本文選題：雙相障礙 + 功能磁共振��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的用局部一致性(ReHo)和低頻振幅(ALFF)為數(shù)據(jù)處理方法,探究首次抑郁發(fā)作期的抑郁障礙和雙相障礙腦功能的差異,以及首次抑郁期的雙相障礙腦功能與臨床特征的關(guān)系,以期為雙相障礙的早期識(shí)別提供新的依據(jù)。方法(1)病例追蹤:隨訪2006年1月至2014年6月期間所收集的處于首次抑郁發(fā)作期的心境障礙患者,根據(jù)臨床追蹤結(jié)局分為單相抑郁組和雙相抑郁組。(2)數(shù)據(jù)處理:提取兩組在首次抑郁發(fā)作期的腦功能磁共振數(shù)據(jù)及相關(guān)資料,以ReHo和ALFF為影像數(shù)據(jù)處理方法。使用獨(dú)立樣本t檢驗(yàn)比較兩組ReHo、ALFF差異(Alphasim矯正,P0.01),再用ROC分析驗(yàn)證差異腦區(qū)的異質(zhì)性程度;對(duì)于雙相抑郁組,做全腦體素的ReHo、ALFF與臨床特征相關(guān)量表的相關(guān)。結(jié)果(1)與正常對(duì)照相比,單相抑郁組:ReHo值升高的腦區(qū):右側(cè)額中回、右內(nèi)側(cè)額上回、右側(cè)楔葉、左側(cè)枕中回、左側(cè)緣上回。ReHo值降低的腦區(qū):左側(cè)眶部額中回、右側(cè)額蓋區(qū)。ALFF值升高的腦區(qū):右側(cè)額中回、右側(cè)背外側(cè)額上回、左側(cè)眶部額下回、右側(cè)腦島、右側(cè)楔葉、左側(cè)枕上回、左側(cè)頂上回。ALFF值降低的腦區(qū):左側(cè)眶內(nèi)額上回。(2)與正常對(duì)照相比,雙相抑郁組:ReHo值升高的腦區(qū):右側(cè)額中回、右內(nèi)側(cè)額上回、左側(cè)三角部額下回、右側(cè)梭狀回。ReHo值降低的腦區(qū):左側(cè)顳上回、右側(cè)枕中回。ALFF值升高的腦區(qū):右側(cè)中央前回、左側(cè)三角部額下回、右側(cè)腦島。ALFF值降低的腦區(qū):右側(cè)顳上回、左側(cè)海馬旁回。(3)與單相抑郁組相比,雙相抑郁組:ReHo值降低的腦區(qū):右側(cè)額蓋區(qū)、左側(cè)梭狀回。右側(cè)額蓋區(qū)的ReHo值識(shí)別雙相抑郁障礙的敏感度為0.667,特異度為0.810,曲線下面積為0.769;左側(cè)梭狀回的ReHo值識(shí)別雙相抑郁障礙的敏感度為0.619,特異度為0.905,曲線下面積為0.780。ALFF值升高的腦區(qū):左側(cè)顳上回。ALFF值識(shí)別雙相抑郁障礙的敏感度為0.714,特異度為0.952,曲線下面積為0.862。(4)雙相抑郁組腦功能與臨床量表相關(guān)分析:漢密爾頓焦慮量表總分:正相關(guān):左側(cè)顳中回、左側(cè)舌回、左側(cè)楔葉ReHo值。負(fù)相關(guān):左側(cè)額上回的ReHo值;右側(cè)背外側(cè)額上回、左側(cè)補(bǔ)充運(yùn)動(dòng)區(qū)ALFF值。漢密爾頓抑郁量表總分:正相關(guān):左側(cè)顳下回、左側(cè)枕中回ReHo值;右側(cè)顳中回ALFF值。負(fù)相關(guān):左側(cè)中央前回ReHo值;右側(cè)中央前回ALFF值。(5)雙相抑郁組腦功能與認(rèn)知功能測(cè)驗(yàn)相關(guān)分析:正相關(guān):左側(cè)額中回、右側(cè)背外側(cè)額上回、右側(cè)三角部額下回、右側(cè)顳下回ReHo值;右內(nèi)側(cè)和旁扣帶腦回、右側(cè)腦島ALFF值。負(fù)相關(guān):右側(cè)中央旁小葉、右側(cè)楔前葉ReHo值。結(jié)論(1)與正常對(duì)照相比,單相抑郁障礙和雙相抑郁障礙均在額中回、內(nèi)側(cè)額上回、枕中回存在異常,這預(yù)示著抑郁障礙和雙相障礙的病理機(jī)制有一定的相似性,可能屬于同一疾病的不同狀態(tài)。(2)單相抑郁障礙和雙相抑郁障礙在右側(cè)額蓋區(qū)、左側(cè)梭狀回的局部一致性以及左側(cè)顳上回的低頻振幅存在差異,經(jīng)過(guò)ROC分析,差異腦區(qū)相應(yīng)指標(biāo)有較好的特異性,有可能作為雙相障礙早期識(shí)別的腦功能指標(biāo)。(3)雙相抑郁障礙額葉局部活動(dòng)特性與臨床癥狀及認(rèn)知功能密切相關(guān)。
[Abstract]:Objective to explore the difference between depressive disorder and biphasic dysfunction in the first depressive episode and the relationship between the biphasic dysfunction and clinical characteristics during the first depressive period, with local consistency (ReHo) and low frequency amplitude (ALFF) as data processing methods, so as to provide a new basis for the early recognition of bipolar disorder. Method (1) follow up: follow up: The patients who were collected during the first depression period from January 2006 to June 2014 were divided into single phase depression group and bipolar depression group according to the clinical outcome. (2) data processing: extracting two groups of brain functional magnetic resonance data and related data in the first depressive episode, using ReHo and ALFF as image data processing methods. The independent sample t test was used to compare the two groups of ReHo, ALFF difference (Alphasim correction, P0.01), and then ROC analysis was used to verify the degree of heterogeneity in the differential brain region; for the bipolar depression group, the ReHo, ALFF and the clinical characteristic correlation scale were related to the whole brain voxel. (1) compared with the normal control, the single phase depression group: the brain area of the higher ReHo value: right frontal gyrus, right The medial frontal gyrus, the right cuneate lobe, the left occipital gyrus, the lower.ReHo value of the left margin of the brain: the left orbital frontal gyrus and the.ALFF value in the right frontal cortex: the right frontal gyrus, the right dorsal lateral frontal gyrus, the left orbital frontal gyrus, the right insula, the right cuneate, the left occipital upper gyrus, and the left superior.ALFF value in the left orbital area: the left orbital region: the left orbital region: the left orbital area: the left orbital region: the left orbital region of the left apex upper gyrus: the left orbital region: the left orbital area left to the left apical gyrus: the left orbital region: the left orbital region: the left orbital region with the left superior.ALFF value of the left apex (2) compared with the normal control, the diphasic depression group: the brain area of the ReHo value increased: the right frontal gyrus, the right medial upper frontal gyrus, the left triangle of the frontal gyrus, the lower.ReHo value of the right fusiform gyrus, the left lateral temporal gyrus and the.ALFF value in the right occipital gyrus, the right anterior central gyrus, the left trigone inferior frontal gyrus, and the right insula.ALFF value drop. The lower brain area: right right temporal gyrus and left parahippocampal gyrus. (3) compared with the single phase depression group, the bipolar depression group: the ReHo value decreased in the brain area: the right frontal cortex, the left fusiform gyrus. The sensitivity of the ReHo value of the right frontal cortex to identify the bipolar depressive disorder was 0.667, the specificity was 0.810, the area under the curve was 0.769, and the ReHo value of the left fusiform gyrus was biphasic. The sensitivity of depression was 0.619, the specificity was 0.905, the area under the curve was 0.780.ALFF. The sensitivity of the.ALFF value of the left temporal gyrus was 0.714, the specificity was 0.952, the area under the curve was 0.862. (4) in the bipolar depression group, the brain function and the clinical scale related analysis: the Hamilton Anxiety Scale total score: positive phase The left temporal gyrus, left lingual gyrus, left cuneate ReHo value. Negative correlation: the ReHo value of the left upper frontal gyrus, the upper lateral lateral frontal gyrus, and the left supplementary motor area ALFF value. The Hamilton Depression Scale total score: the left temporal gyrus, the left middle occipital gyrus ReHo value; the right temporal gyrus ALFF value; the negative left central anterior gyrus; the right central precentral ReHo; right central anterior gyrus. Back ALFF value. (5) correlation analysis of brain function and cognitive function test in bipolar depression group: positive correlation: left middle frontal gyrus, right dorsolateral frontal and lateral frontal gyrus, right trigonometric lower frontal gyrus, right temporal gyrus ReHo value; right medial and paranasal cingulate gyrus, right insula ALFF value. Negative correlation: right paraventricular lobule, right anterior lobe ReHo value. Conclusion (1) and normal control In comparison, monophasic depressive disorder and bipolar depressive disorder were both in the middle frontal gyrus, the medial superior frontal gyrus and the middle occipital gyrus, which indicated that the pathological mechanism of depressive disorder and bipolar disorder had a certain similarity, and may belong to the different state of the same disease. (2) the single phase depressive disorder and bipolar depressive disorder in the right frontal cortex and left fusiform gyrus There was a difference in the low frequency amplitude of the left temporal gyrus and the consistency of the left temporal gyrus. After ROC analysis, the corresponding index of the different brain regions had a good specificity. (3) the local activity of the frontal lobe of the bipolar depressive disorder was closely related to the clinical symptoms and cognitive function.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R749.4

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