發(fā)布時(shí)間：2018-02-28 10:03

  本文關(guān)鍵詞： 青少年 抑郁癥 執(zhí)行功能 腦網(wǎng)絡(luò) 功能連接　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的影像學(xué)研究已發(fā)現(xiàn)大型腦網(wǎng)絡(luò)功能失衡與抑郁癥病理特性相關(guān)。但是腦網(wǎng)絡(luò)功能異常與青少年抑郁癥患者臨床癥狀及認(rèn)知功能之間的關(guān)聯(lián)仍不清楚。本研究旨在探索首發(fā)未用藥青少年抑郁癥患者腦網(wǎng)絡(luò)功能連接的特點(diǎn)及其與抑郁嚴(yán)重程度和執(zhí)行功能的相關(guān)性。方法1.2014年9月-2016年12月在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院精神科門診及住院部入組首發(fā)未用藥青少年抑郁癥患者28例,在當(dāng)?shù)厣鐓^(qū)入組年齡、性別及文化程度與患者相匹配的健康青少年24例作為對(duì)照。2.采用兒童抑郁評(píng)定量表(Children's Depression Rating Scale-Revised,CDRS-R)和漢密爾頓抑郁量表(Hamilton Depression Rating Scale-17 items,HAMD-17)結(jié)合與家屬面對(duì)面訪談評(píng)估研究對(duì)象的抑郁癥狀。采用威斯康星卡片分類測驗(yàn)(Wisconsin Card Sorting Test,WCST)、持續(xù)操作測試(Continuous Performance Test,CPT)、彩色連線測驗(yàn)(Trail Making Test,TMT)和 STROOP 卡片測驗(yàn)(Stroop Word-Color Interference Test,SCWT)來評(píng)估研究對(duì)象的執(zhí)行功能。3.對(duì)兩組研究對(duì)象進(jìn)行靜息態(tài)功能磁共振掃描,采用基于種子點(diǎn)的感興趣區(qū)功能連接分析法,分別以雙側(cè)背外側(cè)前額葉(認(rèn)知控制網(wǎng)絡(luò)),雙側(cè)膝下前扣帶回(情感網(wǎng)絡(luò))和雙側(cè)楔前葉(默認(rèn)網(wǎng)絡(luò))為種子點(diǎn)研究上述三個(gè)腦網(wǎng)絡(luò)的靜息態(tài)功能連接。比較抑郁組與對(duì)照組腦網(wǎng)絡(luò)功能連接的組間差異,并將異常的腦區(qū)間功能連接強(qiáng)度與抑郁組患者癥狀嚴(yán)重程度及執(zhí)行功能進(jìn)行相關(guān)分析。結(jié)果1.經(jīng)多重矯正后發(fā)現(xiàn)青少年抑郁癥患者在STROOP卡片測驗(yàn)中表現(xiàn)較正常對(duì)照差,表明青少年抑郁癥患者執(zhí)行功能中選擇性注意,信息處理速度和抑制功能受損 Stroop B(t=3.33,P0.01),Stroop C(t=2.826,P0.01)。2.抑郁組在認(rèn)知控制網(wǎng)絡(luò)、情感網(wǎng)絡(luò)及默認(rèn)網(wǎng)絡(luò)均存在靜息態(tài)功能連接異常,具體表現(xiàn)為:在認(rèn)知控制網(wǎng)絡(luò)中,位于雙側(cè)背外側(cè)前額葉皮質(zhì)的種子點(diǎn)與右側(cè)顳葉,扣帶回中部,右側(cè)額下回,右側(cè)島葉等腦區(qū)的功能連接減弱;在情感網(wǎng)絡(luò)中,位于雙側(cè)膝下前扣帶回皮質(zhì)的種子點(diǎn)與左側(cè)梭狀回、小腦后葉、舌回、右側(cè)顳上回、右側(cè)顳中回等腦區(qū)的功能連接增強(qiáng);在默認(rèn)網(wǎng)絡(luò)中,位于雙側(cè)楔前葉的種子點(diǎn)與小腦后葉,右側(cè)島葉的功能連接減弱。3.相關(guān)分析發(fā)現(xiàn)左側(cè)背外側(cè)前額葉皮質(zhì)與右側(cè)額下回的功能連接與HAMD得分呈負(fù)相關(guān),右側(cè)背外側(cè)前額葉皮質(zhì)與雙側(cè)扣帶回中部的功能連接與Stroop測試得分呈負(fù)相關(guān)(Stroop B,StroopC)。右側(cè)膝下前扣帶回皮質(zhì)與左側(cè)小腦后葉的功能連接與與HAMD得分呈負(fù)相關(guān)。結(jié)論1.青少年抑郁癥患者執(zhí)行功能以及認(rèn)知控制網(wǎng)絡(luò)、情感網(wǎng)絡(luò)和默認(rèn)網(wǎng)絡(luò)的靜息態(tài)功能連接存在異常.2.認(rèn)知控制網(wǎng)絡(luò)的功能異常與抑郁嚴(yán)重程度及執(zhí)行功能受損相關(guān),可能揭示了青少年抑郁癥的神經(jīng)病理生理機(jī)制。同時(shí),這些研究結(jié)果可能為青少年抑郁癥的治療提供新的靶點(diǎn)。
[Abstract]:Objective Imaging studies have found that large brain network dysfunction is associated with the pathological characteristics of depression, but the association between brain network dysfunction and clinical symptoms and cognitive function in adolescent depression patients is still unclear. The purpose of this study was to explore the characteristics of brain network functional connection in first-episode untreated adolescents with depression and its correlation with depression severity and executive function. 1. From September to December 2016, 2014, the first affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University. Twenty-eight patients with untreated adolescent depression were enrolled in psychiatric outpatient department and inpatient department. Age in local communities, 24 healthy adolescents matched with gender and education as control .2.Child Depression Rating Scale-Revised CDRS-R) and Hamilton Depression Rating Scale-17 Scale-17 Hamd 17) were used to evaluate the subjects with face-to-face interviews with family members. Wisconsin Card Sorting test, continuous Performance test, color wired test, and STROOP card test Stroop Word-Color Interference test were used to evaluate the executive function of the subjects. The image is scanned by resting functional magnetic resonance, The method of functional connection analysis of region of interest based on seed point is used. The resting functional connections of the above three brain networks were studied with bilateral dorsolateral prefrontal lobe (cognitive control network), bilateral subgenu cingulate gyrus (emotional network) and bilateral wedge prefrontal lobe (default network) as seed points. The difference of functional connections of brain network between depression group and control group, Results 1. After multiple correction, it was found that the performance of adolescent depression patients in STROOP card test was worse than that in normal controls. 2. The results showed that the patients with adolescent depression had selective attention, impaired information processing speed and inhibitory function (Stroop Bt) 3.33 ~ 3 ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~. In the cognitive control network, the functional connections of the right temporal lobe, the middle cingulate gyrus, the right inferior frontal gyrus, the right insular lobe, and so on are weakened in the bilateral dorsolateral prefrontal cortex. The functional connections between the seed points in the bilateral anterior cingulate gyrus cortex and the left fusiform gyrus, the posterior cerebellar lobe, the lingual gyrus, the right superior temporal gyrus, the right middle temporal gyrus, and the right middle temporal gyrus are enhanced; in the default network, the seed points located in the bilateral anterior cuneate lobe are associated with the posterior lobe of the cerebellum. The functional connections between the left dorsolateral prefrontal cortex and the right inferior frontal gyrus were negatively correlated with HAMD scores. The functional connections between the right dorsolateral prefrontal cortex and the middle cingulate gyrus were negatively correlated with the Stroop scores. The functional connections between the right subgenu anterior cingulate cortex and the left posterior cerebellar lobe were negatively correlated with the HAMD score. Conclusion 1. The executive function and cognitive control network of adolescent depression patients, 2. The abnormal function of cognitive control network is related to the severity of depression and the impairment of executive function, which may reveal the neuropathophysiological mechanism of adolescent depression. These findings may provide new targets for the treatment of adolescent depression.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.4
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本文編號(hào)：1546830