認(rèn)知行為治療作用于抑郁癥患者靜息態(tài)腦功能的追蹤研究
發(fā)布時(shí)間：2018-09-06 12:21
【摘要】：近幾年,靜息態(tài)核磁共振在抑郁癥發(fā)病機(jī)制和治療的研究中應(yīng)用廣泛,研究一致認(rèn)為抑郁癥的病理學(xué)基礎(chǔ)不是單個(gè)腦區(qū)的損傷,而是與不同腦區(qū)共同組成的功能相關(guān)的神經(jīng)環(huán)路、腦網(wǎng)絡(luò)之間功能連接的異常有關(guān)。認(rèn)知行為治療(cognitive behavior therapy,CBT)可帶來(lái)患者相關(guān)病理腦區(qū)和功能連接的恢復(fù),臨床上患者抑郁癥狀可以有長(zhǎng)期和持續(xù)的改變。目前國(guó)內(nèi)外相關(guān)研究?jī)H設(shè)置治療前后兩個(gè)時(shí)間點(diǎn),并不能呈現(xiàn)CBT對(duì)抑郁癥治療的神經(jīng)變化過(guò)程,而且當(dāng)前的研究結(jié)果并不一致。本研究主要在南京腦科醫(yī)院門診處收取抑郁癥病人(數(shù)據(jù)剔除后,n=18例)并招募與其在性別、年齡、受教育程度相匹配的健康者(數(shù)據(jù)剔除后,n=15例),入組篩選后,被試填寫一般人口學(xué)資料表,并使用漢密爾頓抑郁量表(Hamilton Depression Scale, HAMD)進(jìn)行雙盲評(píng)分。兩組被試在入組48h內(nèi)進(jìn)行基線期靜息態(tài)fMRI掃描,比較抑郁癥患者神經(jīng)自發(fā)活動(dòng)水平的低頻波振幅(amplitude of low frequency-fluctuation,ALFF)與健康組的差異。之后對(duì)抑郁組進(jìn)行個(gè)體化CBT治療,設(shè)基線期、治療初期(6周后)、治療穩(wěn)定期(24周后)三個(gè)時(shí)間點(diǎn),探索不同時(shí)間點(diǎn)CBT對(duì)抑郁癥患者腦活動(dòng)變化水平的差異。結(jié)合以往研究以及本研究初步ALFF值結(jié)果,選取CBT治療6周后、24周后抑郁組的差異腦區(qū)左側(cè)楔前葉、右側(cè)楔前葉為感興趣區(qū)點(diǎn),對(duì)抑郁組和健康組的全腦功能連接分析(Functional Connectivity, FC),進(jìn)一步探索CBT對(duì)抑郁癥治療帶來(lái)的腦功能連接變化。結(jié)果如下:1、ALFF結(jié)果:(1)抑郁組與健康對(duì)照組基線期相比,抑郁患者的右側(cè)舌回ALFF顯著增強(qiáng)、左側(cè)枕中回ALFF顯著減弱(p0.01);(2)抑郁組6周CBT治療后與基線期相比,左側(cè)顳中回、左(右)側(cè)額中回ALFF值顯著增高;左側(cè)舌回、左側(cè)楔前葉、左側(cè)額下回眶部ALFF值顯著降低(p0.01)。(3)抑郁組24周CBT治療后與基線期相比,左側(cè)額上回ALFF值顯著增高;左側(cè)梭狀回、左側(cè)額下回眶部、右側(cè)枕中回、右側(cè)楔前葉ALFF值顯著降低(p0.01);2、FC結(jié)果:(1)抑郁組與健康組基線期對(duì)比,左側(cè)楔前葉與輔助運(yùn)動(dòng)區(qū)的功能連接水平顯著低于健康對(duì)照組(p0.05);(2)6周治療后抑郁組與基線期對(duì)比,左側(cè)楔前葉與額中回、右側(cè)楔前葉功能連接顯著減弱;右側(cè)楔前葉與扣帶回的功能連接顯著減弱,與右側(cè)中央前回的功能連接顯著增強(qiáng)(p0.05);(3)24周治療后抑郁組與基線期相比,左側(cè)楔前葉與左側(cè)海馬旁回、右側(cè)中央前回功能連接降低,與右側(cè)中央前回功能連接增強(qiáng);右側(cè)楔前葉與右側(cè)中央前回功能連接增強(qiáng),與顳下回功能連接減弱(p0.05)。本研究發(fā)現(xiàn):(1)6周CBT治療作用于認(rèn)知控制網(wǎng)絡(luò)和突顯網(wǎng)絡(luò)內(nèi)的相關(guān)腦區(qū)如額中回、中央前回等,抑制默認(rèn)網(wǎng)絡(luò)內(nèi)腦區(qū)如楔前葉的激活,患者對(duì)信息的注意轉(zhuǎn)移能力增強(qiáng);(2)24周CBT治療能帶來(lái)認(rèn)知控制網(wǎng)絡(luò)腦區(qū)的大范圍功能修復(fù),患者的反應(yīng)抑制能力恢復(fù);(3)CBT治療初期,抑郁癥患者病理腦區(qū)功能逐步修復(fù),而穩(wěn)定期是對(duì)腦功能正常作用的進(jìn)一步強(qiáng)化。
[Abstract]:In recent years, resting-state magnetic resonance imaging has been widely used in the study of the pathogenesis and treatment of depression. It is generally accepted that the pathological basis of depression is not the injury of a single brain area, but the abnormality of functional connections between neural circuits and brain networks associated with the function of different brain areas. Ehavior therapy (CBT) can bring about the recovery of the related pathological brain regions and functional connections, and the depressive symptoms of patients can be changed for a long time and persistently. In this study, depression patients (n = 18 after data elimination) were recruited from the outpatient department of Nanjing Brain Hospital and healthy persons matched with their sex, age and education level (n = 15 after data elimination) were enrolled. After enrollment, the subjects filled out the general demographic data sheet and used the Hamilton Depression Scale (Hamilton Depression Sca). Two groups of subjects underwent baseline resting state fMRI within 48 hours to compare the difference of amplitude of low Frequency-fluctuation (ALFF) in depressive patients with healthy controls. To explore the changes of brain activity in depression patients at three time points during the stable period (24 weeks later). Combining with previous studies and preliminary ALFF results of this study, the left anterior cuneiform lobe, right anterior cuneiform lobe were selected as the regions of interest in depression group and healthy group. The results were as follows: 1. ALFF results: (1) Compared with the baseline period of the healthy control group, ALFF in the right lingual gyrus of the depressive group was significantly increased, and ALFF in the left middle occipital gyrus was significantly decreased (p0.01); (2) CBT treatment in the depressive group for 6 weeks resulted in significant changes in the functional connectivity of the brain. Compared with baseline period, ALFF values of left middle temporal gyrus and left (right) middle frontal gyrus were significantly increased, while ALFF values of left lingual gyrus, left anterior cuneate lobe and left inferior frontal gyrus were significantly decreased (p0.01). (3) After 24 weeks CBT treatment, ALFF values of left superior frontal gyrus were significantly increased in depression group, left fusiform gyrus, left inferior frontal gyrus, right middle occipital gyrus and right inferior frontal gyrus were significantly increased. The ALFF value of the anterior cuneiform lobe was significantly decreased (p0.01); 2, FC results: (1) Compared with the healthy group, the functional connectivity between the left anterior cuneiform lobe and the auxiliary motor area was significantly lower in the depressive group than in the healthy group (p0.05); (2) After 6 weeks of treatment, the functional connectivity between the left anterior cuneiform lobe and the middle frontal gyrus, and the right anterior cuneiform lobe was significantly weakened in the depressive group compared with the baseline stage. The functional connection between the anterior cuneate lobe and cingulate gyrus was significantly weakened, and the functional connection with the right anterior central gyrus was significantly enhanced (p0.05); (3) After 24 weeks of treatment, the functional connection between the left anterior cuneate lobe and the left parahippocampal gyrus, the right anterior central gyrus and the right anterior central gyrus was decreased, and the functional connection between the right anterior cuneate lobe and the right anterior central gyrus was enhanced. This study found that: (1) 6-week CBT therapy inhibited the activation of brain regions in the default network, such as the middle frontal gyrus and the anterior central gyrus, and enhanced the patient's ability to shift attention to information; (2) 24-week CBT therapy could bring about the enhancement of the patient's ability to transfer attention to information. In the early stage of CBT treatment, the pathological brain function of depressive patients was gradually restored, while the stable stage was the further strengthening of normal brain function.
【學(xué)位授予單位】：南京師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：B842.1
本文編號(hào)：2226334
[Abstract]:In recent years, resting-state magnetic resonance imaging has been widely used in the study of the pathogenesis and treatment of depression. It is generally accepted that the pathological basis of depression is not the injury of a single brain area, but the abnormality of functional connections between neural circuits and brain networks associated with the function of different brain areas. Ehavior therapy (CBT) can bring about the recovery of the related pathological brain regions and functional connections, and the depressive symptoms of patients can be changed for a long time and persistently. In this study, depression patients (n = 18 after data elimination) were recruited from the outpatient department of Nanjing Brain Hospital and healthy persons matched with their sex, age and education level (n = 15 after data elimination) were enrolled. After enrollment, the subjects filled out the general demographic data sheet and used the Hamilton Depression Scale (Hamilton Depression Sca). Two groups of subjects underwent baseline resting state fMRI within 48 hours to compare the difference of amplitude of low Frequency-fluctuation (ALFF) in depressive patients with healthy controls. To explore the changes of brain activity in depression patients at three time points during the stable period (24 weeks later). Combining with previous studies and preliminary ALFF results of this study, the left anterior cuneiform lobe, right anterior cuneiform lobe were selected as the regions of interest in depression group and healthy group. The results were as follows: 1. ALFF results: (1) Compared with the baseline period of the healthy control group, ALFF in the right lingual gyrus of the depressive group was significantly increased, and ALFF in the left middle occipital gyrus was significantly decreased (p0.01); (2) CBT treatment in the depressive group for 6 weeks resulted in significant changes in the functional connectivity of the brain. Compared with baseline period, ALFF values of left middle temporal gyrus and left (right) middle frontal gyrus were significantly increased, while ALFF values of left lingual gyrus, left anterior cuneate lobe and left inferior frontal gyrus were significantly decreased (p0.01). (3) After 24 weeks CBT treatment, ALFF values of left superior frontal gyrus were significantly increased in depression group, left fusiform gyrus, left inferior frontal gyrus, right middle occipital gyrus and right inferior frontal gyrus were significantly increased. The ALFF value of the anterior cuneiform lobe was significantly decreased (p0.01); 2, FC results: (1) Compared with the healthy group, the functional connectivity between the left anterior cuneiform lobe and the auxiliary motor area was significantly lower in the depressive group than in the healthy group (p0.05); (2) After 6 weeks of treatment, the functional connectivity between the left anterior cuneiform lobe and the middle frontal gyrus, and the right anterior cuneiform lobe was significantly weakened in the depressive group compared with the baseline stage. The functional connection between the anterior cuneate lobe and cingulate gyrus was significantly weakened, and the functional connection with the right anterior central gyrus was significantly enhanced (p0.05); (3) After 24 weeks of treatment, the functional connection between the left anterior cuneate lobe and the left parahippocampal gyrus, the right anterior central gyrus and the right anterior central gyrus was decreased, and the functional connection between the right anterior cuneate lobe and the right anterior central gyrus was enhanced. This study found that: (1) 6-week CBT therapy inhibited the activation of brain regions in the default network, such as the middle frontal gyrus and the anterior central gyrus, and enhanced the patient's ability to shift attention to information; (2) 24-week CBT therapy could bring about the enhancement of the patient's ability to transfer attention to information. In the early stage of CBT treatment, the pathological brain function of depressive patients was gradually restored, while the stable stage was the further strengthening of normal brain function.
【學(xué)位授予單位】：南京師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：B842.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前6條
1 朱雪玲;陳璐;袁福來(lái);;青年重性抑郁癥靜息態(tài)大腦低頻振幅研究[J];中國(guó)臨床心理學(xué)雜志;2016年05期
2 滕昌軍;王純;張寧;馬輝;譚雅容;肖朝勇;高帥;李鴻磊;張文tD;張秀娟;;認(rèn)知行為治療對(duì)首次發(fā)病輕中度抑郁癥患者膝下前扣帶回功能連接的影響[J];中華精神科雜志;2016年04期
3 朱雪玲;袁福來(lái);;基于區(qū)域的抑郁癥默認(rèn)網(wǎng)絡(luò)內(nèi)部功能連接研究[J];中國(guó)臨床心理學(xué)雜志;2016年02期
4 閻銳;姚志劍;湯浩;韋茂彬;陳建淮;花玲玲;盧青;;首發(fā)抑郁癥患者腦區(qū)低頻振幅特征與癥狀群的相關(guān)性[J];中華行為醫(yī)學(xué)與腦科學(xué)雜志;2014年08期
5 譚雅容;王陽(yáng);張寧;王純;肖朝勇;曹瑞想;高帥;楊娟;李鴻磊;;首發(fā)輕中度抑郁癥患者認(rèn)知行為治療前后大腦局部變化的功能磁共振研究[J];中華行為醫(yī)學(xué)與腦科學(xué)雜志;2014年06期
6 王純;張亞林;張寧;;抑郁癥心理治療的神經(jīng)影像學(xué)研究[J];國(guó)際精神病學(xué)雜志;2008年03期
，本文編號(hào)：2226334
本文鏈接：http://sikaile.net/shekelunwen/xinlixingwei/2226334.html
最近更新
教材專著
