發(fā)布時間：2018-06-04 22:33

  本文選題：創(chuàng)傷后應激障礙 + 磁共振腦功能成像��； 參考：《第三軍醫(yī)大學》2012年博士論文

【摘要】：研究背景和目的 創(chuàng)傷后應激障礙(Post traumatic stress disorder, PTSD)指在遭遇或對抗重大壓力后，人的心理狀態(tài)失調產生的后遺癥。主要癥狀包括過度警覺、惡夢、回避等。隨著汽車大量進入家庭，每年車禍傷的發(fā)生較自然災害更加普遍，當事故發(fā)生后，創(chuàng)傷后應激障礙的發(fā)病率可達到38%,說明車禍事件創(chuàng)傷后應激障礙的發(fā)生十分常見。根據創(chuàng)傷應激事件,結合臨床癥狀和創(chuàng)傷后應激障礙量表檢測診斷創(chuàng)傷后應激障礙并不困難，但目前早期診斷和發(fā)病機制尚待進一步研究。 隨著磁共振功能神經影像學的發(fā)展，有關創(chuàng)傷后應激障礙的腦功能研究越來越多。借助磁共振腦功能成像技術，可以在整體、系統(tǒng)、環(huán)路、功能柱、細胞以及分子水平上對患者腦的結構與功能及其相互關系進行深入研究。因此，本項研究運用多模態(tài)磁共振功能成像技術及方法，研究交通傷后應激障礙患者重要腦區(qū)皮層結構、白質纖維傳導束及腦區(qū)神經元功能的改變，揭示其產生的原因及神經生物學機制。 材料和方法 1.20例因經歷車禍所致的創(chuàng)傷后應激障礙患者年齡18-40歲，平均32.92歲，病程在6至12個月。經臨床精神科醫(yī)師及心理咨詢師檢查，所有患者創(chuàng)傷后應激障礙的診斷成立，符合臨床醫(yī)生專用創(chuàng)傷后應激障礙評估量表評分。同時募集20名健康對照組，年齡20-38歲，平均，31.53歲，與創(chuàng)傷后應激障礙患者組在年齡、性別、受教育年限方面的差異均無統(tǒng)計學意義。 2.采集兩組被試者的頭部高分辨率磁共振T1加權像數據，運用Freesurfer軟件處理大腦的磁共振T1加權像數據，自動重建大腦皮層的表面，分析和計算大腦皮質的厚度、面積和容積等指標。通過Qdec插件進行創(chuàng)傷后應激障礙和健康對照兩組間各個腦區(qū)的組分析和比較。 3.采集兩組被試者的靜息態(tài)功能磁共振成像數據，運用的Matlab平臺的REST1.5和SPM5處理和分析靜息態(tài)磁共振數據，分析和比較患者組和健康對照組的全腦低頻振幅圖和重要腦區(qū)的低頻振幅值。 4.采集兩組被試者的磁共振彌散張量成像數據，采用FSL軟件進行DTI數據處理及統(tǒng)計分析。分別提取各腦區(qū)的FA和MD值，分析各個腦區(qū)FA和MD值與PCL-C評分之間的相關性。 結果 1.皮層厚度分析結果顯示，創(chuàng)傷后應激障礙患者在其左側大腦半球的扣帶回體部、額下回島蓋部、額下回眶部、額下回三角部及中央前回均存在大腦皮層厚度的變薄。運用qdec插件進行組分析也清楚地顯示兩組被試在左側半球多個腦區(qū)皮質厚度顯著變薄，具體顯示為創(chuàng)傷后應激障礙患者的前扣帶皮層(BA33)、內側前額葉皮質(BA10)、額下回眶部(BA47)、島蓋部(BA44)及三角部(BA45)等腦區(qū)與健康對照組相比具有顯著性差異。 2.比較兩組被試者之間的低頻振幅值，結果顯示創(chuàng)傷后應激障礙組相對于健康對照組在左側額中回(BA10)和前扣帶回(BA32)低頻振幅值顯著升高。各腦區(qū)低頻振幅與皮層厚度的結果進行線性相關統(tǒng)計結果顯示，左側額中回(BA10)的低頻振幅升高與皮層厚度變薄具有顯著相關。對各腦區(qū)低頻振幅值的變化與CAPS量表評分進行相關分析，結果顯示在左側額中回(BA10)的低頻振幅值增加與CAPS評分呈現(xiàn)顯著的正相關。 3.對兩組被試的腦結構彌散張量成像進行比較，創(chuàng)傷后應激障礙患者相較于對照組在雙側額中回、右側額上回、左側殼核的FA值顯著降低。創(chuàng)傷后應激障礙患者在雙側額中回、左側杏仁核、前扣帶、左側腦島、左側蒼白球的MD值顯著高于對照組。對兩組被試的全腦網絡連接有效性進行比較，，結果顯示，兩組人群網絡均顯示出很高的全局和局部腦區(qū)連接效率，表明這些腦網絡具有小世界網絡屬性。非參數秩和檢驗的結果顯示，兩組被試者的腦網絡特征之間存在差異顯著。 結論 交通傷后應激障礙患者的腦內結構、功能及腦網絡改變涉及多個腦區(qū)，其中包括扣帶回、額中回、額下回、海馬旁回和杏仁核等區(qū)域。因此可以推斷此類創(chuàng)傷后應激障礙是一種多腦區(qū)結構和功能同時發(fā)生改變所引起的精神疾病。在本項多模態(tài)研究中觀察到，額中回和前扣帶回是此類創(chuàng)傷后應激障礙發(fā)生的關鍵腦區(qū)域。額中回和扣帶回腦區(qū)的結構和功能變化從神經解剖學角度解釋了患者常發(fā)生的幾種典型臨床癥狀。這一研究結果為交通傷后應激障礙的預防、治療和評估發(fā)生提供了磁共振功能影像證據。
[Abstract]:Background and purpose of the study

Post traumatic stress disorder is the sequelae of post traumatic stress disorder . The main symptoms include excessive alertness , nightmares , avoidance , etc . The incidence of post - traumatic stress disorder is more common . As the accident occurs , the incidence of post - traumatic stress disorder can be up to 38 % . It is not difficult to diagnose post - traumatic stress disorder according to the event of traumatic stress . However , the early diagnosis and pathogenesis are still to be further studied .

With the development of magnetic resonance functional neuroimaging , more and more research on the brain function of post - traumatic stress disorder is more and more . With the aid of magnetic resonance brain functional imaging technique , the structure and function of the brain of the patient and their relationship are studied in the whole , system , loop , functional column , cell and molecular level .

Materials and Methods

1 . 20 patients with post - traumatic stress disorder caused by car accident ranged from 18 to 40 years old , mean 32.92 years old , and the course was 6 to 12 months .

2 . The high - resolution magnetic resonance T1 weighted image data of two groups of subjects were collected , the magnetic resonance T1 weighted image data of the brain was processed by Freesurfer software , the surface of cerebral cortex was reconstructed automatically , the thickness , area and volume of cerebral cortex were analyzed and calculated .

3 . To acquire the static state functional magnetic resonance imaging data of two groups of subjects , and to process and analyze the static state magnetic resonance data by the REST1.5 and SPM5 of the Matlab platform , and analyze and compare the whole brain low frequency amplitude map of the patient group and the healthy control group and the low frequency amplitude value of the important brain region .

4 . The magnetic resonance diffusion tensor imaging data of two groups were collected , and the data were analyzed by using FSL software . The FA and MD values of each brain region were extracted respectively , and the correlation between FA and MD values and PCL - C score was analyzed .

Results

1 . The thickness of cortex in the left hemisphere of patients with post - traumatic stress disorder showed that the thickness of cortex in the left hemisphere was significantly thinner than that in healthy control group .

2 . Comparing the low - frequency amplitude values between the two groups of subjects , the results showed that the low - frequency amplitude of the left frontal gyrus ( BA10 ) was significantly higher than that of the healthy control group . The results showed that the low - frequency amplitude of the left frontal gyrus ( BA10 ) was significantly correlated with the thickness thinning .

3 . Compared with the control group , the MD values of the two groups were significantly lower than those in the control group . The results showed that the network of the two groups showed high global and local brain area connection efficiency . The results showed that these brain networks had small global network attributes . The results of non - parametric rank and test showed that there was a significant difference between the two groups .

Conclusion

The brain structure , function and brain network change of patients with post - traumatic stress disorder involve multiple brain regions , including the gyrus , the frontal gyrus , the frontal gyrus , the parahippocampal gyrus , and the almond kernel . Therefore , it can be concluded that the post - traumatic stress disorder is a key brain region after such traumatic stress disorder .
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：博士
【學位授予年份】：2012
【分類號】：R749.5

【參考文獻】

相關期刊論文 前8條

1 杜U

本文編號：1979112