以靜息態功能性磁振造影探討頸動脈支架手術對於頸動脈狹窄病患大腦功能之影響

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姓名	陳維浩(Wei-Hao Chen) 查詢紙本館藏	畢業系所	生醫科學與工程學系
論文名稱	以靜息態功能性磁振造影探討頸動脈支架手術對於頸動脈狹窄病患大腦功能之影響 (Investigation into therapeutic effects of carotid artery stenting based on resting state brain connectivity)
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摘要(中)	頸動脈狹窄是造成腦部缺血引起中風的重要原因，據統計高達約有25-30%缺血性腦梗塞即肇因於頸動脈狹窄，且患者通常伴隨著認知功能下降之症狀。在接受頸動脈支架手術後，可恢復血液流量，但在認知功能上不一定有所回復，其原因推測可能與頸動脈狹窄患者的大腦部份網路其神經功能較正常值低落有關。為了確切了解其神經生理機制，本研究著重於以神經造影技術探討無症狀性頸動脈狹窄患者在頸動脈支架置放前後大腦網路的功能性連結與認知行為表現的關係。本研究共招募13位單側無症狀性頸動脈狹窄病患與17位對照組。於起始時評估一般認知能力，記憶和執行功能，並在執行頸動脈支架置放術前1週、1個月後和1年後三個時間點進行靜息態功能性磁振造影掃描，比較群組間五個功能性網路以及其與認知量表的關聯性。研究結果顯示：(1)術前和對照組相比，頸動脈狹窄患者的感覺運動皮質網路和警覺網路有顯著降低；(2)病患在術前健康側的功能性連結與對照組相比，有較強的功能性連結，推測可能源自側枝循環的過度補償效應；(3)頸動脈狹窄患者健康側的其過度連結程度愈高則對應到愈差的認知行為表現；(4)部份大腦網路的功能性連結即便在支架手術一年後仍較對照組為低，推測其為患者認知行為表現未在術後得以回復之原因。
摘要(英)	Asymptomatic carotid stenosis is one of the possible causes of stroke. Beyond its high risk for ischemic stroke, the cognitive functions are declining for patients with carotid artery stenosis. Carotid artery stent placement is one of the ways to treat carotid stenosis, which may be with the effect to alleviate patients’ cognitive decline. However, the mechanism of the cognitive recovery after stenting has yet been fully understood. We speculated that the sustained decline of cognitive performances associates with the functionality of brain networks. Therefore, this study aims to compare the brain function connectivity between patients with asymptomatic carotid stenosis and health control. A total of 13 patients with unilateral asymptomatic carotid stenosis and 17 healthy controls were included in this study between subjects and controls without significant differences in age and education. At the outset, general cognitive ability, memory and executive function were assessed and resting functional magnetic resonance imaging was performed 1 week, 1 month, and 1 year before performing carotid artery stent placement. Five brain function networks were analyzed, and functional connectivity between asymptomatic carotid stenosis and healthy controls was compared. Results were four folds: (1) Compared with the healthy control group, all of the functional connectivity networks we studied had significant changes in the sensory motor cortex network and the alertness network; (2) The functional connectivity after stenting had the trend of gradual recovery; (3) The patient′s functional connectivity at the preoperative health side had a higher level of connectivity strength than the healthy side in the control group; and (4) multiple brain connectivity in patients after stenting demonstrated the sustained reduced level even after 1 year follow-up, implying the originality of cognitive decline after stenting. We reasoned that carotid stenosis patient′s healthy side had a high functional link, a phenomenon that may be a compensatory mechanism for maintenance of their cognitive performances.
關鍵字(中)	★ 頸動脈狹窄 ★ 頸動脈支架置放術 ★ 功能性磁振造影 ★ 靜息態功能性連結 ★ 種子相關	關鍵字(英)	★ carotid artery stenosis ★ carotid artery stenting ★ fMRI ★ functional connectivity ★ seed-based
論文目次	目錄中文摘要 i Abstract iii 誌謝 iv 目錄 v 圖目錄 viii 表目錄 ix 縮寫對照 x 第一章緒論 1 1.1介紹頸動脈狹窄及治療方式 1 1.2 探討治療方式的優劣於頸動脈狹窄 2 1.3 靜息態功能性磁振造影 3 1.4 靜息態的生理背景 4 1.5 功能性網路與認知功能 5 1.6頸動脈狹窄對於功能性連結的可能影響 8 1.7 研究假設與實驗目的 9 第二章實驗材料與實驗方法 11 2.1 功能性磁振造影實驗程序 11 2.1.1 實驗設計 11 2.1.2 磁振造影使用參數 12 2.1.3 認知功能評估 13 2.2 數據分析 13 2.2.1 靜息態功能性磁振造影影像前處理流程 14 2.2.2 功能性連結分析 17 2.2.3 群組分析 18 2.2.4 SPSS統計分析 19 2.2.5 靜息態功能性磁振造影影像時間曲線 19 第三章研究結果 20 3.1 無症狀性頸動脈狹窄病患臨床特徵 20 3.2 無症狀性頸動脈狹窄後大腦功能性連結變化 20 3.3頸動脈支架置放後大腦功能性連結的差異 22 3.4無症狀性頸動脈狹窄後對於認知功能變化 23 第四章討論 24 4.1頸動脈狹窄和支架手術對於病患認知功能之可能影響 24 4.2 頸動脈支架手術對於大腦功能性網路之影響 27 4.3 本研究的限制與未來方向 28 第五章結論 29 參考文獻 30 附圖 35 附表 59
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指導教授	羅孟宗吳昌衛(Men-Tzung Lo Chang-Wei Wu)	審核日期	2018-1-29
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