本文選題：精神分裂癥 + 認(rèn)知矯正　； 參考：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：精神分裂癥(SZ)患者存在廣泛的認(rèn)知功能損害，神經(jīng)影像學(xué)研究發(fā)現(xiàn)SZ患者腦白質(zhì)纖維完整性受損，并且這種損害與認(rèn)知損害有關(guān)；計(jì)算機(jī)化認(rèn)知矯正治療(CCRT)能有效改善患者的認(rèn)知損害，但它改善認(rèn)知功能的神經(jīng)機(jī)制尚不清楚，特別是他對(duì)腦白質(zhì)完整性的影響研究還較少。本研究采用磁共振彌散張量(DTI)技術(shù)嘗試探討CCRT的神經(jīng)機(jī)制。 方法：對(duì)15例符合美國(guó)精神疾病診斷與統(tǒng)計(jì)手冊(cè)第4版（DSM-IV）SZ診斷標(biāo)準(zhǔn)、長(zhǎng)期住院治療的患者，及15名性別構(gòu)成、年齡及受教育年限相匹配的對(duì)照組被試進(jìn)行連線任務(wù)（TMT）、霍普金斯詞匯學(xué)習(xí)任務(wù)（HVLT-R）、威斯康星卡片分類(lèi)任務(wù)（WCST）測(cè)試、持續(xù)操作任務(wù)（CPT）以及數(shù)字廣度測(cè)試（DS）等神經(jīng)心理學(xué)背景測(cè)試，同時(shí)對(duì)SZ患者進(jìn)行PANSS量表評(píng)定，然后所有被試進(jìn)行DTI掃描�；颊呓M進(jìn)行為期6個(gè)月，每周3次的CCRT治療后再次進(jìn)行前述心理測(cè)驗(yàn)、PANSS量表及DTI掃描。觀察患者組治療前后認(rèn)知功能、PANSS評(píng)分在CCRT治療前后是否有差異；同時(shí)應(yīng)用DTIstudio軟件包對(duì)兩組圖像進(jìn)行預(yù)處理，統(tǒng)計(jì)各個(gè)感興趣區(qū)（ROIs）的FA值，觀察治療前后以及與正常對(duì)照組的差異。 結(jié)果：1:患者組治療前與正常對(duì)照組相比在TMT、HVLT—R、WCST、CPT以及DS任務(wù)上差異有統(tǒng)計(jì)學(xué)意義（P㩳0.01）；2：患者組治療后與正常對(duì)照組相比在TMT、WCST、CPT、HVLT-R部分子任務(wù)以及DS的反序任務(wù)上有統(tǒng)計(jì)學(xué)差異（P㩳0.01或P㩳0.05），而HVLT-R延遲記憶、再認(rèn)及DS的順序任務(wù)上無(wú)明顯差異（P㧐0.05）；3：患者組治療前后相比在TMT、HVLT—R、WCST、CPT以及DS任務(wù)上均有顯著提升，差異有統(tǒng)計(jì)學(xué)意義（P㩳0.01）；4：患者組治療前后PANSS總評(píng)分及陰性分與治療前有統(tǒng)計(jì)學(xué)差異（P㩳0.01或P㩳0.05），而陽(yáng)性分無(wú)統(tǒng)計(jì)學(xué)差異；5：患者組ROIs與對(duì)照組比較FA降低的有雙側(cè)前扣帶、雙側(cè)胼胝體壓部、左側(cè)小腦上腳（P㩳0.01或P㩳0.05），其他ROIs的FA值與對(duì)照組無(wú)統(tǒng)計(jì)學(xué)差異（P㧐0.05）；未發(fā)現(xiàn)患者組有腦區(qū)白質(zhì)FA值高于對(duì)照。6、患者組腦白質(zhì)FA值治療前后無(wú)明顯變化。 結(jié)論：CCRT能有效改善SZ患者的認(rèn)知功能損害，對(duì)精神癥狀作用不明顯；SZ患者存在雙側(cè)前扣帶、雙側(cè)胼胝體壓部、左側(cè)小腦上腳區(qū)域的白質(zhì)纖維完整性異常，可能與SZ的認(rèn)知損害有關(guān)，，CCRT對(duì)慢性病程的長(zhǎng)期住院SZ患者白質(zhì)纖維完整性影響不明顯。
[Abstract]:Objective: there are extensive cognitive impairment in patients with schizophrenia (SZ). Neuroimaging studies have found that the integrity of white matter fibers is impaired in patients with SZ, and this damage is related to cognitive impairment. Computerized cognitive correction therapy (CCRT) can effectively improve the cognitive impairment of patients, but its neuromechanism for improving cognitive function is still unclear, especially his influence on white matter integrity. In this study, magnetic resonance diffusion Zhang Liang DTI technique was used to explore the neural mechanism of CCRT. Methods: fifteen patients who met the diagnostic criteria of DSM-IVSZ in the fourth edition of the American Handbook for the diagnosis and Statistics of Mental Disorders, and 15 patients with long-term hospitalization, and 15 patients with sex composition, were included in the study. Subjects matched in age and years of education underwent neuropsychological background tests such as TMTT, Hopkins vocabulary learning task HVLT-RN, Wisconsin card sorting task (WCST), continuous manipulation task (CPT) and digital span test (DSDS). At the same time, SZ patients were assessed with PANSS scale, and then all subjects were scanned with DTI. The patients were treated with CCRT 3 times a week for 6 months. To observe whether there were differences in cognitive function and PANSS scores before and after CCRT treatment in the patients group, and to use DTIstudio software package to preprocess the images of the two groups, and to calculate the FA values of each region of interest. The difference between before and after treatment and normal control group was observed. Results: there were significant differences in the tasks of TMTT HVLT-RnWCST-CPT and DS between the patients group and the normal control group before and after treatment. There were statistical differences between the patients group and the normal control group in the TMTWCST-CPT part of HVLT-R task and the reverse sequence task of DS after treatment. The difference was between P0. 01 and Pu. 05, while HVLT-R delayed memory. There was no significant difference in the sequence of recognition and DS tasks. There were significant differences in CPT and DS tasks between the two groups before and after treatment. There was significant difference in total PANSS score and negative score before and after treatment. There was no significant difference in positive score between patients group and control group. There were bilateral anterior cingulate band and bilateral corpus callosum in patients group compared with control group, but there was no significant difference in positive score between patients group and control group (P < 0.01), but there was no significant difference in positive score between patients group and control group (P < 0.05), there were bilateral anterior cingulate bands and bilateral corpus callosum in the patients group compared with the control group. The FA values of other ROIs in the left superior cerebellum were not significantly different from those in the control group (P < 0.05), and no significant changes were found in the white matter FA value of the patients group compared with the control group (P < 0.05), but there was no significant change in the white matter FA value before and after treatment in the patients group. ConclusionThe cognitive impairment of SZ patients can be effectively improved by WCCRT. There are bilateral anterior cingulate bands, bilateral corpus callosum and left superior cerebellar peduncles in patients with SZ who have no obvious effect on mental symptoms, and the white matter fiber integrity of the left superior cerebellum area is abnormal. CCRT may be related to the cognitive impairment of SZ. The effect of CCRT on the integrity of white matter fibers in long-term hospitalized SZ patients with chronic disease course is not obvious.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R749.3

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