本文關鍵詞：基于靜息態(tài)腦功能磁共振成像探討青年抑郁癥自殺未遂的神經基礎　出處：《重慶醫(yī)科大學》2017年博士論文　論文類型：學位論文

  更多相關文章： 青年抑郁癥 自殺未遂 靜息態(tài)功能磁共振成像 低頻振幅 沖動性 青年抑郁癥 自殺未遂 靜息態(tài) 功能磁共振成像 功能連接 青年抑郁癥 自殺未遂 靜息態(tài)腦網絡 功能網絡連接 獨立成分分析

【摘要】：第一部分青年抑郁癥自殺未遂的腦局部活動研究目的:采用靜息態(tài)功能磁共振成像探討局部腦功能活動的異常與青年抑郁癥患者自殺未遂之間的相關性。方法:對35例自殺未遂的青年抑郁癥患者(SU組)、18例不伴自殺未遂的青年抑郁癥患者(NSU組)以及47名性別、年齡和受教育年限相匹配的健康對照者(HC組)進行臨床心理量表評估和靜息態(tài)f MRI掃描。采用低頻振幅(Amplitude of low-frequency fluctuations,ALFF)的分析方法比較三組間z ALFF值的差異,并將SU組和NSU組z ALFF存在顯著差異的腦區(qū)作為感興趣區(qū)(regions-of-interest,ROIs),與臨床行為量表之間進行相關性分析,同時采用受試者操作特征(Receiver Operating Characteristics,ROC)曲線評價上述腦區(qū)異常的z ALFF值作為影像標記對青年抑郁癥患者自殺自殺行為的預測價值。結果:1、人口學資料和臨床心理量表分析結果顯示,SU、NSU和HC三組在性別(P=0.513)、年齡(P=0.584)和受教育年限(P=0.289)方面無統計學差異,但是SU組和NSU組在QSA、BIS-11、HAMD、BDI、BHS和SSI得分上顯著高于HC組,三組得分之間的差異具有統計學意義(P0.001),post-hoc分析顯示SU組與NSU組在QSA(P=0.219)、HAMD(P=0.089)、BDI(P=0.263)、BHS(P=0.125)和SSI(P=0.836)總分上無統計學差異,而在BIS-11得分上,SU組顯著高于NSU組(P=0.036)。2、低頻振幅分析發(fā)現,與NSU組和HC組相比,SU組在右側顳上回(R-STG)、左側顳中回(L-MTG)和左側枕中回(L-MOG)的z ALFF值升高;此外,SU組左側額上回(L-SFG)和左側額中回(L-MFG)的z ALFF值較NSU組顯著降低,同時SU組左側額上回(L-SFG)和左側額中回(L-MFG)的z ALFF值與BIS呈顯著負相關(r=-0.36,P=0.03)。3、ROC曲線分析的結果顯示左側額上回(L-SFG)和左側額中回(L-MFG)的z ALFF值在鑒別SU和NSU時敏感性為71.4%,特異性為83.3%。結論:左側額上回(L-SFG)和左側額中回(L-MFG)的活動降低引起其沖動性增高,進而介導了青年抑郁癥患者自殺行為的發(fā)生。L-SFG/MFG的內在自發(fā)神經活動的異常是自殺的神經易感性因素。第二部分青年抑郁癥自殺未遂的腦功能連接分析目的:靜息態(tài)功能磁共振成像(resting-state functional magnetic resonance imaging,rs-f MRI)將有助于更好地理解青年抑郁癥患者自殺未遂所潛在的神經生物機制。本研究將探尋伴有自殺未遂的青年抑郁癥患者靜息態(tài)腦功能連接(resting-state functional connectivity,RSFC)的異常及其與自殺未遂的關系,探索其在自殺未遂發(fā)生中可能潛在的神經生物學作用。方法:使用基于種子點的功能連接分析方法(seed-based functional connectivity)將第一部分SU和NSU組z ALFF存在顯著差異的左側額中回(l-MFG)和左側額上回(L-SFG)作為種子點,進行基于全腦體素的種子點功能連接分析,并采用spearman相關分析探尋青年抑郁癥自殺未遂患者異常腦功能連接與臨床心理量表之間的相關性。結果:1、基于種子點功能連接分析發(fā)現,以左側額中回(L-MFG)作為感興趣區(qū)分析時發(fā)現,與NSU組相比,SU組左側額中回(L-MFG)與左側頂上回(L-SPL)的功能連接降低,與HC組相比,SU組左側額中回與左側島回(L-insular)和左側頂上回(L-SPL)的功能連接均降低,NSU組較HC組在左側額中回與右側額中回(R-MFG)和額下回眶部(R-IFG-orbit)的功能連接降低,與左側島回(L-Insula)功能連接增強。以左側額上回(L-SFG)作為感興趣區(qū)分析時結果顯示,SU組較NSU組左側額上回(L-SFG)與右側額上回(R-SFG)的功能連接增強,較HC組左側額上回(L-SFG)與右側前扣帶回(R-ACC)的功能連接減弱,NSU組較HC組左側額上回(L-SFG)和左側額下回眶部(L-MFG-orbit)的功能連接增強。2、腦區(qū)功能連接與臨床量表相關分析發(fā)現,SU組左側額中回(L-MFG)與左側頂上小葉(L-SPL)的功能連接值與SSI(r=-0.4056,P=0.0156)和BIS(r=-0.3498,P=0.0394)量表總分呈顯著負相關。左側額上回(L-SFG)與右側前扣帶回(R-ACC)的功能連接與BIS(r=-0.3472,P=0.0410)量表總分呈顯著負相關,與SSI(r=-0.2602,P=0.1312)無相關性。結論:本研究結果顯示左側眶額葉與左側頂葉和右側前扣帶回功能連接的改變與青年抑郁癥自殺未遂行為相關。我們的結果為臨床抑郁癥青年自殺未遂的靜息態(tài)功能連接(RSFC)提供了新的認識,并且認為青年抑郁癥患者的額-頂網絡和額-邊緣網絡功能連接異�？赡苁瞧浒l(fā)生自殺未遂的一個影像學預測因子。第三部分青年抑郁癥自殺未遂的腦功能網絡連接分析目的:探討自殺未遂青年抑郁癥患者靜息態(tài)腦網絡(resting-state network,RSN)內和網絡間功能連接的差異,分析神經網絡之間的相互作用,從而了解青年抑郁癥自殺未遂所潛在的神經機制。方法:采用基于群組的獨立成分分析方法將靜息態(tài)f MRI數據分解為不同的RSNs,并提取CEN、DMN和SN三大核心認知腦網絡,比較SU、NSU和HC三個RSNs內在腦活動特征以及腦網絡功能連接(functional network connectivity,FNC)的差異。結果:1、識別出5個靜息態(tài)腦網絡(resting state networks,RSNs)作為感興趣的成分,分別為左側額頂網絡(IC8:L-FPN)、凸顯網絡(IC12:SN)、默認網絡前部(IC14:a DMN)、右側額頂網絡(IC16:R-FPN)和默認網絡后部(IC32:p DMN)。單樣本t檢驗顯示三組具有典型的RSN空間分布模式,三組腦網絡進行ANOVA分析顯示,三組間5個靜息態(tài)腦網絡內自發(fā)活動存在顯著差異。2、三組間FNC分析發(fā)現,SU組前默認網絡(a DMN)與凸顯網絡(SN)和右側額頂網絡(R-FPN)的功能網絡連接較NSU組降低,而凸顯網絡與右側額頂網絡(R-FPN)的功能網絡連接增強;與HC組相比,SU組前默認網絡與左側額頂網絡(L-FPN)以及后默認網絡(p DMN)的功能網絡連接降低,而凸顯網絡與左側額頂網絡的功能網絡連接增加;NSU組后默認網絡與右側額頂網絡的功能網路連接下降。結論:青年抑郁癥自殺未遂行為與DMN、SN和CEN三大核心神經認知網絡功能連接異常有關,廣泛涉及網絡的多個節(jié)點。本研究為探尋青年抑郁癥自殺未遂的大腦功能組織模式提供了新的證據。
[Abstract]:The first part of the youth depression objective to study regional cerebral activity Dutch act: correlation between attempted attempted Dutch act with abnormal youth depression patients using resting state functional magnetic resonance imaging to investigate the function of local brain activity. Methods: 35 cases of young patients with depression Dutch act attempted (SU group), 18 cases of young patients with depression without Dutch act attempted (NSU group) and 47 healthy controls were gender, age and education matched (group HC) clinical psychological assessment and resting state f MRI scan. The amplitude of low frequency (Amplitude of low-frequency fluctuations, ALFF) the difference of the method of comparative analysis between the three groups in Z ALFF, and the brain there are significant differences between SU group and NSU group Z ALFF as a region of interest (regions-of-interest, ROIs), and the correlation analysis between clinical behavior scale, at the same time using receiver operating characteristic (Receiver Opera Ting Characteristics, ROC) in the brain abnormal curve to evaluate the Z value ALFF as a marker for young patients with depression image value Dutch act behavior prediction Dutch act. Results: 1, surface analysis showed that the SU demographic data and clinical psychology, NSU and HC of the three groups in gender, age (P=0.513) and Education (P=0.584) age (P=0.289) had no significant difference, but the SU group and NSU group in QSA, BIS-11, HAMD, BDI, BHS and SSI score was significantly higher than that in HC group, the difference was statistically significant between the three groups score (P0.001), post-hoc analysis showed that SU group and NSU group in QSA (P=0.219), HAMD (P=0.089), BDI (P=0.263), BHS (P=0.125) and SSI (P=0.836) had no significant difference in the total score, and BIS-11 score, SU group was significantly higher than that of group NSU (P=0.036).2, low-frequency amplitude analysis found that, compared with NSU group and HC group, SU group in the right superior temporal gyrus (R-STG), left temporal in the back and left occipital (L-MTG) In (L-MOG) Z ALFF value increased; in addition, the SU group of left superior frontal gyrus (L-SFG) and the left middle frontal gyrus (L-MFG) of the Z ALFF value decreased significantly compared with NSU group, SU group and left superior frontal gyrus (L-SFG) and the left middle frontal gyrus (L-MFG) of the Z ALFF value was negatively correlated with BIS (r=-0.36, P=0.03).3, ROC curve analysis showed that the left superior frontal gyrus (L-SFG) and the left middle frontal gyrus (L-MFG) of Z ALFF SU and NSU value in the differential sensitivity was 71.4%, specificity was 83.3%. conclusion: the left superior frontal gyrus (L-SFG) and the left middle frontal gyrus (L-MFG). The impulse activity decreased and then increased, the abnormal mediated behaviors in patients with depression in young Dutch act.L-SFG/MFG intrinsic spontaneous neural activity is the nerve susceptibility factors Dutch act. The second part Dutch act attempted youth depression of brain functional connectivity analysis objective: resting state functional magnetic resonance imaging (resting-state functional magnetic Resonance imaging, rs-f MRI) will have the neurobiological mechanism to contribute to a better understanding of the young patients with depression Dutch act attempted potential. This study will explore the young patients with depression accompanied by Dutch act attempted resting brain functional connectivity (resting-state functional connectivity, RSFC) and the relationship between abnormal and Dutch act attempted to explore its role in neurobiology, Dutch act the occurrence of attempted potential. Methods: using the connection analysis method based on the function of the seed point (seed-based functional connectivity) will be the first part of the SU and NSU group Z ALFF significant difference between the left middle frontal gyrus (l-MFG) and left superior frontal gyrus (L-SFG) as the seed point, connectivity analysis of seed points of whole brain body function Plain Based on Spearman correlation analysis was used to explore the connection and youth depression Dutch act attempted in patients with abnormal brain function table correlation and clinical psychology. 緇撴灉:1,鍩轟簬縐嶅瓙鐐瑰姛鑳借繛鎺ュ垎鏋愬彂鐜，

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