發(fā)布時(shí)間：2018-04-30 13:45

  本文選題：兒童期創(chuàng)傷 + 皮質(zhì)醇覺醒反應(yīng)��； 參考：《中南大學(xué)》2014年博士論文

【摘要】：目的 兒童期創(chuàng)傷是兒童時(shí)期最常見的心理應(yīng)激事件,會(huì)顯著地影響兒童和青少年的身心發(fā)展,目前已成為了一個(gè)全球廣泛關(guān)注的重大社會(huì)公共衛(wèi)生問題。大量的流行病學(xué)調(diào)查顯示兒童期創(chuàng)傷與許多精神疾病和不良行為的發(fā)生顯著相關(guān),但兒童期創(chuàng)傷導(dǎo)致個(gè)體對精神疾病易感的生物學(xué)機(jī)制目前仍不清楚。因此本研究的主要目的是探討兒童期創(chuàng)傷對健康成人下丘腦-垂體-腎上腺(HPA)軸系統(tǒng)功能以及腦結(jié)構(gòu)和腦功能的影響,試圖為兒童期創(chuàng)傷致個(gè)體對精神疾病易感的潛在生物學(xué)機(jī)制提供可能的證據(jù)。 方法 本研究主要分為兩個(gè)部分：首先采用一般情況表、兒童期創(chuàng)傷問卷、抑郁自評量表、焦慮自評量表、功能失調(diào)性態(tài)度問卷、社會(huì)支持量表以及簡版艾森克人格問卷對555名在校大學(xué)生人群進(jìn)行兒童期創(chuàng)傷發(fā)生率及其相關(guān)心理特征的調(diào)查；其次招募24例伴兒童期創(chuàng)傷的健康成人以及24例年齡、性別匹配的不伴兒童期創(chuàng)傷的健康對照,對所有受試者采集晨起覺醒后0、30、45、60分鐘時(shí)的唾液樣本以檢測皮質(zhì)醇覺醒反應(yīng),同時(shí)采用飛利浦3.OT磁共振儀收集腦結(jié)構(gòu)、彌散張量成像和靜息態(tài)功能磁共振數(shù)據(jù)。磁共振數(shù)據(jù)分析分別采用基于體素的形態(tài)學(xué)分析法、基于體素的分析法和基于局部一致性的分析法。 結(jié)果 1.調(diào)查顯示555名大學(xué)生中有103名報(bào)告存在兒童期創(chuàng)傷史,占調(diào)查總?cè)藬?shù)的18.6%,其中42.7%的個(gè)體報(bào)道存在兩種或兩種以上類型的童年創(chuàng)傷經(jīng)歷,最常見的創(chuàng)傷類型為軀體忽略。兒童期創(chuàng)傷的發(fā)生率和創(chuàng)傷的類型無明顯的性別差異。伴兒童期創(chuàng)傷的個(gè)體抑郁自評量表、焦慮自評量表、功能失調(diào)性態(tài)度問卷以及艾森克人格問卷的P、N維度分均顯著升高；而社會(huì)支持量表以及艾森克人格問卷的E維度分則顯著降低。2.伴兒童期創(chuàng)傷的個(gè)體晨起后30、45分鐘時(shí)的唾液皮質(zhì)醇水平顯著升高,皮質(zhì)醇覺醒反應(yīng)曲線下面積和曲線下增加的面積也顯著升高,皮質(zhì)醇覺醒反應(yīng)曲線下面積分別與兒童期創(chuàng)傷問卷的情感虐待分和總分呈顯著的正相關(guān)。3.伴兒童期創(chuàng)傷的受試者右側(cè)中扣帶回、左側(cè)額中回、左側(cè)內(nèi)側(cè)前額葉皮質(zhì)灰質(zhì)體積均顯著減小,且兒童期創(chuàng)傷問卷總分與右側(cè)中扣帶回、左側(cè)額中回灰質(zhì)體積呈負(fù)相關(guān),皮質(zhì)醇覺醒反應(yīng)曲線下面積與右側(cè)中扣帶回灰質(zhì)體積呈負(fù)相關(guān)。4.伴兒童期創(chuàng)傷的個(gè)體胼胝體膝部和體部以及左側(cè)枕葉梭狀回白質(zhì)FA值顯著降低。5.伴兒童期創(chuàng)傷的受試者雙側(cè)島葉、左側(cè)顳上回、右側(cè)頂下葉ReHo值顯著降低；而后扣帶回ReHo值顯著升高。 結(jié)論 1.大學(xué)生人群中兒童期創(chuàng)傷的發(fā)生率為18.6%,伴兒童期創(chuàng)傷的成人存在更多的抑郁、焦慮情緒、歪曲認(rèn)知和人格缺陷,同時(shí)他們的社會(huì)支持也更少。2.兒童期創(chuàng)傷可引起個(gè)體成年后HPA軸異常激活、腦灰質(zhì)結(jié)構(gòu)、白質(zhì)完整性和腦靜息態(tài)功能異常改變。這些改變即使在健康人中也早已存在,可能反映了伴兒童期創(chuàng)傷個(gè)體對精神疾病易感的生物學(xué)特征。3.伴兒童期創(chuàng)傷個(gè)體扣帶回灰質(zhì)體積的減小可能與皮質(zhì)醇水平的升高相關(guān)。
[Abstract]:objective
Childhood trauma is the most common psychological stress event in childhood, which will significantly affect the physical and mental development of children and adolescents. At present, it has become a major social public health problem worldwide. A large number of epidemiological investigations show that childhood trauma is closely related to the occurrence of many seminal diseases and bad behavior, but The main purpose of this study is to explore the effects of childhood trauma on the function of the hypothalamus pituitary adrenal (HPA) axis system and the brain structure and brain function in healthy adults. The biological mechanism provides possible evidence.
Method
This study was divided into two parts: first, the general table, the childhood trauma questionnaire, the self rating depression scale, the self rating anxiety scale, the dysfunctional attitude questionnaire, the social support scale and the simple Eysenck personality questionnaire were used to investigate the incidence of childhood trauma and their related psychological characteristics in 555 College Students. Secondly, 24 healthy adults with childhood trauma and 24 age, sex matched healthy controls without childhood trauma were recruited to collect saliva samples at 0,30,45,60 minutes after morning awakening to detect the cortisol awakening reaction, and the PHILPS 3.OT magnetic resonance apparatus was used to collect the brain structure, diffuse tensor imaging and Resting state functional magnetic resonance data. The analysis of magnetic resonance data is based on voxel based morphological analysis, based on voxel analysis and analysis based on local consistency.
Result
1. the survey showed that 103 of the 555 college students reported childhood trauma history, accounting for 18.6% of the total number of respondents. 42.7% of them reported two or more than two types of childhood trauma experience, the most common type of trauma was physical neglect. There was no significant gender difference in the incidence of childhood trauma and the type of trauma. Children with children had no significant gender differences. The self rating depression scale, the self rating anxiety scale, the dysfunctional attitude questionnaire and the P personality questionnaire of Eysenck, and the N dimension scores were significantly higher, while the social support scale and the E dimension of the Eysenck personality questionnaire significantly decreased the salivary cortisol level at 30,45 minutes after the morning onset of.2. associated children. The area and the area under the curve under the cortisol awakening response curve increased significantly. The area under the cortisol response curve was significantly correlated with the emotional abuse and total score of the childhood trauma questionnaire. The right median cingulate gyrus, the left middle frontal cortex, the left medial prefrontal cortex were positively correlated with the.3. associated child trauma subjects. The volume of gray matter decreased significantly, and the total score of the childhood trauma questionnaire was negatively correlated with the right middle cingulate gyrus and the left middle frontal gyrus. The area under the cortisol response curve and the right cingulate cortex of the right cingulate gyrus were negatively related to the.4. associated child trauma in the individual corpus callosum and the body part and the left occipital spindle gyrus white matter FA value. The ReHo value of bilateral insula, left superior temporal gyrus, right inferior parietal lobe decreased significantly, while the ReHo value of the cingulate gyrus increased significantly in.5. subjects.
conclusion
1. the incidence of childhood trauma in the college students was 18.6%, and adults with associated child trauma had more depression, anxiety, distortion of cognitive and personality defects, and their social support less.2. childhood trauma could cause abnormal activation of the HPA axis, gray matter structure, white matter integrity and resting state function. These changes, even in healthy people, may have been existed in the healthy people, and may reflect the biological characteristics of the individual traumatized individuals for mental illness. The decrease in the cingulate volume of the cingulate cortex of the individual.3. associated child trauma may be associated with the increase of cortisol levels.

【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R749.4

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本文編號：1824787