發(fā)布時間：2018-06-03 06:29

  本文選題：廣泛性焦慮障礙 + 驚恐障礙��； 參考：《中南大學(xué)》2013年博士論文

【摘要】：目的：從腦網(wǎng)絡(luò)的角度,研究廣泛性焦慮障礙患者和驚恐障礙患者腦恐懼環(huán)路的特點,探討疾病特異性的腦網(wǎng)絡(luò)生物學(xué)標(biāo)記,為理解疾病的病理機(jī)制和臨床診斷提供新線索和依據(jù)。 方法：應(yīng)用功能核磁共振技術(shù),設(shè)計情緒計數(shù)Stroop認(rèn)知任務(wù)和靜息態(tài)杏仁核與全腦功能連接方法,研究廣泛性焦慮障礙(Generalized anxiety disorder,GAD)患者,驚恐障礙(Panic disorder, PD)患者和健康對照組(healthy controls,HCs)腦恐懼環(huán)路的特點。具體實施由兩名精神科主治醫(yī)生應(yīng)用《DSM-Ⅳ-TR軸Ⅰ障礙定式臨床檢查病人版》(即SCID-I/P)診斷工具,篩選符合廣泛性焦慮障礙和驚恐障礙診斷標(biāo)準(zhǔn)且無共病、年齡在18-44歲之間、從未接受過臨床治療的患者。GAD組22例,PD組24例,按照年齡以及受教育程度匹配入組健康對照35例,三組均采用漢密爾頓焦慮量表(HAMA)、漢密爾頓抑郁量表(HAMD)進(jìn)行評估,GAD患者組評估賓尼法尼亞擔(dān)心狀態(tài)問卷(PSQW),PD患者組評估驚恐發(fā)作嚴(yán)重程度的量表(PDSS),健康對照組HAMA評分7分/HAMD7分。 所有研究對象完成MRI掃描后,排除頭動等因素導(dǎo)致有質(zhì)量問題的數(shù)據(jù)：1)入組認(rèn)知任務(wù)ecStroop研究的GAD組和PD組各14例,HCs25例,以單因素方差分析檢測三組ecStroop任務(wù)激活腦區(qū)的差異,并以post hoc檢驗進(jìn)行組間兩兩比較。2)入組靜息態(tài)功能連接的GAD組15例,PD組17例和HCs22例,以雙側(cè)杏仁核為種子點,進(jìn)行全腦功能連接分析。以單因素方差分析檢測三組雙側(cè)杏仁核與全腦功能連接的差異,并以post hoc檢驗進(jìn)行組間兩兩比較。 結(jié)果：(1)認(rèn)知任務(wù)ecStroop結(jié)果：三組加工中性詞匯激活腦區(qū)結(jié)果：PD組、GAD組相比HCs激活增加的腦區(qū)是：左側(cè)杏仁核、右側(cè)頂下小葉、右側(cè)島葉和左側(cè)丘腦；PD組相比GAD組、HCs激活增加的腦區(qū)是左側(cè)腦干。三組加工焦慮詞匯激活腦區(qū)結(jié)果：GAD組、PD組相比HCs激活增加的腦區(qū)是左側(cè)丘腦和右側(cè)島葉；GAD組相比PD組、HCs激活減弱的腦區(qū)是右側(cè)額上回Brodman(BA)9區(qū)。三組加工焦慮詞匯與中性詞匯相比較激活腦區(qū)結(jié)果：GAD組、PD組相比HCs激活減弱的腦區(qū)是左側(cè)杏仁核；PD組相比GAD組、HCs激活減弱的腦區(qū)是右側(cè)海馬。 (2)雙側(cè)杏仁核與全腦功能連接結(jié)果：GAD組、PD組相比HCs,左側(cè)杏仁核--右側(cè)楔前葉功能連接增強(qiáng),左側(cè)杏仁核--右側(cè)海馬功能連接減弱。PD組相比GAD組、HCs,左側(cè)杏仁核--左側(cè)腦干中腦功能連接增強(qiáng),左側(cè)杏仁核--右側(cè)海馬功能連接減弱。PD組、GAD組相比HCs右側(cè)杏仁核--右側(cè)腦橋功能連接增強(qiáng),PD組最強(qiáng)；右側(cè)杏仁核--右側(cè)海馬功能連接減弱,PD組最弱。GAD組相比PD組、HCs右側(cè)杏仁核--左側(cè)島葉功能連接增強(qiáng)。 結(jié)論：1、GAD和PD以杏仁核為核心的大腦恐懼環(huán)路敏感、易激活,可能是患者丘腦感覺信息過濾障礙,導(dǎo)致條件恐懼刺激泛化。 2、GAD恐懼環(huán)路激活可能是患者前額葉受損引起“自上而下”的認(rèn)知調(diào)控缺陷所致。 3、PD恐懼環(huán)路激活可能是患者腦干受損導(dǎo)致警覺性增高和海馬受損導(dǎo)致條件恐懼背景信息識別偏差,因而由“自下而上”的情緒調(diào)控失調(diào)所致。 4、大腦顯著性網(wǎng)絡(luò),額頂網(wǎng)絡(luò),默認(rèn)網(wǎng)絡(luò)等功能網(wǎng)絡(luò)參與了焦慮障礙腦恐懼環(huán)路的網(wǎng)絡(luò)調(diào)控。
[Abstract]:Objective: To study the characteristics of brain fear loop in patients with generalized anxiety disorder and panic disorder from the perspective of brain network, and to explore the specific brain network biomarkers of disease, and provide new clues and basis for understanding the pathological mechanism and clinical diagnosis of disease.
Methods: using functional nuclear magnetic resonance (fMRI), the Stroop cognitive task and the resting state amygdala and the whole brain functional connection were designed to study the characteristics of the Generalized anxiety disorder (GAD) patients, Panic disorder, PD patients and the healthy control group (healthy controls, HCs) brain fear loop. The body was carried out by two psychiatric doctors using the All the subjects completed the MRI scan, excluding the head motion and other factors leading to the quality problems: 1) 14 cases in group GAD and PD group, 14 cases in group GAD and HCs25, the difference between three groups of ecStroop tasks was detected by single factor variance analysis, and the resting state work of group 22 compared with post hoc test was carried out. 15 cases of GAD, 17 cases of group PD and HCs22 cases were connected. The whole brain functional connection was analyzed with bilateral amygdala as seed point. The difference between three groups of bilateral amygdala and whole brain function was detected by single factor analysis of variance, and 22 comparison between groups was performed by post hoc test.
Results: (1) the results of cognitive task ecStroop: three groups of processing neutral words activated the brain region: group PD, group GAD compared with HCs activation increased brain area: left amygdala, right apical lobule, right Island leaf and left thalamus; PD group compared to group GAD, HCs activation increased the brain area is left brainstem. Three groups of processing anxiety vocabulary activated brain region results. GAD group, group PD compared with HCs activation increased the left thalamus and right Island lobe; GAD group compared with PD group, HCs activation weakened brain area was the right frontal gyrus Brodman (BA) 9. The three groups of processing anxiety vocabulary compared with neutral vocabulary to activate the brain region results: GAD group, PD group compared to HCs activation of the brain area is left amygdala; PD group compared with those In group D, the weakened brain area of HCs activation was the right hippocampus.
(2) the results of bilateral amygdala and whole brain function connection: group GAD, group PD compared to HCs, left amygdala - right anterior lobe functional connection, left amygdala - the right hippocampal functional connection weakened group.PD compared to the GAD group, HCs, left amygdala - the left brainstem middle brain functional connection increased, left amygdala - right hippocampal functional connection weakened the.PD group. In group GAD, the right amygdala - the right amygdala - the right pontine functional connection was enhanced and the PD group was the strongest; the right amygdala - the right hippocampal functional connection was weakened, and the weakest.GAD group in group PD was compared to the PD group, and the right amygdala in the right amygdala HCs was enhanced in the left Island leaf function.
Conclusion: 1, GAD and PD are sensitive and active in the brain fear loop, which is the core of the amygdala. It may be the disorder of sensory information filtering in the thalamus, which leads to the generalization of conditional fear stimulation.
2, the activation of GAD fear loop may be caused by the "top-down" cognitive deficits caused by frontal lobe damage.
3, the activation of PD fear loop may be caused by impaired brain stem damage resulting in increased alertness and hippocampus damage resulting in conditional fear background information identification bias, resulting from a "bottom-up" emotional disorder.
4, the brain's saliency network, the frontal network, the default network and other functional networks are involved in the network control of the anxiety disorder brain fear loop.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R749.7

【共引文獻(xiàn)】

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3 劉志強(qiáng);徐麗君;肖新蘭;;神經(jīng)影像學(xué)在焦慮癥中的應(yīng)用研究進(jìn)展[J];功能與分子醫(yī)學(xué)影像學(xué)(電子版);2013年04期

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本文編號：1971822

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