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

【摘要】：目的 調(diào)查首發(fā)兒童精神分裂癥患者病前行為特征、顱腦結(jié)構(gòu)特征和認(rèn)知功能,探討本病病前行為特征與顱腦結(jié)構(gòu)特征及認(rèn)知功能之間的關(guān)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(duì)象。 2.采用Achenbach兒童行為量表(Child Behavior Check-list, CBCL),回顧性調(diào)查患者在4～5歲和6～11歲時(shí)的行為特征。量表記分項(xiàng)目包括社會(huì)能力和行為問(wèn)題兩部分,社會(huì)能力記總分,行為問(wèn)題記總分及七個(gè)因子分(分裂強(qiáng)迫、抑郁、體訴、社交退縮、多動(dòng)、攻擊性和違紀(jì))。 3.在磁共振成像(Magnetic resonance imaging, MRI)下測(cè)量患者的顱腦結(jié)構(gòu)特征,測(cè)量指標(biāo)包括：三腦室橫徑、三腦室側(cè)壁至左右腦島面距、側(cè)腦室前角間距、側(cè)腦室體最大距、左右顳角寬度、左右外側(cè)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(guān)電位(Event-related Potentials, ERP) P300和探究性眼動(dòng)分析(exploratory eye movement, EEM)評(píng)估患者的認(rèn)知功能,P300的評(píng)估指標(biāo)包括潛伏期和波幅,EEM的評(píng)估指標(biāo)包括凝視點(diǎn)數(shù)(number of eye fixations, NEF)和反應(yīng)性探索評(píng)分(responsive search score, RSS)。 5.用t檢驗(yàn)比較CBCL量表各因了高分組與低分組患者之間顱腦結(jié)構(gòu)測(cè)量值及治療前后P300及EEM各數(shù)據(jù)之間的差別,用協(xié)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(jié)構(gòu)測(cè)量值的差異,用Pearson相關(guān)分析分析CBCL量表各因子分、顱腦結(jié)構(gòu)測(cè)量值、治療前后P300及EEM指標(biāo)各數(shù)據(jù)之間的相互關(guān)系。 結(jié)果 1.CBCL量表社會(huì)能力與顱腦結(jié)構(gòu)及認(rèn)知功能的關(guān)系： (1)社會(huì)能力與顱腦結(jié)構(gòu)的關(guān)系：在4-5歲年齡段,社會(huì)能力總分與胼胝體厚呈正相關(guān)(r=0.253,P0.05)；在6-11歲年齡段,社會(huì)能力總分與右顳角寬度呈正相關(guān)(r=0.345,P0.01)；在4-5歲和6-11歲兩個(gè)年齡段,社會(huì)能力總分均與頂葉腦溝寬呈負(fù)相關(guān)(r=-0.253,-0.273,P0.05)。 (2)社會(huì)能力與認(rèn)知功能的關(guān)系：在4～5歲和6-11歲兩個(gè)年齡段,社會(huì)能力總分均與治療前P300潛伏期呈負(fù)相關(guān)(r=-0.215,-0.231；P0.05)。 2. CBCL量表行為問(wèn)題與顱腦結(jié)構(gòu)及認(rèn)知功能的關(guān)系： (1)行為問(wèn)題與顱腦結(jié)構(gòu)的關(guān)系：在4-5歲年齡段,分裂強(qiáng)迫因子分與側(cè)腦室前角間距呈正相關(guān)(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(wèn)題總分與右外側(cè)裂腦溝根部寬呈正相關(guān)(r=0.347,0.278,0.289,0.309：P0.05,P0.01)。在6-11歲年齡段,分裂強(qiáng)迫因子分、抑郁因子分與三腦室橫徑呈中相關(guān)(r=0.301,0.264；P0.05),行為問(wèn)題總分與胼胝體厚呈負(fù)相關(guān)(r=-0.252,P0.05)。在4-5歲和6～11歲兩個(gè)年齡段,攻擊性因子分均與胼胝體厚呈負(fù)相關(guān)(r=-0.291,-0.323：P0.05,P0.01)。 (2)行為問(wèn)題與認(rèn)知功能的關(guān)系：在4-5歲年齡段,抑郁因子分與治療前RSS呈負(fù)相關(guān)(r=-0.246,P0.05)；在6-11歲年齡段,行為問(wèn)題總分與治療前NEF呈負(fù)相關(guān)(r=-0.227,P0.05)。在4-5歲和6-11歲兩個(gè)年齡段,社交退縮因子分均與治療前NEF呈負(fù)相關(guān)(r=-0.225,-0.344；P0.05,P0.01)。 3.顱腦結(jié)構(gòu)與認(rèn)知功能的關(guān)系 縱裂寬度與治療后P300潛伏期呈正相關(guān)(r=0.315,P0.05),額葉腦溝寬與治療后P300波幅呈負(fù)相關(guān)(r=-0.353,P0.05)。 結(jié)論 1.首發(fā)兒童精神分裂癥患者病前社會(huì)能力與行為問(wèn)題均與顱腦結(jié)構(gòu)存在相關(guān)關(guān)系,社會(huì)能力越低,行為問(wèn)題越多,腦室擴(kuò)大和腦結(jié)構(gòu)異常越明顯。 2.首發(fā)兒童精神分裂癥患者病前社會(huì)能力與行為問(wèn)題均與認(rèn)知功能存在相關(guān)關(guān)系,社會(huì)能力越低,行為問(wèn)題越多,認(rèn)知功能損害越嚴(yán)重。 3.首發(fā)兒童精神分裂癥患者顱腦結(jié)構(gòu)與認(rèn)知功能之間存在相關(guān)關(guān)系,腦室擴(kuò)大和腦結(jié)構(gòu)異常越明顯,認(rèn)知功能損害越嚴(yán)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(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.3

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