【摘要】：背景 青少年超重和肥胖的流行趨勢在全球范圍內(nèi)升高,造成了他們進入成年早期就會面臨慢性代謝紊亂風(fēng)險的增加�，F(xiàn)有的流行病學(xué)已經(jīng)表明慢性心理社會應(yīng)激和兒童青少年肥胖相關(guān)。研究認為慢性應(yīng)激可促進過度飲食和體重增加,一部分原因是生理機制的失調(diào),包括應(yīng)激下皮質(zhì)醇等生物標志的分泌增加可引起身體對能量需求的增加,導(dǎo)致大腦信號對糖和脂肪等食物卡路里攝入的需求,與此同時,長期慢性應(yīng)激暴露使大腦和自我認知控制能力相關(guān)的中心區(qū)域功能活動受損,而控制卡路里的攝入和體重的增長需要自我認知控制能力,因此本研究主要評價青少年慢性心理社會應(yīng)激對BMI變化的預(yù)測作用以及慢性心理社會應(yīng)激如何通過影響認知情緒控制能力而促進肥胖的發(fā)展,并嘗試從神經(jīng)心理學(xué)角度去驗證應(yīng)激應(yīng)答—認知控制網(wǎng)絡(luò)和肥胖的相關(guān)關(guān)系。 目的 闡明慢性心理社會應(yīng)激是否促進青少年肥胖的發(fā)展以及認知控制功能在這一過程中作用。具體目的包括：①通過隨訪研究評價慢性心理社會應(yīng)激對青少年BMI的影響：②探討認知情緒控制在慢性應(yīng)激致青少年BMI增加中的中介作用；③從神經(jīng)心理學(xué)角度驗證應(yīng)激應(yīng)答—認知控制網(wǎng)絡(luò)和肥胖關(guān)系。 方法 研究一的對象為徐州城區(qū)初一和高一年級的中學(xué)生,采用方便整群抽樣方法于2011年9月分別在徐州城區(qū)選取10所中學(xué)(5所初中,5所高中),以所有在校的學(xué)生作為研究對象,進行2年的隨訪研究。基線收集人口統(tǒng)計學(xué)、社會心理應(yīng)激、情緒癥狀和生活行為方式等信息,采用青少年多維生活事件量表(Multidimensional Life Events Rating Questionnaire, MLERQ)作為社會心理應(yīng)激暴露測定,該量表包括家庭生活事件、學(xué)校生活事件、同伴關(guān)系、兩性關(guān)系及健康成長五大維度,基線調(diào)查共獲得5473名中學(xué)生(男性2841名,女性2632名)完整數(shù)據(jù)資料。2013年9月獲取第二輪體格檢查數(shù)據(jù),隊列研究共獲得完整數(shù)據(jù)資料4316名(其中男性2171名,女性2145名)。研究二對在隨訪研究中體重增加的超重肥胖青少年,并同時獲取基線的認知情緒控制信息,使用認知情緒控制量表(Cognitive Emotion Regulation Questionnaire, CERQ)作為評價認知情緒控制的工具,用來作為應(yīng)激致BMI增加的中介因素的評價。研究三選取初中女性青少年39人,其中肥胖組20人,同時選取同齡(出生日期相差不超過±3個月),身高相近(相差不超過±3cm),同班級,青春發(fā)育等級相當(dāng)?shù)恼ｓw重者19人。使用特里爾社會應(yīng)激實驗(Trier Social Stress Test for Children, TSST-C)作為心理應(yīng)激源,測定應(yīng)激前后皮質(zhì)醇反應(yīng)度,同時使用自我控制實驗室任務(wù)—延遲折扣(Delay Discounting, DD)實驗程序來評價青少年延遲滿足能力。 結(jié)果 基線調(diào)查中女性青少年慢性應(yīng)激總分和BMI-Z分在控制了年齡、青春發(fā)育等級、社會經(jīng)濟狀況和生活行為方式等協(xié)變量后相關(guān)性依然顯著。隨訪研究表明基線超重肥胖的女性青少年應(yīng)激總分和隨訪BMI-Z分增加相關(guān)有顯著統(tǒng)計學(xué)意義,而在男性中,基線調(diào)查中應(yīng)激總分和BMI-Z分的相關(guān)性無顯著統(tǒng)計學(xué)意義,隨訪研究顯示無論在體重正常或超重肥胖組,應(yīng)激總分和隨訪BMI-Z分變化的相關(guān)性無顯著統(tǒng)計學(xué)意義。 超重肥胖女性青少年暴露于慢性應(yīng)激下可致2年后體重的增加,而高水平慢性應(yīng)激可使正向認知情緒控制能力下降,從而會導(dǎo)致2年后BMI的增加,提示認知情緒控制能力在應(yīng)激致BMI增加中的中介作用。 肥胖組女性青少年和正常體重組相比具有更高的皮質(zhì)醇反應(yīng)度和更低的延遲折扣率,同時,肥胖組青少年皮質(zhì)醇反應(yīng)度高者延遲折扣率更低,兩者呈顯著負相關(guān),且相關(guān)性具有顯著統(tǒng)計學(xué)意義,而在體重正常組兩者相關(guān)性無顯著統(tǒng)計學(xué)意義。 結(jié)論 慢性心理社會應(yīng)激暴露可導(dǎo)致青春期超重肥胖女性未來的BMI增加,女性超重肥胖青少年為慢性應(yīng)激心理社會致體重增加的易感人群。同時結(jié)果也顯示認知情緒控制在超重肥胖青少年慢性應(yīng)激致體重增加中的中介效應(yīng)(即慢性社會心理應(yīng)激—認知情緒控制—BMI),提示在這些人群中進行認知情緒干預(yù)以控制未來體重增長非常必要。最后,研究從神經(jīng)心理學(xué)角度驗證了應(yīng)激應(yīng)答—認知控制網(wǎng)絡(luò)和肥胖關(guān)系,提出了肥胖青少年中HPA軸高活動性可影響延遲折扣水平(即延遲滿足能力),以此推測應(yīng)激應(yīng)答系統(tǒng)的過敏性可能導(dǎo)致對美味高能食物需求的控制能力減弱,從而導(dǎo)致能量攝入過多使體重增加。
[Abstract]:background The prevalence of overweight and obesity among adolescents is rising globally, creating an increase in the risk of chronic metabolic disorders that they face in early adulthood. The current epidemiology has shown that chronic psychosocial stress and childhood obesity The study found that chronic stress can promote over-eating and weight gain, a part of which is the disorder of the physiological mechanism, including the increase in the secretion of biological markers such as cortisol, which can lead to increased body-to-energy demand, resulting in the need for food-calorie intake of the brain signal to sugar and fat At the same time, chronic stress exposure, at the same time, has impaired the function of the central region associated with the brain and self-cognitive control, while the control of caloric intake and body weight requires self-cognitive control. Therefore, this study mainly evaluates the effect of chronic psychological and social stress on the change of BMI, and how to promote the development of obesity by influencing the control ability of cognitive emotion. Exhibitions and attempts to validate stress response, cognitive control network, and related to obesity from a neuropsychological point of view Department. Objective To study whether the chronic psychological social stress promotes the development of juvenile obesity and the function of cognitive control. The purpose of this study was to evaluate the effect of chronic psychological social stress on the BMI of adolescents by follow-up study: to explore the intermediate role of cognitive-emotional control in the increase of BMI of young people with chronic stress, and to verify the cognitive control network of stress response from the point of neuropsychology. and fertilizer The aim of the method is to select the middle school students of the first and the second grades of Xuzhou urban area, and select 10 secondary schools (5 junior high schools and 5 high schools) in Xuzhou City in September 2011, respectively, to take all the students in the school as a study object, A 2-year follow-up study was conducted. Baseline collection of information such as demographic, psychosocial stress, mood symptoms, and lifestyle behavior was measured using the Multi-dimensional Life Events Rating Questionnaire (MLERQ) as a psychosocial stress exposure, which included family life In the five dimensions of events, school life events, peer relationship, sexual relations and healthy growth, a total of 5473 middle school students (2841 males and 2632 females) were obtained from the baseline survey, and a second round of physical examination data was obtained in September 2013, and a total of 4316 complete data were obtained from the cohort study. Of these, 2,171 men Two pairs of overweight and obese adolescents with weight gain in the follow-up study were studied, and the cognitive mood control information of the baseline was acquired at the same time, and the cognitive mood control scale (CERQ) was used as an evaluation. A tool for cognitive mood control, which is used as a stress-induced BMI. The middle school of the middle school is 39 people, among which 20 are the obese group, while the same age is selected (the date of birth is not more than 3 months), the height is close (the phase difference is not more than 3 cm), the same class and the level of the development of the youth are comparable. The response of cortisol before and after stress was measured using the Trier Social Stress Test for Children (TSST-C) as a source of psychological stress. green and small The annual delay meets the capacity. The total score of chronic stress and BMI-Z in female adolescents in the baseline survey are controlled by age, level of youth development, socio-economic status and life The correlation was still significant after covariates of the formula. The follow-up study showed significant statistical significance for the overall score of stress and the follow-up of BMI-Z for women with overweight and obese, whereas in men, the total score of stress and BMI-Z in the baseline survey The correlation of the scores was not statistically significant, and the follow-up study showed that the total score of the stress and the follow-up BMI-Z were varied, either in the normal or overweight obese group, There is no significant statistical significance in the correlation between overweight and obese women. The exposure of overweight and obese women to chronic stress can increase the body weight after 2 years, while the high level of chronic stress can lead to a decrease in the control ability of the positive cognitive mood, which can lead to an increase in BMI after 2 years, indicating the control ability of the cognition. The intermediate effect of the increase of the stress-induced BMI is that the obese group has higher cortisol response and lower delayed discount rate as compared with the normal body recombination, while the higher the delayed discount rate of the higher of the hypercortisolism in the obese group, both of which are significant. There was a negative correlation, and the correlation was statistically significant, and in the body heavy-and-right Conclusion The exposure of chronic psychological social stress can lead to the increase of the future BMI of the overweight and obese women and the overweight and obesity of the female. The results also show the intermediate effect of cognitive mood control in the weight gain of overweight and obese adolescents with chronic stress (i.e., chronic social psychological stress and cognitive mood control, BMI), suggesting that in these people Cognitive emotion intervention is necessary to control the future weight growth. Finally, the study of the cognitive control network and the obesity relation of stress response from the angle of neuropsychology has put forward the high HPA axis in obese adolescents. Activity may affect the delay discount level (i.e., the delay meets the ability) to infer that the response to the stress response system may lead to a control of the demand for a delicious high-energy food
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R723.14

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本文編號：2386054