本文選題：抑郁癥　切入點：抑郁易感　出處：《蘭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:應(yīng)用靜息態(tài)功能磁共振成像技術(shù)(resting-state functional magnetic resonance imaging,rs-fMRI),首先對比觀察首發(fā)未服藥抑郁癥患者及抑郁易感者基礎(chǔ)狀態(tài)下的腦功能活動,其次研究抑郁癥患者異常腦功能活動區(qū)與臨床癥狀的相關(guān)性,探索抑郁易感及抑郁癥發(fā)病的病理生理學(xué)機制,為今后抑郁癥的診斷、治療和抑郁易感人群的預(yù)防提供科學(xué)參考及客觀依據(jù)。方法:對23例首發(fā)未服藥抑郁癥患者、26例抑郁易感者和與之年齡、性別相匹配的15例健康志愿者完成rs-fMRI掃描。首先采取低頻振幅(amplitude of low frequency fluctuation,ALFF)、低頻振幅比率(fractional amplitude of low-frequency fluctuation,fALFF)和局部一致性(regional homogeneity,ReHo)等多種分析方法對三組人群的影像學(xué)數(shù)據(jù)進行統(tǒng)計學(xué)處理,得出各組間的差異腦區(qū);然后將抑郁癥患者組腦ALFF、fALFF和ReHo均值與抑郁總嚴重度(HAMD總分)和各臨床因子分進行相關(guān)分析。結(jié)果:1.ALFF分析:抑郁癥患者組相比對照組ALFF值顯著增大的腦區(qū)在左小腦前葉、中央后回、頂下小葉、額上回及雙側(cè)中央前回,顯著減小的在雙側(cè)小腦后葉;抑郁易感組ALFF值顯著增大的腦區(qū)在右小腦后葉,顯著減小的在右額上回。易感組相對患者組ALFF值顯著增大的腦區(qū)在雙側(cè)小腦后葉、右舌回,顯著減小的為右丘腦及左頂下小葉、楔前葉�；颊呓M左小腦前葉ALFF值與抑郁嚴重度和焦慮正相關(guān)(P=0.015、0.010);額上回ALFF值與認知障礙正相關(guān)(P=0.012);中央前回ALFF值與絕望感正相關(guān)(P=0.009);顳上回ALFF值與體重減輕正相關(guān)(P=0.014);右前扣帶回ALFF值與睡眠障礙正相關(guān)(P=0.015)。2.fALFF分析:與對照組對比,抑郁癥患者組左額下回、中央后回及右中央前回fALFF值顯著增大,雙側(cè)小腦后葉及右顳中回顯著減小;抑郁易感組右小腦后葉fALFF值顯著增大,左顳中回及額上回顯著減小。與患者組相比,易感組雙側(cè)小腦后葉、左顳中回及舌回fALFF值顯著增大。抑郁癥患者的抑郁嚴重度和焦慮與左小腦后葉fALFF值負相關(guān)(P=0.015、0.007);絕望感與右小腦后葉fALFF值負相關(guān)(P=0.008);日夜變化與左丘腦fALFF值正相關(guān)(P=0.012)。3.ReHo分析:與對照組對比,抑郁癥患者組右額上回、雙側(cè)前扣帶回及左中央后回局部一致性增強,右殼核、小腦后葉及顳上回局部一致性減弱;抑郁易感組左殼核及右前扣帶回局部一致性增強,左舌回、額上回及右顳上回局部一致性減弱。易感組相對患者組右殼核、小腦后葉、顳上回及扣帶回局部一致性增強,左楔前葉及額上回局部一致性減弱�；颊呓M抑郁嚴重度與左小腦后葉ReHo值負相關(guān)(P=0.010);絕望感與右小腦后葉ReHo值負相關(guān)(P=0.013);日夜變化與左扣帶回ReHo值負相關(guān)(P=0.014),與左丘腦ReHo值正相關(guān)(P=0.048)。結(jié)論:與健康人群對比分析,抑郁癥患者和抑郁易感者基礎(chǔ)狀態(tài)下均存在異常腦功能區(qū),主要分布在額葉、顳葉、頂葉、枕葉、小腦和邊緣系統(tǒng),同時抑郁癥患者的部分異�；顒幽X區(qū)與抑郁嚴重度和臨床癥狀群存在線性關(guān)聯(lián)。因此,證明抑郁癥是一個涉及多腦區(qū)、多系統(tǒng)的疾病,且這些異�；顒幽X區(qū)可能是抑郁易感和發(fā)病的潛在神經(jīng)病理機制。
[Abstract]:Objective: the application of resting state functional magnetic resonance imaging (resting-state functional magnetic resonance imaging, rs-fMRI), the first observation of first-episode patients with depression and depression susceptible brain function activities under basal conditions, followed by the study of depression in patients with different brain function areas often associated with clinical symptoms, to explore the pathophysiology of susceptible and depression the incidence of depression of the mechanism for the future diagnosis of depression, and provide scientific reference and objective basis for prevention of susceptible population and treatment of depression. Methods: 23 patients with first-episode depression patients, 26 cases of depression susceptible and 15 healthy volunteers were age, gender matched rs-fMRI. First take low frequency scanning (amplitude of low frequency fluctuation amplitude, ALFF amplitude, low frequency ratio (fractional) amplitude of low-frequency fluctuation, fALFF) and local uniform Of (regional homogeneity, ReHo), statistical data processing and other analysis methods of the three group images, showed that the differences in brain regions between each group; then the depression group of brain ALFF, fALFF and ReHo mean and depression severity (HAMD score) and the clinical factors of correlation analysis. Results: 1.ALFF analysis: depression group compared group ALFF significantly increased the value of brain regions in the left anterior lobe of cerebellum control, postcentral gyrus, inferior parietal lobule, superior frontal gyrus and bilateral precentral gyrus, significantly decreased in bilateral posterior lobe; depression susceptible group ALFF values significantly increased the brain areas in the right posterior lobe of cerebellum. Significant decreases in the right superior frontal gyrus. The susceptible group relative to patients in group ALFF were significantly increased in value of brain regions of bilateral posterior lobe, right lingual gyrus, right thalamus was significantly reduced and left inferior parietal lobule, precuneus. Patients with left anterior lobe of cerebellum ALFF value and depression severity and anxiety Positive correlation (P=0.015,0.010); superior frontal gyrus ALFF value was positively correlated with cognitive impairment (P=0.012); the precentral gyrus ALFF value and hopelessness positive correlation (P=0.009); temporal gyrus ALFF value was positively correlated with body weight loss (P=0.014); right anterior cingulate ALFF value was positively correlated with sleep disorders (P=0.015) and.2.fALFF analysis. The control group, depression group left inferior frontal gyrus, postcentral gyrus and right precentral gyrus fALFF value increased significantly, bilateral posterior lobe and right middle temporal gyrus decreased significantly; the susceptible group of right cerebellar depression leaf fALFF values increased significantly, the left middle temporal gyrus and superior frontal gyrus was significantly decreased. Compared with the patients. The susceptible group of bilateral posterior lobe of cerebellum, left middle temporal gyrus and lingual gyrus. The value of fALFF increased significantly in patients with depression and anxiety and depression severity of left behind small leaf fALFF was negatively correlated (P=0.015,0.007); a sense of despair and leaf fALFF value of right cerebellum posterior negative correlation (P= 0.008); diurnal and left thalamus fALFF values Positive correlation (P=0.012).3.ReHo analysis: compared with the control group, depression group right superior frontal gyrus, bilateral anterior cingulate and left postcentral gyrus local consistency enhancement, right putamen, temporal lobe gyrus weakened local consistency after cerebellar; depression susceptible group and left putamen and right anterior cingulate local consistency increased, left lingual gyrus, superior frontal gyrus and right superior temporal gyrus local consistency decreased. The susceptible group relative to patients with right posterior lobe of cerebellum, putamen, temporal gyrus, cingulate regionalhomogeneity enhancement, left precuneus superior frontal gyrus and local consistency weakened. Patients with depression severity and left posterior lobe of cerebellum was negatively correlated (ReHo P=0.010); a sense of despair and leaf ReHo value of right cerebellum posterior negative correlation (P=0.013); diurnal variation and left cingulate ReHo negative correlation (P=0.014), positive correlation with left thalamus ReHo values (P=0.048). Conclusion: analysis and comparison of healthy people, suffering from depression susceptible state and depression under There were abnormal brain functional areas, mainly in the frontal lobe, temporal lobe, parietal lobe, occipital lobe, cerebellum and limbic system, while part of abnormal brain activity and severity of depression in patients with depression and clinical symptoms there is a linear correlation. Therefore, evidence that depression is involved in a number of brain regions, multi system disease, and these abnormal brain activity may be a potential neural pathological mechanism of susceptibility and incidence of depression.

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R749.4

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