I重复经颅磁刺激与帕金森病的局部一致性的研究中文摘要目的: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SPSS22处理相关数据结果。结果:①rTMS治疗前后患者的UPDRSII/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IIAbstractObjective:Parkinson'sdiseaseisadegenerativediseaseofthecentralnervoussystem,whichiscommoninthemiddle-agedandelderlypeople.IthasahighrateofmorbidityanddisabilityinChina.Medicineisthemostimportantwaytorelievesymptoms,whilebothdrugandsurgeryhavelimitations.OuraimistoobtainthedifferenceofReHovalue,beforeandafterrTMStreatment.Thenwewillanalyzetherelatedcausesanddetectthepossiblepathophysiologicalmechanisms;WealsoaimtoverifyoftheefficacyofhighfrequencyrTMSformovementdisorderinpatients.METHODS:Accordingtotheinclusionandexclusioncriteria,SeventeenpatientsdiagnosedwithPDparticipatedinthestudy.Wecompleteanrs-fMRIbeforeandafterrTMS,aswellastheUPDRSscoresandMMSEscoresinpatients.ThenMatlab2016a,DPARSFD,andSPSS22wereusedtoobtainthefinaldataandimages.Results:TheUPDRSII/IIIandmotor-relatedtotalscoresweredecreasedafter5HzrTMStreatment,thedifferencewasstatisticallysignificant,aswellasintheAkinetic-rigid’sgroup.TherewasanoppositeresultintheMMSEscore.ComparedtothedataobtainedbeforerTMS,wefoundthatthereisanincreasedReHointheparacingulategyrus(L),posteriordivisionoftherightsuperiortemporalgyrus(R),leftcerebellarandtherightintracalcarinecortex.ThereisadecreaseinReHovalueintherightparacingulategyrus,rightanteriordivisionofcingulategyrus,rightposteriordivisionofcingulategyrus,andleftposteriordivisionofthecingulategyrus.Conclusion:Wefoundthathigh-frequencyrTMSmaysignificantlyimprovemotorbehaviorinPDpatientsandtheAkinetic-rigid’sgroup.ComparedtoReHoresultswithoutrTMS,wesawadifferenceinthepatient'sdifferentbrainareas,whichimpliesrTMSmaypromotethevisualpathway,theleftparacingulategyrusandthemotorIIIconductionpathway,aswellasinhibitingtheDMN.Themainmechanismmightbethechangeinthevisualpathway,cortico-cerebellarcircuit,andsubcorticalstriatum-cerebellarcircuit.Keywords:Parkinson’sdisease;Regionalhomogeneity;repetitiveTranscranialMagneticStimulation,resting-statefunctionalmagneticresonanceimaging,motorcortex.目录致谢...............................................................Ⅰ中文摘要...........................................................ⅡAbstract..............
