發(fā)布時間：2018-05-01 07:46

  本文選題：焦慮障礙 + 驚恐障礙�。� 參考：《上海交通大學》2013年博士論文

【摘要】：【背景】驚恐障礙(PD)是焦慮障礙的常見類型,其對心跳知覺的異常感受及其“災(zāi)難性”理解是最典型癥狀,但迄今為止PD心跳知覺異常的腦功能機制仍未闡明�！灸康摹�1.研究PD患者心跳知覺敏感度特征及相關(guān)心理學影響因素;2.分析PD患者腦結(jié)構(gòu)、靜息態(tài)和任務(wù)態(tài)影像學特征,尋找其心跳知覺異常的神經(jīng)病理學機制;3.系統(tǒng)評價重復經(jīng)顱磁刺激(rTMS)治療PD的療效,確定PD患者功能異常腦區(qū)�！痉椒ā�1.行為學和腦影像部分采用病例對照研究設(shè)計,入組PD患者,同期收集廣泛性焦慮癥(GAD)和健康志愿者為病例對照和正常對照組,使用心跳知覺追蹤范式評定三組被試的心跳感知敏感性,并評估焦慮癥狀、軀體感知敏感性、述情障礙和人格特征。MRI掃描采用3.0T磁共振成像系統(tǒng),使用VBM8軟件分析三組間腦結(jié)構(gòu)差異;任務(wù)態(tài)采用Block設(shè)計的心跳知覺任務(wù)范式,應(yīng)用AFNI軟件分析心跳知覺(內(nèi)感知)和計數(shù)純音(外感知)任務(wù)下的腦激活特征;將腦結(jié)構(gòu)和功能異常區(qū)作為感興趣區(qū)(ROI),分析靜息態(tài)下ROI與全腦的功能連接特征。2.系統(tǒng)綜述:檢索r TMS治療PD的隨機對照研究(RCT),按照納入與排除標準選擇文獻、提取資料和文獻質(zhì)量評估�！窘Y(jié)果】1.行為學研究。共納入pd患者45例,gad患者141例,健康對照組56例。pd患者心跳知覺敏感性高于健康對照組(p=0.000),也高于gad患者(p=0.011),但未發(fā)現(xiàn)gad與健康對照者之間的差異(p=0.78)。2.磁共振成像研究。納入pd和gad患者各19例,健康對照組20例。(1)心跳知覺功能磁共振結(jié)果:在感知心跳任務(wù)下,pd患者左側(cè)扣帶回激活增強;在計數(shù)純音任務(wù)下,pd患者雙側(cè)楔前葉、左側(cè)內(nèi)側(cè)前額葉、右側(cè)緣上回、左側(cè)頂下小葉、左側(cè)中央后回和顳中回激活增強,并且左側(cè)內(nèi)側(cè)前額葉bold變化均值與bpq問卷的應(yīng)激反應(yīng)方式Ⅰ評分呈正相關(guān)(r=0.540;p=0.031);在內(nèi)外感知交互作用條件下,pd患者的左側(cè)中央后回、左側(cè)額中回(包括sma區(qū))、左側(cè)扣帶回、雙側(cè)額內(nèi)側(cè)、雙側(cè)枕中回、左側(cè)額下回和左側(cè)島葉顯著負激活。在相同的檢驗標準下,均未發(fā)現(xiàn)gad患者的異常活動腦區(qū),探索性分析發(fā)現(xiàn)(單體素設(shè)為p=0.005)發(fā)現(xiàn),gad患者右側(cè)額中回激活增強(內(nèi)感知)。(2)腦結(jié)構(gòu)影像結(jié)果:pd患者在雙側(cè)殼、胼胝體下回、尾狀核、前扣帶回和右側(cè)上眶額回、左側(cè)島葉和杏仁核的灰質(zhì)體積增加。(3)靜息態(tài)功能磁共振:pd患者左側(cè)扣帶回與雙側(cè)中央后回、雙側(cè)島葉、雙側(cè)顳上回連接增強。3.共納入2項rct研究,40例患者,治療參數(shù)均采用1hz頻率刺激右側(cè)背外側(cè)前額區(qū)。治療次數(shù)20次時,rtms真刺激組療效優(yōu)于偽刺激組(t=3.04,p=0.007)�！窘Y(jié)論】1.pd患者心跳感知敏感性異常增加。2.pd患者存在多個腦區(qū)結(jié)構(gòu)和功能異常,尤其是同時調(diào)控內(nèi)感知和恐懼條件反射通路的皮層和核團。GAD患者右側(cè)額中回功能相對增強,可能對心跳知覺異常有部分代償作用。3.低頻rTMS刺激背外側(cè)前額葉可能有效,但仍需進一步證明。
[Abstract]:[background] panic disorder (PDD) is a common type of anxiety disorder. Its abnormal feeling of heartbeat perception and its "catastrophic" understanding are the most typical symptoms, but the brain function mechanism of PD abnormal heartbeat perception has not been elucidated up to now. [objective] 1. To study the characteristics of heart rate sensitivity and related psychological factors in PD patients. The imaging features of brain structure, resting state and task state in PD patients were analyzed to find out the neuropathological mechanism of abnormal heartbeat perception. To evaluate the efficacy of repetitive transcranial magnetic stimulation (RTMS) in the treatment of PD, and to determine the abnormal brain area in PD patients. [methods] 1. The behavioral and brain images were designed in a case-control study. GADs were collected from patients with generalized anxiety disorder (GAD) and healthy volunteers as case control group and normal control group. The sensitivity of heartbeat perception was assessed by the heartbeat perception tracking paradigm. Anxiety symptoms, somatic sensitivity, alexithymia and personality characteristics were assessed using 3.0T magnetic resonance imaging system. VBM8 software was used to analyze the diencephalon structure differences among the three groups, and the task-mode of heartbeat perception designed by Block was used to analyze the brain activation characteristics under the tasks of heartbeat perception (internal perception) and counting pure tone (external perception) using AFNI software. The abnormal areas of brain structure and function were regarded as the regions of interest to analyze the functional connections between ROI and the whole brain in resting state. 2. Systematic review: a randomized controlled study of r TMS therapy for PD was searched. According to the criteria of inclusion and exclusion, the literature was selected, the data extracted and the quality of literature evaluated. [results] 1. Behavioral research. A total of 45 patients with PD and 141 patients with Gad were included. The sensitivity of heartbeat perception in 56 patients with PD in healthy control group was higher than that in healthy control group. It was also higher than that in patients with gad. However, there was no difference between gad and healthy controls. Magnetic resonance imaging. Results: activation of left cingulate gyrus was enhanced in PD patients with perceived heartbeat task, bilateral precuneiform lobe and left medial prefrontal lobe in PD patients, and left medial prefrontal lobe in PD patients under pure tone counting task. The activation of right superior marginal gyrus, left inferior parietal lobule, left posterior central gyrus and middle temporal gyrus were enhanced. The mean value of bold in left medial prefrontal lobe was positively correlated with the stress response mode 鈪，

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