振对维持性透析患者认知功能的评价

目的 探讨简易精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）联合颅脑磁共振（MRI）弥散加权成像（DWI）/扩散张量成像（DTI）对透析患者认知功能的评估价值。方法 选择2015年5月至2016年5月于安徽医科大学第二附属医院肾内科进行透析的患者65例,采用MMSE和MoCA评估患者认知功能,MRI扫描脑白质区并计算表观弥散系数（ADC）和部分异向性（FA）量化值;根据MoCA结果分为认知正常组（38例）和认知障碍组（27例）,比较两组患者量表评分、ADC值及FA值的差异性。结果 MoCA检出率高于MMSE,差异有统计学意义（χ²=17.725,P=0.001）,且MMSE和MoCA总分呈正相关（r=0.660,P=0.001）。认知障碍组患者MMSE评分的定向力、记忆力、注意力、语言和总分低于认知正常组,而MoCA评分的执行力、注意力、语言、延迟回忆、定向力和总分均低于认知正常组,差异有统计学意义（P<0.05）;额叶和顶叶ADC值高于正常组,额叶、顶叶、胼胝体及侧脑室FA值低于正常组,差异有统计学意义（P<0.05）。结论 多认知量表联合评估可提高透析患者认知障碍的检出率;且存在认知障碍的透析患者主要表现为执行力、定向力、注意力、语言和记忆力的下降,和大脑额叶、顶叶、胼胝体和侧脑室白质的损伤相对应。     

DTI在早产儿脑白质损伤中的应用

目的 探讨扩散张量成像(DTI)在早产儿脑白质损伤中的应用价值.方法 97例早产儿分为脑白质损伤组(48例)和无脑白质损伤组(49例).按胎龄分为早期(28～31周)早产儿22例、中期(32～34周)早产儿35例和晚期(35～36周)早产儿40例;在纠正胎龄36～38周时进行磁共振DTI检查,分析各向异性分数(FA)和表观弥散系数(ADC)的差异.结果 DTI图像显示,无脑白质损伤组双侧大脑半球、小脑和侧脑室等均未见异常.脑白质损伤组DTI图像发现,脑白质软化灶2例,缺氧缺血性脑病2例,蛛网膜下腔出血4例,硬脑膜下出血2例,额叶出血2例,脑出血17例,其他类型的脑损伤19例.脑白质损伤组早期、中期和晚期早产儿胼胝体膝部、胼胝体压部、内囊后肢、内囊前肢和丘脑的FA值均小于无脑白质损伤组(P＜0.05),而两组ADC值比较无统计学差异(P＞0.05).早期早产儿内囊前肢、左侧内囊后肢、胼胝体压部和右侧丘脑FA值低于晚期早产儿,右侧内囊前肢、胼胝体压部和丘脑FA值低于中期早产儿(P＜0.05).早期早产儿内囊后肢和胼胝体压部ADC值高于中期早产儿和晚期早产儿,早期早产儿和中期早产儿胼胝体膝部ADC值高于晚期早产儿(P＜0.05).结论 DTI能够识别早产儿脑白质损伤.     

磁共振弥散张量成像评估早期创伤性轴索损伤的价值

目的探讨磁共振弥散张量成像(DTI)对早期创伤性脑损伤(TBI)患者轴索损伤的临床应用价值。方法对21例TBI早期(伤后10d内)患者(TBI组)及10例正常志愿者(对照组)行DTI检查,分别测量两侧大脑半球6个感兴趣区(胼胝体膝部、胼胝体压部、内囊前肢、内囊后肢、外囊及背侧丘脑)的部分各向异性(FA)值,并构建上述部位三维弥散张量纤维束成像(3D-DTT)图。比较以上两组感兴趣区平均FA值的差异,并对TBI组的FA值与临床GCS评分进行相关性分析。结果 FA图像上可以清楚观察到呈高信号的脑白质纤维束,损伤局部呈低信号。TBI组平均FA值为0.562±0.042,明显低于对照组的0.609±0.045(P<0.01)。TBI患者FA值与GCS评分呈正相关(r=0.508,P<0.05)。3D-DTT图可以直观显示胼胝体、内外囊等白质纤维束的损伤情况。结论 FA值的变化反应了TBI患者脑白质纤维束水分子各向异性程度的变化,对评估伤情及判断预后有重要意义。     

磁刺激神经调控治疗运动发育迟缓患儿增强核心肌群力量的临床疗效分析

目的 分析磁刺激神经调控治疗在运动发育迟缓患儿增强核心肌群力量中应用的临床疗效。方法 选择2017年3月至2018年6月在徐州医科大学附属儿童医院接受康复治疗的65例运动发育迟缓患儿作为研究对象,按照入院先后顺序对所有患儿进行编号,将前34例患儿作为观察组,其余31例患儿作为对照组。对照组患儿接受传统康复治疗,观察组患儿在传统康复治疗的基础上接受磁刺激神经调控治疗。比较两组患儿治疗3个月后治疗总有效率、肌肉自主运动情况、粗大运动功能评估量表（GMFM-88评分）变化、Gesell发育量表变化。并比较两组患儿治疗后6个月10 m步行测试（10MWT）和阶梯试验（TST）测试结果的差异。结果 观察组患者治疗总有效率高于对照组,差异有统计学意义（88.24%vs 64.52%,P<0.05）。治疗前,两组患儿GMFM各区评分和Gesell发育诊断量表评分比较,差异无统计学意义（P>0.05）。两组患儿的GMFM各区评分以及各项Gesell评分随治疗时间逐渐升高,观察组患者的上升幅度明显大于对照组,差异有统计学意义（P<0.05）。观察组患儿在治疗前后的10m步行时间、10m步数以及上下阶梯时间减少水平明显高于对照组,差异有统计学意义（P<0.05）。结论 磁刺激神经调控治疗能够显著增强运动发育迟缓患儿的核心肌群力量,使其粗大运动功能得到显著提升,在运动发育迟缓患儿康复治疗中能够发挥积极作用。     

2种加温方式预防婴儿先天性巨结肠手术中低体温的效果比较

目的 探讨2种加温方式预防先天性巨结肠症（HD）患儿术中低体温的效果。方法 选取2016年11月至2019年12月在安徽省儿童医院行Soave术患儿50例,根据数字的奇偶性随机分为电阻升温毯组（R组,n=26）与充气加温毯组（F组,n=24）。结果 两组患儿体温存在组别效应（P<0.05）,麻醉诱导后第30分钟体温开始下降,不同时间点体温变化差异有统计学意义（P<0.05）,但这种体温体温随着时间的改变因分组而不同（P<0.05）。两组患儿不同时间点MAP、HR变化差异具有统计学意义（P<0.05）。F组患儿手术结束到自主呼吸恢复时间、气管导管拔出时间及苏醒室复苏时间均短于R组,差异有统计学意义（P<0.05）。结论 在Soave术中使用充气加温毯,能有效维持HD患儿术中体核温度的稳定。     

纳洛酮联合促红细胞生成素注射液治疗新生儿缺氧缺血性脑病的效果观察

目的 探讨纳洛酮联合促红细胞生成素（erythropoietin,EPO）注射液治疗新生儿缺氧缺血性脑病（hypoxic-ischemicencephalopathy,HIE）的临床效果。方法 选取2014年9月~2017年9月青海红十字医院新生儿科门诊收治的216例HIE患儿作为研究对象,随机分为观察组和对照组,各108例。观察组采用纳洛酮联合EPO注射液治疗,对照组采用纳洛酮治疗。比较2组患儿临床疗效、临床症状改善时间、贝利婴幼儿发展量表评分、Gesell量表评分、血细胞计数、血清神经功能指标、血清细胞因子及后遗症发生情况。结果 观察组总有效率（95.4%）显著高于对照组（85.2%）（P<0.05）,且观察组中度有效率和重度有效率均显著高于对照组（P<0.05）。观察组意识恢复时间、原始反射恢复时间及肌张力恢复时间显著短于对照组（P<0.05）。2组患儿治疗后1周新生儿行为神经测定（neonatal behavioral neurological assessment,NBNA）评分无统计学差异,观察组患儿治疗后2周NBNA评分显著高于对照组（P<0.05）。观察组患儿3月龄、6月龄神经发育指数和心理运动发育指数评分均显著高于对照组（P<0.05）。观察组Gesell量表大运动能区、精细运动能区、语言能区、个人社区能区、社会适应能区发育商分值均显著高于对照组（P<0.05）。治疗后,观察组血红蛋白、网织红细胞计数、血小板计数水平显著高于对照组（P<0.05）。观察组血清神经元特异性烯醇化酶、髓鞘碱性蛋白、S100钙结合蛋白水平显著低于对照组（P<0.05）。观察组血清tau、内源性激活素A、TNF-α水平显著低于对照组（P<0.05）。2组患儿后遗症发生率无统计学差异。结论 纳洛酮联合EPO注射液治疗HIE的疗效显著,可有效改善患儿的神经系统功能,减少后遗症的发生率。     

抗链球菌溶血素O阳性为小儿过敏性紫癜复发的危险因素

目的 明确抗链球菌溶血素O阳性是否为小儿过敏性紫癜复发率的危险因素，以期为预防其复发提供临床指导依据。方法 选择2014年1月-2015年12月绵阳市中医医院收治的过敏性紫癜患儿136例，回顾性分析其临床资料，根据患儿出院后12个月内是否复发，将患儿分为复发组（n=48）和未复发组（n=88），统计两组患儿入院时抗链球菌溶血素O的阳性率，采用多因素logistics回归分析探讨过敏性紫癜患儿复发的危险因素。结果 复发组患儿抗链球菌溶血素O的阳性率显著高于未复发组，差异有统计学意义（66.67% vs 32.95%，P=0.000）。多因素logistics回归分析显示消化道出血、关节炎和抗链球菌溶血素O阳性均为过敏性紫癜患儿复发的危险因素（P<0.05）。对于抗链球菌溶血素O阳性的患儿，未接受抗链球菌治疗者的复发率显著高于接受抗链球菌治疗的患儿（44.00% vs 23.26%，P=0.036）。结论 抗链球菌溶血素O阳性为过敏性紫癜患儿复发的危险因素，通过加强对抗链球菌溶血素O阳性患儿的抗链球菌治疗可降低其复发率。     

弥散张量成像对早期肌萎缩侧索硬化症上运动神经元损害的诊断意义

目的:探讨弥散张量成像(DTI)在发现早期肌萎缩侧索硬化症(ALS)上运动神经元损害中的临床意义.方法:21例ALS患者在行DTI检查时,8例无明显上运动神经元(UMN)受累体征,但在病程后期均出现了临床锥体束征的ALS患者作为A组,13例有明确UMN损害体征的ALS患者作为B组,20例健康人作为对照组.对所有研究对象行轴位DTI扫描,选取感兴趣区(ROI)测量部分各向异性分数(FA)和平均弥散系数(MD).结果:与对照组比较,A组内囊后肢(u=3.974,P<0.01)、大脑脚(u=3.580,P<0.01)、延髓锥体(u=2.402,P<0.05)处的FA值明显减低,内囊后肢(u=2.168,P<0.05)处的MD值增高,A、B 2组间该3个ROI处的FA、MD值差异无统计学意义.结论:DTI可发现ALS早期UMN损害,有助于ALS的早期诊断.     

Cigarette smoking and white matter microstructure

Rationale  

Diffusion tensor imaging has been used before in testing associations between cigarette smoking and white matter integrity, with inconsistent results. Published reports indicate higher fractional anisotropy (FA, a measure of linear water diffusion) in some brain regions and lower FA in others in adult smokers compared to nonsmokers. Adolescent smokers exhibited elevated FA at several brain regions and a positive correlation of FA in the genu corpus callosum with exposure to smoking (pack-years).     

Greater Than Age-Related Changes in Brain Diffusion of HIV Patients After 1 Year

Chronic infection with HIV is associated with neuroinflammation. Prior diffusion tensor imaging (DTI) studies demonstrated increased mean diffusion (MD) and decreased fractional anisotropy (FA) in the white matter (WM) and subcortical brain regions of HIV patients. The current study aims to detect whether there are greater than age-related brain changes in HIV patients after a 1-year follow-up period using DTI. Thirty-nine antiretroviral-stable HIV subjects and 32 HIV-seronegative (SN) controls were evaluated, with neuropsychological tests and DTI, at baseline and after 1 year. MD and FA in the genu and splenium of the corpus callosum and in six other subcortical and white matter regions were evaluated bilaterally. Compared to SN controls, HIV subjects had significantly higher MD in the frontal WM (p = 0.0104) and lower FA in the parietal WM (p = 0.006). After 1 year, HIV subjects showed increase in MD in frontal and parietal WM, putamen, and genu; HIV subjects also showed greater increased genu diffusion than SN controls (p = 0.005). Changes in global cognitive deficit score correlated with changes in MD in the genu and FA in the parietal and frontal WM and putamen (multiple regression, p = 0.0008). Lastly, normal age-dependent changes in frontal WM diffusion and FA in genu and putamen were not observed in HIV subjects. Since increased MD may reflect increased neuroinflammation, our findings suggest greater than normal age-related inflammatory changes in the genu of these HIV patients, which may contribute to the cognitive deficits. Measurements of MD in the genu may be useful for monitoring disease progression in HIV brain infection.     

Reduced anterior corpus callosum white matter integrity is related to increased impulsivity and reduced discriminability in cocaine-dependent subjects: diffusion tensor imaging.

Brain imaging studies find evidence of prefrontal cortical dysfunction in cocaine-dependent subjects. Similarly, cocaine-dependent subjects have problems with behaviors related to executive function and impulsivity. Since prefrontal cortical axonal tracts cross between hemispheres in the corpus callosum, it is possible that white matter integrity in the corpus callosum could also be diminished in cocaine-dependent subjects. The purpose of this study was to compare corpus callosum white matter integrity as measured by the fractional anisotropy (FA) on diffusion tensor imaging (DTI) between 18 cocaine-dependent subjects and 18 healthy controls. The Barratt Impulsiveness Scale (BIS-11) and a continuous performance test: the Immediate and Delayed Memory Task (IMT/DMT) were also collected. Results of the DTI showed significantly reduced FA in the genu and rostral body of the anterior corpus callosum in cocaine-dependent subjects compared to controls. Cocaine-dependent subjects also had significantly higher BIS-11 scores, greater impulsive (commission) errors, and reduced ability to discriminate target from catch stimuli (discriminability) on the IMT/DMT. Within cocaine dependent subjects there was a significant negative correlation between FA in the anterior corpus callosum and behavioral laboratory measured impulsivity, and there was a positive correlation between FA and discriminability. The finding that reduced integrity of anterior corpus callosum white matter in cocaine users is related to impaired impulse control and reduced ability to discriminate between target and catch stimuli is consistent with prior theories regarding frontal cortical involvement in impaired inhibitory control in cocaine-dependent subjects.     

针刺、推拿联合康复训练对痉挛型脑性瘫痪患儿临床症状及下肢功能的影响

目的 研究针刺、推拿联合康复训练对痉挛型脑性瘫痪患儿临床症状及下肢功能的影响.方法 选择2011年5月至2014年5月来本院就诊的90例痉挛型脑性瘫痪患儿作为研究对象,随机分为两组,对照组给予康复训练治疗,实验组给予针刺、推拿联合康复训练治疗.治疗3个月后,采用改良Ash-worth量表和粗大运动功能评定量表(GMFM-88)评估量表评价两种治疗方案对痉挛型脑性瘫痪患儿临床症状和下肢功能的影响.结果 治疗后实验组总有效率为84.44％,显著高于对照组的62.22％,差异具有统计学意义(P＜0.05).实验组GMFM-88总百分比为(68.94±4.75)％,显著高于对照组的(60.13±4.86)％,差异具有统计学意义(P＜0.05).结论 针刺、推拿联合康复训练可显著改善痉挛型脑性瘫痪患儿的临床症状,恢复患儿下肢功能,疗效显著,值得推广.     

基于网络的团体心理干预治疗对脑性瘫痪患儿母亲抑郁焦虑指数的影响

目的 探讨基于网络的团体心理干预治疗对脑性瘫痪（CP）患儿母亲的焦虑、抑郁状态的影响。方法 选择2013年5月至2013年12月在安徽医科大学第一附属医院、安徽省立儿童医院及亳州市第一人民医院接受治疗的134例CP患儿的母亲,随机分为治疗组（68例）和对照组（66例）。治疗组予以基于网络的团体心理干预治疗,而对照组仅予以一般心理支持治疗。在入组时、治疗3个月后,分别采用抑郁自评量表（SDS）、焦虑自评量表（SAS）对CP患儿母亲进行评定。结果 治疗组治疗后SDS与SAS总分显著低于治疗前,差异有统计学意义（P<0.05）,对照组治疗前后差异无统计学意义（P>0.05）。干预疗效与母亲年龄、母亲学历、患儿年龄、患儿性别及居住地无相关性（P>0.05）。结论 基于网络的团体心理干预治疗能够有效改善CP患儿母亲的抑郁、焦虑状态。     

The Paradoxical Relationship between White Matter,Psychopathology and Cognition in Schizophrenia: A Diffusion Tensor and Proton Spectroscopic Imaging Study

White matter disruption has been repeatedly documented in schizophrenia consistent with microstructural disorganization (reduced fractional anisotropy (FA)) and axonal dysfunction (reduced N-acetylaspartate NAAc). However, the clinical significance of these abnormalities is poorly understood. Diffusion tensor and proton spectroscopic imaging where used to assess FA, axial diffusivity and radial diffusivity (RD), and supra-ventricular white matter NAAc, respectively, in 64 schizophrenia and 64 healthy subjects. Schizophrenia patients had reduced FA across several regions, with additional regions where FA correlated positively with positive symptoms severity. These regions included genu, body and splenium of corpus callosum, anterior and superior corona radiata, superior longitudinal and inferior fronto-occipital fasciculi, and internal capsule. The FA/symptoms relationships corresponded with opposite correlations between RD and positive symptoms. The schizophrenia group (SP group) had progressively reduced NAAc with age, and NAAc correlated negatively with positive symptoms. Cognition correlated positively with both FA and NAAc in controls, whereas in the SP group it had a negative correlation with NAAc and no significant relationship with FA. Antipsychotic dose did not account for the results. Correlates of psychosis, cognitive and negative symptoms can be found in white matter. The significant correlations between positive symptoms in schizophrenia and diffusion and NAAc measures suggest decreased axonal density with increased glial cells and higher myelination in this subpopulation. A separate set of abnormal relationships between cognition and FA/RD, as well as with NAAc, converge to suggest that in schizophrenia, white matter microstructure supports the two core illness domains: psychosis and cognitive/negative symptoms.     

学龄脑瘫儿童康教结合对其粗大运动发育和生活能力的影响

目的探讨学龄脑性瘫痪（脑瘫）儿童康教结合对其粗大运动发育和生活能力的影响。方法将58例脑瘫患儿随机分为两组。实验组由康复医师、学校康复老师、学科教师组成小组进行训练;对照组由特殊学校康复老师、学科教师进行训练。在康复治疗前和治疗12个月后,分别采用粗大运动功能量表（GMFM-88）对D区、E区和日常生活活动能力（ADL）进行评估。结果实验组和对照组治疗后ADL评分显效率差异有统计学意义（P〈0．05）,两组治疗前后的GMFM-88评分显效率差异有统计学意义（P〈0．05）。结论学龄脑瘫儿童康教结合能有效提高脑瘫患儿的粗大运动功能和生活能力。     

Predicting White Matter Integrity from Multiple Common Genetic Variants

Several common genetic variants have recently been discovered that appear to influence white matter microstructure, as measured by diffusion tensor imaging (DTI). Each genetic variant explains only a small proportion of the variance in brain microstructure, so we set out to explore their combined effect on the white matter integrity of the corpus callosum. We measured six common candidate single-nucleotide polymorphisms (SNPs) in the COMT, NTRK1, BDNF, ErbB4, CLU, and HFE genes, and investigated their individual and aggregate effects on white matter structure in 395 healthy adult twins and siblings (age: 20–30 years). All subjects were scanned with 4-tesla 94-direction high angular resolution diffusion imaging. When combined using mixed-effects linear regression, a joint model based on five of the candidate SNPs (COMT, NTRK1, ErbB4, CLU, and HFE) explained ∼6% of the variance in the average fractional anisotropy (FA) of the corpus callosum. This predictive model had detectable effects on FA at 82% of the corpus callosum voxels, including the genu, body, and splenium. Predicting the brain''s fiber microstructure from genotypes may ultimately help in early risk assessment, and eventually, in personalized treatment for neuropsychiatric disorders in which brain integrity and connectivity are affected.     

贫困家庭脑瘫儿童参加政府救助项目治疗后的康复状况

目的 通过对100例贫困家庭脑瘫儿童参加湖南省政府救助项目,在湘雅博爱康复医院儿童康复中心治疗后,各项功能恢复状况的总结,探讨政府救助项目对改善贫困家庭脑瘫儿童未来生存状况的影响.方法 选取100例参加政府救助项目治疗的贫困家庭0～6岁脑瘫儿童,运用杨杰主任的治疗方法(1个理念、2个结合、4种形式)连续参加3期治疗,分别在治疗前后采用GMFM-88和脑瘫儿童综合功能评定表进行评估,分析治疗后的改善情况.结果 100例患儿治疗前后GMFM-88和脑瘫综合功能评定结果显示,92％的患儿进步明显.结论 政府连续性救助项目对改善贫困家庭脑瘫儿童生存状况效果明显,有显著的社会意义.