本文選題：精神分裂癥　切入點：兒章　出處：《新鄉(xiāng)醫(yī)學院》2012年碩士論文　論文類型：學位論文

【摘要】：目的 調查首發(fā)兒童精神分裂癥患者病前行為特征、顱腦結構特征和認知功能,探討本病病前行為特征與顱腦結構特征及認知功能之間的關系。 方法 1.選擇102例首發(fā)兒童精神分裂癥患者作為研究對象。 2.采用Achenbach兒童行為量表(Child Behavior Check-list, CBCL),回顧性調查患者在4～5歲和6～11歲時的行為特征。量表記分項目包括社會能力和行為問題兩部分,社會能力記總分,行為問題記總分及七個因子分(分裂強迫、抑郁、體訴、社交退縮、多動、攻擊性和違紀)。 3.在磁共振成像(Magnetic resonance imaging, MRI)下測量患者的顱腦結構特征,測量指標包括：三腦室橫徑、三腦室側壁至左右腦島面距、側腦室前角間距、側腦室體最大距、左右顳角寬度、左右外側裂腦溝根部寬、額葉腦溝寬、頂葉腦溝寬、縱裂寬度、左右尾狀核頭寬度和胼胝體厚度。 4.用事件相關電位(Event-related Potentials, ERP) P300和探究性眼動分析(exploratory eye movement, EEM)評估患者的認知功能,P300的評估指標包括潛伏期和波幅,EEM的評估指標包括凝視點數(number of eye fixations, NEF)和反應性探索評分(responsive search score, RSS)。 5.用t檢驗比較CBCL量表各因了高分組與低分組患者之間顱腦結構測量值及治療前后P300及EEM各數據之間的差別,用協方差分析比較CBCL量表各因子高分組與低分組患者之間顱腦結構測量值的差異,用Pearson相關分析分析CBCL量表各因子分、顱腦結構測量值、治療前后P300及EEM指標各數據之間的相互關系。 結果 1.CBCL量表社會能力與顱腦結構及認知功能的關系： (1)社會能力與顱腦結構的關系：在4-5歲年齡段,社會能力總分與胼胝體厚呈正相關(r=0.253,P0.05)；在6-11歲年齡段,社會能力總分與右顳角寬度呈正相關(r=0.345,P0.01)；在4-5歲和6-11歲兩個年齡段,社會能力總分均與頂葉腦溝寬呈負相關(r=-0.253,-0.273,P0.05)。 (2)社會能力與認知功能的關系：在4～5歲和6-11歲兩個年齡段,社會能力總分均與治療前P300潛伏期呈負相關(r=-0.215,-0.231；P0.05)。 2. CBCL量表行為問題與顱腦結構及認知功能的關系： (1)行為問題與顱腦結構的關系：在4-5歲年齡段,分裂強迫因子分與側腦室前角間距呈正相關(r=0.316,P0.05),抑郁因子分、體訴因子分、社交退縮因子分及行為問題總分與右外側裂腦溝根部寬呈正相關(r=0.347,0.278,0.289,0.309：P0.05,P0.01)。在6-11歲年齡段,分裂強迫因子分、抑郁因子分與三腦室橫徑呈中相關(r=0.301,0.264；P0.05),行為問題總分與胼胝體厚呈負相關(r=-0.252,P0.05)。在4-5歲和6～11歲兩個年齡段,攻擊性因子分均與胼胝體厚呈負相關(r=-0.291,-0.323：P0.05,P0.01)。 (2)行為問題與認知功能的關系：在4-5歲年齡段,抑郁因子分與治療前RSS呈負相關(r=-0.246,P0.05)；在6-11歲年齡段,行為問題總分與治療前NEF呈負相關(r=-0.227,P0.05)。在4-5歲和6-11歲兩個年齡段,社交退縮因子分均與治療前NEF呈負相關(r=-0.225,-0.344；P0.05,P0.01)。 3.顱腦結構與認知功能的關系 縱裂寬度與治療后P300潛伏期呈正相關(r=0.315,P0.05),額葉腦溝寬與治療后P300波幅呈負相關(r=-0.353,P0.05)。 結論 1.首發(fā)兒童精神分裂癥患者病前社會能力與行為問題均與顱腦結構存在相關關系,社會能力越低,行為問題越多,腦室擴大和腦結構異常越明顯。 2.首發(fā)兒童精神分裂癥患者病前社會能力與行為問題均與認知功能存在相關關系,社會能力越低,行為問題越多,認知功能損害越嚴重。 3.首發(fā)兒童精神分裂癥患者顱腦結構與認知功能之間存在相關關系,腦室擴大和腦結構異常越明顯,認知功能損害越嚴重。
[Abstract]:objective
To investigate the preclinical behavioral characteristics, cranial structure and cognitive function of the first onset children with schizophrenia, and to explore the relationship between premorbid behavioral characteristics and brain structural characteristics and cognitive function.
Method
1. the subjects of 102 schizophrenic children were selected as the research subjects.
2. with the Achenbach Child Behavior Checklist (Child Behavior, Check-list, CBCL), a retrospective survey of patients in the 4~5 and 6~11 years of age characteristics. The two part points the project scale including the social ability and behavior problems, social behavior problems on ability to remember scores, total score and seven factors (the splitting of compulsion, depression, body v., social withdrawal, hyperactivity, aggression and discipline).
3. in the magnetic resonance imaging (Magnetic resonance, imaging, MRI) brain structure were measured, the measurement indicators include: the three ventricle diameter, three ventricle wall surface distance to the left and right insula, anterior horn of lateral ventricle spacing, lateral ventricle maximum distance, about the width of the temporal horn, left and right lateral sulcus width split root the frontal sulci, parietal lobe width, groove width, slit width, right caudate head width and thickness of the corpus callosum.
4. by event related potentials (Event-related Potentials, ERP P300) and exploratory eye movement (exploratory eye, movement, EEM) to evaluate the cognitive function of patients, evaluation index including P300 latency and amplitude, the evaluation index of EEM (number of eye including gaze points fixations, NEF) and responsive search score (responsive search score. RSS).
5. using t test to compare CBCL scale factors between high score and low score in patients with brain structure measurements before and after treatment of P300 and EEM and the difference in the data, analysis and comparison of CBCL scale differences between the various factors of the high score and low score in patients with brain structure measurement value by analysis of covariance, CBCL scale factors using Pearson correlation analysis, brain structure measurement, the relationship between P300 and EEM index data before and after treatment.
Result
The relationship between the social ability of the 1.CBCL scale and the craniocerebral structure and cognitive function:
(1) the relationship between social competence and brain structure: in 4-5 years of age, total score and social ability were positively related to corpus callosum body thickness (r=0.253, P0.05); in 6-11 years of age, social ability score and the right width of the temporal horn was positively correlated (r=0.345, P0.01); in the 4-5 and 6-11 year old age of two social competence scores are, and parietal lobe groove width was negatively correlated (r=-0.253, -0.273, P0.05).
(2) the relationship between social function and cognitive function: the total score of social ability was negatively correlated with the latent period of P300 before treatment (r=-0.215, -0.231; P0.05) at 4~5 and 6-11 years old two age groups.
The relationship between the behavior problems of the 2. CBCL scale and the craniocerebral structure and cognitive function:
(1) the relationship between behavior problems and brain structure: in 4-5 years of age, forced split factors with the anterior horn of the lateral ventricle spacing was positively correlated (r=0.316, P0.05), depression factor score, body action factor scores, social withdrawal scores and behavior problems score and right lateral root width was positively related to brain sulcus (r=0.347,0.278,0.289,0.309:P0.05, P0.01). In 6-11 years of age, split forcing factor, depression factor scores and the three ventricle diameter was related (r=0.301,0.264; P0.05), the total score of CBCL was negatively correlated with the corpus callosum thickness (r=-0.252, P0.05). At the age of 4-5 and 6~11 years old in two age, aggressive factor scores were the corpus callosum was negatively correlated with thickness (r=-0.291, -0.323:P0.05, P0.01).
(2) the relationship between function and cognitive behavior: in 4-5 years of age, depression factor score before treatment with RSS showed a negative correlation (r=-0.246, P0.05); in 6-11 years of age, behavior problems score and NEF before treatment were negatively correlated (r=-0.227, P0.05). In the 4-5 and 6-11 year old age two section, social withdrawal factor scores were negatively correlated with before treatment NEF (r=-0.225, -0.344; P0.05, P0.01).
3. the relationship between craniocerebral structure and cognitive function
There was a positive correlation between the width of the longitudinal fissure and the latent period of P300 after treatment (r=0.315, P0.05). The width of the frontal lobe was negatively correlated with the amplitude of the P300 wave after treatment (r=-0.353, P0.05).
conclusion
1., the social ability and behavior problems of the first onset children with schizophrenia were correlated with the brain structure. The lower the social competence, the more behavioral problems, the more obvious the ventricular enlargement and the brain structural abnormalities.
2., the onset of children's schizophrenia and social function and behavioral problems are all related to cognitive function. The lower social competence, the more behavioral problems, the more serious the cognitive impairment is.
3., there is a correlation between cranial structure and cognitive function in the first onset children with schizophrenia. The greater the ventricular enlargement and the more abnormal brain structure, the more serious the cognitive impairment is.

【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R749.3

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