本文選題：原發(fā)性失眠 + 基于體素的形態(tài)學(xué)測(cè)量　； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：目的 應(yīng)用基于體素的形態(tài)學(xué)測(cè)量（voxel-based morphometry，VBM）技術(shù)和靜息態(tài)功能連接磁共振（resting state functional connectivity magnetic resonanceimaging，rs-fcMRI）技術(shù)方法，研究原發(fā)性失眠（primary insomnia，PI）患者腦結(jié)構(gòu)和功能連接的改變，探討原發(fā)性失眠異常生物學(xué)特性和抑郁障礙可能存在的腦結(jié)構(gòu)及腦功能連接異常的病理生理機(jī)制，為PI的臨床診斷、治療提供影像學(xué)依據(jù)。 資料與方法 30例未經(jīng)治療的原發(fā)性失眠患者且符合《美國精神障礙診斷和統(tǒng)計(jì)手冊(cè)第四版》（DSM-IV）診斷標(biāo)準(zhǔn)，其中有15例PI伴有輕中度抑郁癥狀（primaryinsomnia with depression，PID）與15名的正常對(duì)照組（normal control，NC）進(jìn)行三維腦結(jié)構(gòu)和靜息態(tài)血氧水平依賴功能磁共振成像檢查。所有受試者進(jìn)行臨床量表（匹茲堡睡眠質(zhì)量指數(shù)PSQI、漢密爾頓焦慮量表HAMA、漢密爾頓抑郁量表HAMD和Rey復(fù)雜圖形測(cè)試RCFT）的測(cè)評(píng)。所得掃描數(shù)據(jù)通過Matlab軟件上SPM8（statistical parametric maps）進(jìn)行VBM腦結(jié)構(gòu)形態(tài)學(xué)分析，比較三組受試者腦灰質(zhì)結(jié)構(gòu)的差異；使用REST軟件以雙側(cè)前扣帶回為種子點(diǎn)進(jìn)行靜息態(tài)腦功能連接分析，比較三組之間腦功能連接的差異；使用SPSS17.0軟件包進(jìn)行統(tǒng)計(jì)分析，對(duì)異常腦功能連接區(qū)與各量表評(píng)分進(jìn)行相關(guān)性分析。 結(jié)果 1一般資料三組的性別、年齡及受教育程度比較均無統(tǒng)計(jì)學(xué)差異（P＞0.05）。 2VBM顯示 1、與NC比較，PI患者的雙側(cè)額葉皮質(zhì)、顳葉皮質(zhì)、楔前葉、前扣帶回、腦島、尾狀核、左側(cè)豆?fàn)詈�、頂上回、中央旁小葉、枕中回、海馬、海馬旁回、小腦腳及右側(cè)梭狀回、邊緣葉/后扣帶回體積減少，左側(cè)顳中回體積增大（P＜0.001，簇大小cluster＞50voxels）。 2、與NC比較，PID患者雙側(cè)額上回/補(bǔ)充運(yùn)動(dòng)區(qū)、顳葉皮質(zhì)、邊緣葉/前扣帶回、楔前葉、小腦后葉/小腦8區(qū)、左側(cè)梭狀回、枕葉皮質(zhì)、小腦前葉及右側(cè)內(nèi)側(cè)額上回、島蓋部額下回、角回/緣上回體積減少，雙側(cè)頂葉/中央后回、左側(cè)額中回、中央前后回、腦干/中腦及右側(cè)顳葉/Sub-Gyral、枕葉/舌回、邊緣葉/海馬旁回體積增大（P＜0.001，簇大小cluster＞50voxels）。 3、與PI患者比較，PID患者左側(cè)三角部額下回、顳下回、小腦后葉/小腦8區(qū)、小腦10區(qū)及右側(cè)額上回/補(bǔ)充運(yùn)動(dòng)區(qū)、額下回、角回/顳上回、顳葉/Sub-Gyral體積減小，雙側(cè)額上回/補(bǔ)充運(yùn)動(dòng)區(qū)、顳葉皮質(zhì)、楔前葉、小腦后葉/小腦8區(qū)、左側(cè)梭狀回、中央旁小葉、枕葉皮質(zhì)、前扣帶回和旁扣帶回、小腦前葉及右側(cè)顳中回/三角部額下回、前扣帶回/額中回、顳下回、角回/緣上回體積增大（P＜0.001，簇大小cluster＞50voxels）。 3RS-fcMRI顯示 3.1以雙側(cè)前扣帶回為種子點(diǎn)進(jìn)行腦功能連接分析 1、NC的腦功能連接神經(jīng)網(wǎng)絡(luò)包括雙側(cè)額葉皮質(zhì)、雙側(cè)頂葉/角回、右側(cè)緣上回/顳上回、左側(cè)間腦/內(nèi)側(cè)和旁扣帶腦回、右側(cè)邊緣葉/楔前葉/扣帶回、左側(cè)邊緣葉/海馬旁回、左側(cè)尾狀核/腦島/豆?fàn)詈?前扣帶和旁扣帶腦回、雙側(cè)顳葉皮質(zhì)與前扣帶回呈正相關(guān)；雙側(cè)局部額葉皮質(zhì)、右側(cè)頂葉皮質(zhì)、右側(cè)枕中回/枕上回、左側(cè)顳下回/梭狀回/枕中回、右側(cè)枕葉/梭狀回/舌回/顳下回、左側(cè)小腦半球與前扣帶回呈負(fù)相關(guān)（P＜0.01，體素簇＞20voxels）。 2、PI患者的異常腦功能神經(jīng)網(wǎng)絡(luò)包括左側(cè)額葉/額中回、雙側(cè)頂葉皮質(zhì)、左側(cè)顳下回/枕下回/枕中回、右側(cè)小腦半球與前扣帶回呈負(fù)相關(guān)；左側(cè)前扣帶回/額上回/內(nèi)側(cè)額上回/尾狀核/豆?fàn)詈?眶部額下回/腦島、雙側(cè)顳下回/顳中回、左側(cè)頂葉/角回、左側(cè)頂葉/楔前葉/后扣帶回、右側(cè)邊緣葉/扣帶回/內(nèi)側(cè)和旁扣帶腦回與前扣帶回呈正相關(guān)（P＜0.01，體素簇＞20voxels）。 3、PID患者的異常腦功能神經(jīng)網(wǎng)絡(luò)包括雙側(cè)頂上小葉/頂下回/頂上回、左側(cè)楔前葉、左側(cè)額中回/中央前回、左側(cè)枕中回/枕下回、右側(cè)小腦后葉/下半月小葉/小腦7b區(qū)與前扣帶回呈負(fù)相關(guān)；左側(cè)頂葉/角回/緣上回、左側(cè)后扣帶回/楔前葉、右側(cè)尾狀核頭/尾狀核、左側(cè)額中回/前扣帶回/額上回/前扣帶和旁扣帶腦回/內(nèi)側(cè)額上回/內(nèi)側(cè)和旁扣帶回/中央旁小葉與前扣帶回呈正相關(guān)（P＜0.01，體素簇＞20voxels）。 4、與NC比較，PI患者與前扣帶回功能連接負(fù)相關(guān)腦區(qū)有右側(cè)顳下回、右側(cè)頂上回/頂上小葉/頂下小葉、左側(cè)邊緣葉/扣帶回，與前扣帶回功能連接正相關(guān)腦區(qū)有左側(cè)小腦前葉/山頂/舌回（P＜0.01，體素簇＞20voxels）。 5、與NC比較，PID患者與前扣帶回功能連接負(fù)相關(guān)腦區(qū)有腦干/中腦、左側(cè)顳中回、左側(cè)小腦后葉/小腦Crus1區(qū)，與前扣帶回功能連接正相關(guān)腦區(qū)有左側(cè)頂葉/Sub-Gyral/中央溝蓋、左側(cè)額葉/Sub-Gyral/三角部額下回、右側(cè)頂葉/枕中回、右側(cè)頂上回（P＜0.01，體素簇＞20voxels）。 6、與PI患者比較，PID患者左側(cè)胼胝體/后扣帶回與前扣帶回功能連接負(fù)相關(guān)，中腦右份與前扣帶回功能連接正相關(guān)（P＜0.01，體素簇＞20voxels）。 3.2相關(guān)性分析 1、PI患者與NC組腦功能連接異常區(qū)：左側(cè)扣帶回、左側(cè)舌回、右側(cè)顳下回、右側(cè)頂上回功能連接與PSQI值無明顯相關(guān)性（P＞0.05）。 2、PID患者與NC組腦功能連接異常區(qū)：中腦、左側(cè)顳中回、左側(cè)小腦Crus1區(qū)功能連接與PSQI值呈明顯負(fù)相關(guān)性（P＜0.05），左側(cè)中央溝蓋、左側(cè)三角部額下回、右側(cè)枕中回、右側(cè)頂上回功能連接與其無明顯關(guān)聯(lián)性（P＞0.05）。除了右側(cè)頂上回功能連接的程度與HAMD值呈正相關(guān)（P＜0.05），其他腦功能連接異常區(qū)與其無明顯相關(guān)性（P＞0.05）。 3、PID患者與PI患者腦功能連接異常區(qū)：左側(cè)后扣帶回功能連接與HAMD值呈正相關(guān)性（P＜0.05），中腦右份與HAMD值無明顯關(guān)聯(lián)性（P＞0.05）。結(jié)論 與NC比較，PI患者與PID均有腦結(jié)構(gòu)及腦功能連接的改變，這些可能與原發(fā)性失眠的病理生物學(xué)機(jī)制有關(guān)；PI患者左側(cè)前扣帶回/腦島、左側(cè)后扣帶回、右側(cè)邊緣葉/扣帶回/內(nèi)側(cè)和旁扣帶腦回與ACC連接增強(qiáng)，與PI患者比較，，PID患者左側(cè)胼胝體/后扣帶回與ACC功能連接減弱，額葉、邊緣葉與ACC功能連接增強(qiáng)，這些均支持了PI患者伴發(fā)抑郁情緒會(huì)存在異常的腦網(wǎng)絡(luò)連接；VBM及RS-fcMRI準(zhǔn)確有效的評(píng)價(jià)PI患者腦形態(tài)學(xué)和功能狀態(tài)的改變，為PI的神經(jīng)認(rèn)知科學(xué)領(lǐng)域的研究提供了影像解剖學(xué)基礎(chǔ)。
[Abstract]:Purpose

Based on voxel - based morphological measurements ( VBM ) and resting state functional connectivity magnetic resonance ( rs - fcMRI ) , the changes of brain structure and function were studied in primary insomnia ( PI ) patients .

data and methods

Thirty patients with primary insomnia who were untreated and conformed to the diagnostic criteria of the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders ( DSM - IV ) in the United States . Among them , 15 patients with PI accompanied with mild to moderate depressive symptoms ( PID ) and 15 normal control ( NC ) were tested for three - dimensional brain structure and resting state blood oxygen level dependent functional magnetic resonance imaging . All subjects underwent a clinical rating scale ( Pittsburgh Sleep Quality Index , PSQI , Hamilton Anxiety Scale HAMA , Hamilton Depression Scale ) and Rey Complex Graphic Test ( RTs ) . The obtained scan data were analyzed by means of SPM8 ( statistical parametric maps ) on Matlab software to compare the differences in the structure of cerebral gray matter in three groups of subjects ;
Using REST software to carry out the resting state brain function connection analysis of two - sided front - button gyrus as seed point , and compare the difference of functional connections among three groups ;
Statistical analysis was carried out using SPSS 17.0 software package , and the correlation between abnormal brain function connecting area and each scale score was analyzed .

Results

There was no significant difference in sex , age and educational level among the three groups ( P > 0.05 ) .

2VBM display

1 . Compared with NC , PI patients had bilateral frontal cortex , temporal lobe cortex , anterior wedge lobe , anterior subulate gyrus , cerebral island , tail nucleus , left bean nucleus , top gyrus , central parlobule , middle gyrus , hippocampus , parahippocampal gyrus , cerebellar peduncle and right fusiform gyrus . The volume of left temporal gyrus increased ( P & lt ; 0.001 , cluster size cluster & gt ; 50 擄 ) .

2 . Compared with NC , the double - lateral frontal / supplementary sports area of PID patients , temporal lobe cortex , marginal leaf / anterior subulate gyrus , wedge anterior lobe , posterior lobe of cerebellum , frontal gyrus , left fusiform gyrus , occipital lobe cortex , cerebellum anterior lobe and right medial frontal gyrus , bilateral parietal / central gyrus , left frontal gyrus , posterior central gyrus , brainstem / midbrain and right temporal lobe / Sub - Gyral , occipital lobe / lingual gyrus , marginal leaf / hippocampus bypass volume increased ( P < 0.001 , cluster size cluster > 50惟 ) .

3 . Compared with PI patients , the left triangle frontal gyrus , temporal gyrus , cerebellum posterior lobe / cerebellum 8 area , cerebellum 10 area and right frontal gyrus / supplementary sports area , frontal gyrus , angle gyrus / temporal gyrus , temporal lobe / sub - Gyral volume decrease , bilateral frontal gyrus / supplementary sports area , left fusiform gyrus , posterior central lobule , occipital lobe cortex , anterior and posterior subulate gyrus , anterior buckle gyrus / frontal gyrus , temporal gyrus , angle gyrus / margin increase ( P < 0.001 , cluster size cluster & gt ; 50渭m ) .

3RS - fcMRI Display

3.1 Analysis of brain function connection with two - sided front - button - back as seed point

1 . NC ' s brain function connection neural network includes bilateral frontal lobe cortex , bilateral parietal lobe / angle gyrus , right margin upper gyrus / temporal gyrus , left lateral cerebral / medial side and side buckle , right margin leaf / wedge anterior leaflet / buckle back , left margin leaf / hippocampus bypass , left tail nucleus / brain island / bean nucleus / anterior buckle belt and side buckle belt brain gyrus , and bilateral temporal lobe cortex is positively correlated with anterior buckle back ;
Bilateral local frontal cortex , right parietal cortex , right occipital gyrus / occipital gyrus , left temporal gyrus / fusiform gyrus / occipital gyrus , right occipital lobe / fusiform gyrus / lingual gyrus / temporal gyrus , left cerebellar hemisphere were negatively correlated with anterior buckle ( P & lt ; 0.01 , voxel cluster & gt ; 20 ) .

2 . The abnormal brain function neural network of PI patients included left frontal lobe / frontal gyrus , bilateral parietal cortex , left temporal gyrus / occipital gyrus / pillow middle gyrus , right cerebellar hemisphere and anterior buckle gyrus ;
Left anterior buckle / frontal gyrus / medial frontal / medial frontal / medial frontal / medial frontal gyrus / brain island , bilateral temporal gyrus / temporal gyrus , left parietal / corner gyrus , left parietal lobe / anterior leaflet / posterior buckle , right edge leaf / buckle back / medial and side buckle gyrus were positively correlated ( P & lt ; 0.01 , voxel cluster & gt ; 20 ) .

3 . The abnormal brain function neural network of PID patients consisted of bilateral parietal lobule / top gyrus / top gyrus , left wedge anterior lobe , left frontal gyrus / central anterior gyrus , left occipital gyrus / occipital gyrus , right cerebellum posterior leaflet / inferior lobe / cerebellum 7b area and anterior buckle back ;
The left parietal lobe / corner return / margin , the left rear retaining / wedge front lobe , the right tail nucleus / tail nucleus , the left frontal gyrus / anterior buckle / frontal gyrus / frontal gyrus / medial frontal gyrus / medial frontal gyrus / medial frontal gyrus / medial collateral gyrus / medial collateral lobe were positively correlated with the anterior buckle ( P & lt ; 0.01 , voxel cluster & gt ; 20 ) .

4 . Compared with NC , PI patients had a negative correlation with the anterior buckle back function , the right temporal gyrus , right parietal lobule / apical inferior lobule , left margin leaf / button gyrus , and the frontal gyrus function were connected with the left cerebellum anterior lobe / hilltop / lingual gyrus ( P & lt ; 0.01 , voxel cluster & gt ; 2010a ) .

5 . Compared with NC , the patients with PID were connected with the function of anterior buckle and gyrus with brain stem / midbrain , left temporal gyrus , left cerebellum posterior lobe / cerebellum 1 region , and the left parietal lobe / Sub - Gyral / central sulcus cover , left frontal lobe / Sub - Gyral / triangular frontal gyrus , left frontal lobe / pillow middle gyrus , right parietal lobe / pillow gyrus ( P < 0.01 , voxel cluster & gt ; 2010a ) .

6 . Compared with PI patients , the left corpus callosal / posterior subulate gyrus of PID patients was negatively correlated with the function of anterior buckle and the right of middle cerebral cortex was positively correlated with the function of anterior buckle back ( P < 0.01 , voxel cluster & gt ; 20 ) .

3.2 Correlation Analysis

1 . There was no significant correlation between PI patients and NC group ' s brain function : left button gyrus , left lingual gyrus , right temporal gyrus , right top gyrus function connection and PSQI value ( P > 0.05 ) .

2 銆

本文編號(hào)：1880482