臺灣博碩士論文加值系統

偏頭痛和失眠都是常見的神經系統疾病，此兩疾病涉及不同的病理機制，但仍有某種程度的共病和潛在的雙向關係。先前神經影像學研究指出，偏頭痛和失眠患者在大腦默認模式網絡(default mode network, DMN)之功能性連結表現異常，這些異常功能性連結也涉及到疼痛持續時間、疼痛感知之調控、睡眠調節等臨床指標或認知表現。另一方面，過去研究指出根據不同的認知功能，默認模式網路可以進一步分為不同的子網路系統來進行調控。為了深入探究偏頭痛與失眠的潛在相關性及共病機轉，因此本研究將透過最新的默認模式子網路分區技術並搭配靜息態功能性磁振造影技術深入剖析默認模式子網路功能連結之變化，以探討兩者潛在之共病機制。本研究共收集116名受試者靜息態功能性磁振造影的影像資料，其包括健康受試者、偏頭痛患者、失眠患者以及偏頭痛合併失眠患者四個族群。隨後透過相關文獻整理回顧，將整體默認模式網路劃分為12個子分區，並深度探究各子區域之全腦靜息態功能性連結之變化與臨床疾病嚴重度之可能關係。結果顯示，相較於健康受試者，偏頭痛和失眠患者在背內側前額葉皮層(dorsomedial prefrontal cortex, dmPFC)與後扣帶迴(posterior cingulate gyrus)間的功能性連結，以及後內側皮層(posteromedial cortex, PMC)與前中央迴(precentral gyrus)、舌迴(lingual gyrus)間的功能性連結均有顯著上升，而這些具有功能性連結上統計顯著變化之腦區，在偏頭痛合併失眠患者群組，亦可以發現一致性的變化模式。透過本研究之實驗設計及相關影像分析, 我們首度證實特定默認模式網路子分區之全腦功能性連結於偏頭痛及失眠患者之可能變化情形, 其相關成果將有助於臨床對於偏頭痛和失眠之共病歷程之了解，有助於未來發展偏頭痛與失眠之早期診斷與相關治療。

Migraine (MIG) is a primary headache disorder associated with many comorbidities, including depression, anxiety, and sleep disorders. These complex comorbidities phenomena are also shown to be associated with disease chronification, disability status, and treatment response. Among these, insomnia (INSO) is one of the common forms of sleep disorders and presents a bidirectional relationship with MIG. Previous resting state functional MRI studies have indicated that the alterations of function network in patients with MIG and INSO, especially in the default mode network (DMN). Furthermore, recent studies also provide an empirical evidence that DMN could segregated into multiple sub-networks that involved in different cognitive functions. However, the functional changes of the default mode sub-networks underlying the comorbidity between MIG and INSO remains unknown. To identify patterns of functional alteration of each default mode sub-network among patients with MIG, INSO and comorbid MIG and INSO, we used the pre-defined anatomical regional of interests to map corresponding whole brain functional connectivity (FC) patterns using resting-state fMRI in the current study. Compared to healthy controls, the dorsomedial prefrontal cortex (dmPFC) had increased functional connectivity to posterior cingulate gyrus and the posteromedial cortex (PMC) also exhibited elevated functional connectivity to precentral gyrus and lingual gyrus in patients with MIG and INSO. These functional alteration patterns also evidenced in direct group comparison between patients with comorbid MIG and INSO and healthy participants. The current study provide the first evidence of the specific DMN subnetwork may play an important role in comorbidity of MIG and INSO. Understanding the network mechanism of MIG and INSO may aid in the future development of early diagnosis and potential intervention for these prevalent neurological diseases.

目錄
論文電子檔著作權授權書………………………………………………..i
論文審定同意書………………………………………………………….ii
誌謝………………………………………………………………………iii
中文摘要………………………………………………………………….v
英文摘要………………………………………………………………...vii
目錄……………………………………………………………………....ix
圖目錄…………………………………………………………………...xii
表目錄…………………………………………………………………..xiii
第一章 介紹……………………………………………………………...1
1.1 研究動機………………………………………………………….1
1.2 疾病介紹………………………………………………………….2
1.2.1 偏頭痛……………………………………………………….2
1.2.2 失眠………………………………………………………….3
1.2.3 偏頭痛和失眠的關係……………………………………….4
1.3 靜息態功能性磁振造影………………………………………….7
1.3.1 靜息態功能性磁振造影在偏頭痛和失眠的發現………….8
1.3.2 默認模式網路……………………………………………...10
1.4研究目的………………………………………………………....13
第二章 材料方法……………………………………………………….14
2.1 受試者…………………………………………………………...14
2.2 造影影像擷取與參數…………………………………………...16
2.3 靜息態功能性磁振造影前處理………………………………...18
2.4 種子點功能性連結分析………………………………………...21
2.5 統計分析………………………………………………………...23
2.5.1 人口統計數據分析………….……………………………..23
2.5.2 默認模式的子網路與全腦的功能性連結分析…………...23
2.5.2.1 偏頭痛、失眠與健康受試者的功能性連結差異…….23
2.5.2.2 偏頭痛合併失眠患者的驗證分析…………………...23
2.5.3 功能性連結與臨床特徵之間的關係………………………..24
第三章 結果…………………………………………………………….25
3.1 人口統計學數據與臨床特徵…………………………………...25
3.2 默認模式的子區域與全腦的功能性連結……………………...26
3.2.1 背內側前額葉皮層的子網路和全腦的功能性連結差異...26
3.2.2 後內側皮層皮層的子網路和全腦的功能性連結差異…...27
3.3 生理指標與功能性連結的關係………………………………...28
第四章 討論……………………………………………………….........29
第五章 結論…………………………………………………………….34
參考文獻………………………………………………………………...35


圖目錄
圖一、默認模式網路及其子區域……………………………………….22
圖二、背內側前額葉皮層的子網路和全腦的功能性連結差異……….26
圖三、後內側皮層皮層的子網路和全腦的功能性連結差異………….27
圖四、頭痛病程與功能性連結之相關性……………………………….28


表目錄
表一、磁振造影掃描參數……………………………………………….17
表二、人口統計學數據………………………………………………….25

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