發(fā)布時(shí)間：2018-07-22 15:40

【摘要】：目的：兒童青少年雙相障礙(PBD)是一種嚴(yán)重的退化性的疾病,以反復(fù)發(fā)作的躁狂和抑郁癥狀為特征。早期的磁共振(MRI)研究主要研究PBD的情感或認(rèn)知相關(guān)腦區(qū)的改變。很少有研究探索PBD患兒的情感-認(rèn)知雙神經(jīng)環(huán)路。我們的實(shí)驗(yàn)是為了探知PBD患者的異常情感-認(rèn)知雙神經(jīng)環(huán)路,并研究是否隨著疾病的緩解腦區(qū)活性也隨之改變。 研究方法：我們的研究主要分為三部分。 1.PBD患者結(jié)構(gòu)磁共振的研究。實(shí)驗(yàn)包含了躁狂相18人、緩解相15人和對(duì)照組18人。 2.PBD患者任務(wù)態(tài)磁共振的研究。我們運(yùn)用情緒性go/nogo的任務(wù)。此任務(wù)中運(yùn)用的情緒面孔來自于Ekman的1976年編制的部分情緒面孔。所選面孔進(jìn)行了健康青少年識(shí)別率的測(cè)試。任務(wù)態(tài)磁共振研究包含了躁狂相15人、緩解相13人和對(duì)照組15人。 3.PBD患者靜息態(tài)磁共振的研究。我們運(yùn)用了局部一致性(Regional Homogeneity, ReHo)的方法。實(shí)驗(yàn)包括了躁狂相19人、緩解相17人和對(duì)照組19人。 結(jié)果：1.結(jié)構(gòu)磁共振研究結(jié)果發(fā)現(xiàn)三組方差分析有左側(cè)海馬、海馬旁回、杏仁核的體積差異。兩樣本下t檢驗(yàn)的結(jié)果顯示青少年雙相障礙躁狂相和緩解相相比對(duì)照組都有左側(cè)海馬、海馬旁回、杏仁核的體積減少；而躁狂相相比緩解相沒有明顯的組間差異。同時(shí),沒有發(fā)現(xiàn)躁狂期和緩解期患者的年齡、病程、發(fā)病次數(shù)與左側(cè)海馬、海馬旁回、杏仁核的體積大小有相關(guān)性。 2.任務(wù)態(tài)磁共振的結(jié)果。情緒性干擾因素相比中性干擾因素,方差結(jié)果顯示三組間有活性差異的腦區(qū)為：雙側(cè)額上回、雙側(cè)背中央前額皮質(zhì)、左側(cè)背側(cè)前額皮質(zhì)、雙側(cè)中下眶額皮質(zhì)、右腹側(cè)前扣帶回、左背側(cè)前扣帶回、右側(cè)后扣帶回、雙側(cè)上中顳葉、右側(cè)殼核、雙側(cè)腦島、雙側(cè)海馬、左側(cè)海馬旁回、雙側(cè)丘腦、雙側(cè)上下頂葉、雙側(cè)楔葉和楔前葉和雙側(cè)中下枕回。進(jìn)行方差限定下兩樣本t檢驗(yàn)的分析得出,躁狂相對(duì)比緩解相顯示左側(cè)背側(cè)前額皮質(zhì)和左側(cè)上頂葉有更高活性。 3.靜息態(tài)磁共振方差結(jié)果顯示三組間有ReHo值有差異的腦區(qū)為：右側(cè)額上回、右側(cè)中央前回、右側(cè)眶額皮質(zhì)、右側(cè)背側(cè)前扣帶回、雙側(cè)上顳葉、雙側(cè)腦島、雙側(cè)上頂葉和雙側(cè)楔前葉。進(jìn)行方差限定下兩樣本t檢驗(yàn)的分析得出,躁狂相相比緩解相ReHo值減小的腦區(qū)有：雙側(cè)楔前葉；ReHo值增大的腦區(qū)有雙側(cè)腦島。 結(jié)論：我們的研究從多個(gè)角度發(fā)現(xiàn)PBD腹側(cè)-情感和背側(cè)-認(rèn)知環(huán)路的異常,為闡明PBD的病理生理基礎(chǔ)提供了新的視角。圖17幅,表19個(gè),參考文獻(xiàn)382篇
[Abstract]:Objective: bipolar disorder (PBD) in children and adolescents is a severe degenerative disease characterized by recurrent mania and depression. Early magnetic resonance imaging (MRI) studies focused on affective or cognitive-related brain changes in PBD. Few studies have explored the affective-cognitive double neural loop in children with PBD. Our experiment was to detect abnormal affective cognitive double neural loops in PBD patients and to see if the activity of brain regions changed with the remission of the disease. Methods: our study was divided into three parts. 1. Structural MRI study of PBD patients. The study included 18 patients with manic phase, 15 patients with remission phase and 18 patients with control group. 2. We use emotional go/nogo tasks. The emotional faces used in this task came from some emotional faces compiled by Ekman in 1976. The selected faces were tested on the recognition rate of healthy adolescents. The task-based magnetic resonance study included 15 patients in manic phase, 13 in remission phase and 15 in control group. 3. The study of resting magnetic resonance in PBD patients. We use the method of regional homogeneity (ReHo). The experiment included 19 patients with manic phase, 17 patients with remission phase and 19 people with control group. The result is 1: 1. The results of structural magnetic resonance analysis showed that there were differences in volume of left hippocampus, perihippocampal gyrus and amygdala in the three groups. T test under two samples showed that the volume of left hippocampal, para-hippocampal gyrus and amygdala decreased in bipolar disorder manic phase and remission phase, but there was no significant difference in remission phase in manic phase. At the same time, no correlation was found between age, course of disease and frequency of onset in patients with mania and remission with the volume of left hippocampus, perihippocampal gyrus and amygdala. 2. The results of task-based magnetic resonance imaging. Compared with neutral interference factors, the variance of emotional interference factors showed that the brain regions with different activity were bilateral superior frontal gyrus, bilateral dorsal central prefrontal cortex, left dorsal prefrontal cortex, bilateral middle and lower orbital frontal cortex, right ventral anterior cingulate gyrus. Left dorsal cingulate gyrus, right posterior cingulate gyrus, bilateral superior middle temporal lobe, right putamen nucleus, bilateral cerebral island, bilateral hippocampus, left paracarpal gyrus, bilateral thalamus, bilateral superior parietal lobe, bilateral cuneiform lobe and prewedge lobe and bilateral middle and inferior occipital gyrus. T test of two samples under variance limitation showed that mania showed higher activity in the left dorsal prefrontal cortex and left superior parietal lobe than in the remission phase. The results of resting magnetic resonance variance showed that the difference of ReHo value among the three groups was as follows: right superior frontal gyrus, right precentral gyrus, right orbital frontal cortex, right dorsal anterior cingulate gyrus, bilateral superior temporal lobe, bilateral cerebral island. Bilateral superior parietal lobe and bilateral anterior cuneate lobe. The results of t-test of two samples under the limit of variance showed that the decrease of ReHo value in the manic phase compared with that in the remission phase was found in the brain regions with the increase of ReHo value in the bilateral precuneiform lobe and there were bilateral cerebral islands in the brain regions where the value of ReHo in the bilateral precuneial lobe increased. Conclusion: our study found the abnormality of the ventral-affective and dorsal-cognitive loops in PBD from several angles, which provides a new perspective for elucidating the pathophysiological basis of PBD. 17 figures, 19 tables, 382 references
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R749.94;R445.2

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本文編號(hào)：2137938