本文選題：多重侵害 + 生態(tài)學(xué)執(zhí)行功能　； 參考：《山東大學(xué)》2012年碩士論文

【摘要】：背景 兒童期侵害是普遍存在的社會公共衛(wèi)生問題,由此造成的不良臨床結(jié)果逐漸引起研究者的關(guān)注。目前的研究多集中于對單一侵害的發(fā)生狀況、影響因素的研究,也已有研究者開始進行單一侵害的神經(jīng)心理和影像學(xué)的研究,對多重侵害的研究相對較少。侵害常聚集出現(xiàn),因此對多重侵害進行研究更具有實際意義。侵害與個體執(zhí)行功能損傷有關(guān),本研究綜合使用生態(tài)學(xué)和神經(jīng)心理學(xué)測評工具,比較了多重侵害無創(chuàng)傷后應(yīng)激癥狀組、多重侵害有創(chuàng)傷后應(yīng)激癥狀組、非多重侵害組和正常對照組高職高專學(xué)生的執(zhí)行功能的差異,并使用功能磁共振成像技術(shù)探討了遭受多重侵害的高職高專女生靜息態(tài)大腦局部一致性的特點、與執(zhí)行功能相關(guān)腦區(qū)的靜息態(tài)功能連接特征以及在執(zhí)行反應(yīng)抑制任務(wù)時的磁共振成像特征。 第一章遭受多重侵害高職高專學(xué)生生態(tài)學(xué)和神經(jīng)心理學(xué)執(zhí)行功能測試 目的 探討遭受多重侵害的高職高專學(xué)生的執(zhí)行功能特征 方法 在濟南某高職高專院校參加過多重侵害調(diào)查的學(xué)生中選取被試,采用青少年侵害問卷自評版和創(chuàng)傷后應(yīng)激障礙癥狀清單平民版量表的評分方法作為分組標準,擬選取299名被試,最終取得270人配合。270名研究對象均完成一般信息問卷,執(zhí)行功能行為評定量表成人版和瑞文標準推理測試,根據(jù)執(zhí)行功能行為評定量表成人版(BRIEF-A)計分方法,排除效度分量表得分高于劃界分的被試,最終獲得有效數(shù)據(jù)259份。其中多重侵害有創(chuàng)傷后應(yīng)激癥狀組(a組)53人,多重侵害無創(chuàng)傷后應(yīng)激癥狀組(b組)64人,非多重侵害組(c組)68人,對照組(d組)74人。在招募的研究對象中進行神經(jīng)心理學(xué)測試動員,最終參與者為164人,其中多重侵害有創(chuàng)傷后應(yīng)激癥狀組(a’組)32人,多重侵害無創(chuàng)傷后應(yīng)激癥狀組(b’組)49人,非多重侵害組(c’組)41人,對照組(d’組)42人。神經(jīng)心理學(xué)測驗包括兩項熱身測試和五項與執(zhí)行功能相關(guān)的測試,均來自劍橋神經(jīng)心理測驗。統(tǒng)計分析方法包括描述統(tǒng)計、卡方檢驗、方差分析,檢驗水準為a=0.05。 結(jié)果 1.多變量多因素方差分析得Wilk's lambda為0.794,P0.001,表示四個組組間差異顯著。侵害經(jīng)歷不同的四個組高職高專學(xué)生在生態(tài)學(xué)執(zhí)行功能各維度上的得分隨著侵害種類的增加、創(chuàng)傷后應(yīng)激癥狀的出現(xiàn)而升高,四個組在抑制、轉(zhuǎn)換、情感控制、任務(wù)啟動、工作記憶、計劃、組織和任務(wù)監(jiān)控八個因子上的差異均有顯著意義(P0.01),Scheffe檢驗顯示a組在抑制、轉(zhuǎn)換、情感控制、任務(wù)啟動、工作記憶、組織和任務(wù)監(jiān)控七個因子上的得分均高于d組,在抑制、轉(zhuǎn)換、情感控制、任務(wù)啟動、工作記憶五個因子上的得分高于c組,b組在抑制、情感控制、任務(wù)啟動、計劃和任務(wù)監(jiān)控五個因子上的得分高于d組,在工作記憶因子上的得分高于c組,以上差異均具有統(tǒng)計學(xué)意義(P0.01)。a組與b組在生態(tài)學(xué)執(zhí)行功能各因子上得分的差異無統(tǒng)計學(xué)意義(P0.05),c組和d組在生態(tài)學(xué)執(zhí)行功能各因子上得分的差異也無統(tǒng)計學(xué)意義(P0.05) 2.神經(jīng)心理學(xué)測驗發(fā)現(xiàn),侵害經(jīng)歷不同的四個組在停止信號任務(wù)中的Go試驗的平均正確反應(yīng)時、停止信號延遲和成功停止的比例及劍橋球袋測試中解決問題的起始思考時間這四個指標的差異有統(tǒng)計學(xué)意義(P0.05),內(nèi)隱外顯規(guī)則轉(zhuǎn)換測驗、空間廣度記憶測驗、空間工作記憶測驗的各指標在四個組之間的差異均無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論 1.遭受多重侵害的高職高專學(xué)生生態(tài)學(xué)執(zhí)行功能受損,且隨著侵害種類的增加、創(chuàng)傷后應(yīng)激癥狀的出現(xiàn),執(zhí)行功能受損更加明顯。 2.遭受多重侵害的高職高專學(xué)生在停止信號任務(wù)和劍橋球袋測試中的表現(xiàn)較差,表明遭受多重侵害個體的反應(yīng)抑制能力和計劃能力較差。 3.生態(tài)學(xué)與神經(jīng)心理學(xué)執(zhí)行功能測試均表明PV經(jīng)歷與執(zhí)行功能損傷有關(guān)。 第二章遭受多重侵害高職高專女生靜息態(tài)和任務(wù)態(tài)功能磁共振成像研究 目的 利用功能磁共振技術(shù),探討靜息態(tài)和任務(wù)態(tài)下遭受多重侵害高職高專女生的腦功能區(qū)活動情況。 方法 采用Simens Verio3.0T磁共振掃描儀對15名遭受多重侵害無創(chuàng)傷后應(yīng)激癥狀被試(PV無PTSS組)、15名多重侵害有創(chuàng)傷后應(yīng)激癥狀被試(PV有PTSS組)和15名正常對照依次進行定位相、靜息態(tài)腦功能掃描和GO STOP任務(wù)態(tài)的腦功能掃描。三組年齡、智力、受教育程度匹配。 靜息態(tài)磁共振掃描數(shù)據(jù)采用國際通用的SPM8軟件和靜息態(tài)功能磁共振數(shù)據(jù)處理工具包對數(shù)據(jù)預(yù)處理,之后進行ReHo分析或以前額葉背外側(cè)為感興趣區(qū)進行功能連接分析,分別比較PV無PTSS組與其余兩組腦功能的差異,采用未校正P0.005,體素范圍(K值)≥10認為有統(tǒng)計學(xué)意義。將所得的MNI坐標轉(zhuǎn)換為Talairach坐標后,使用Talairach Daemon (TD)軟件查看其所代表的腦區(qū)。 任務(wù)態(tài)磁共振掃描數(shù)據(jù)采用組塊設(shè)計的方法,用GO STOP沖動控制任務(wù)軟件呈現(xiàn)刺激任務(wù),使用SPM8軟件進行預(yù)處理、單樣本t檢驗和獨立樣本t檢驗,分別比較PV無PTSS組與其余兩組腦功能的差異。單樣本t檢驗采用未校正P0.001且體素范圍(K值)≥100為差異具有統(tǒng)計學(xué)意義,獨立樣本t檢驗采用未校正P0.001且體素范圍(K值)≥10為差異具有統(tǒng)計學(xué)意義。使用xjView軟件查看MNI坐標所代表的腦區(qū)。 結(jié)果 1.靜息狀態(tài)下,與對照組相比,PV無PTSS組ReHo值在左側(cè)額下回、左右額內(nèi)側(cè)回、右側(cè)中央后回、左側(cè)梭狀回、左右海馬旁回、右側(cè)扣帶回、左右豆狀核和右側(cè)島葉低于對照組。ReHo值在左右額上回、左右額中回、左右額下回、左右頂下小葉、左右楔前葉、左右顳上回、左側(cè)顳橫回、左右顳中回、右側(cè)舌回和右側(cè)扣帶后回高于對照組；與PV有PTSS組相比,PV無PTSS組在右側(cè)額中回和額下回、左側(cè)楔前葉、左側(cè)舌回、左右海馬旁回、左側(cè)扣帶回和左側(cè)豆狀核ReHo值降低；在左右額上回、左右額中回、左側(cè)額內(nèi)側(cè)回、右側(cè)中央后回、左側(cè)緣上回、左右頂下小葉、左側(cè)梭狀回和左側(cè)尾狀核ReHo值升高。 2.靜息狀態(tài)下,與對照組相比,PV無PTSS組雙側(cè)背外側(cè)前額葉在右側(cè)額上回,左右額中回,左右額內(nèi)側(cè)回,左側(cè)額下回,右側(cè)楔前葉和右側(cè)扣帶回功能連接升高；與PV有PTSS組相比,PV無PTSS組在左側(cè)額中回和左側(cè)扣帶回的功能連接升高,而在左右額下回,右側(cè)島葉和右側(cè)顳上回功能連接降低。 3.執(zhí)行GO STOP任務(wù)時對照組、PV無PTSS組和PV有PTSS組在額葉、顳葉、頂葉和枕葉均有激活,對照組激活強度大且相對集中,隨著侵害經(jīng)歷和創(chuàng)傷后應(yīng)激癥狀的出現(xiàn),激活強度變小且區(qū)域更為分散。PV無PTSS組與正常對照組GO STOP任務(wù)相比,在右側(cè)額上回、左側(cè)頂上小葉和左右島葉等腦區(qū)的激活高于對照組。與PV有PTSS組相比,在執(zhí)行GO STOP任務(wù)時,腦減活的區(qū)域主要為左側(cè)楔前葉,左右楔葉,左側(cè)枕中回和右側(cè)海馬旁回等。 結(jié)論 1.遭受多重侵害無創(chuàng)傷后應(yīng)激癥狀的高職高專女生在靜息狀態(tài)下腦默認網(wǎng)絡(luò)以及島葉、基底神經(jīng)節(jié)、海馬旁回均存在局部一致性信號異常。 2.與對照組相比,PV無PTSS組雙側(cè)BA46區(qū)與額葉、楔前葉和扣帶回功能連接升高,這種功能連接升高可能是與認知需要相關(guān)的補償機制或基線水平的升高�？蹘Щ負p傷與存在PTSS有關(guān)聯(lián),多重侵害引起的扣帶回的損傷可能尚在代償階段。PTSS與顳上回的功能異常有關(guān),多重侵害與顳上回功能的關(guān)系仍需進一步驗證。 3.執(zhí)行GO STOP任務(wù)時,對照組、PV無PTSS組和PV有PTSS組均有右側(cè)額中回、額下回皮質(zhì)的功能區(qū)的激活,有侵害經(jīng)歷和創(chuàng)傷后應(yīng)激癥狀出現(xiàn)后,在執(zhí)行GO STOP任務(wù)時,腦激活區(qū)域逐漸變得分散。排除PTSS,遭受多重侵害個體的前額神經(jīng)網(wǎng)絡(luò)功能異常,提示其執(zhí)行功能存在損害。
[Abstract]:background
Childhood invasion is a common social public health problem. The resulting adverse clinical results have gradually aroused the attention of the researchers. The current research focuses on the occurrence of single infringement, the study of the influencing factors, and the research on the neuropsychological and imaging studies of the single infraction, and the multiple infractions. The study is relatively small. Infringing often occurs, so it is of practical significance to study multiple invasion. The study is related to the damage to individual execution function. This study comprehensively uses ecological and neuropsychological assessment tools to compare multiple invasive and non traumatic stress symptoms groups, multiple invasive posttraumatic stress symptoms groups and non multiple invasion. The difference in the executive function of the higher vocational and technical college students in the injury group and the normal control group, and using the functional magnetic resonance imaging technique to explore the characteristics of the resting state of the rest state of the brain, the resting state function connection with the executive function related brain regions and the magnetic resonance in the execution of the response inhibition task. Resemble a feature.
Chapter I suffers from multiple violations of Higher Vocational College Students' ecological and neuropsychological executive function tests.
objective
To explore the executive function characteristics of vocational college students with multiple victimization
Method
Among the students who participated in multiple infringement investigations in a higher vocational college in Ji'nan, the subjects were selected as the standard of the score of the self-assessment questionnaire and the symptom checklist of post-traumatic stress disorder (PTSD). 299 subjects were selected, and the general information questionnaire was completed by 270 people and.270 names. The adult version and raven standard reasoning test of the functional behavior assessment scale, according to the adult edition (BRIEF-A) score method of the executive functional behavior assessment scale, excluding the scores of the validity subscales higher than the demarcation score, and finally obtain 259 valid data. Among them, 53 people with multiple invasive posttraumatic stress symptom group (group A), multiple infraction and non traumatic stress should be taken. 64 patients (group B), 68 non multiple invasion group (Group C) and 74 people in control group (Group D) were recruited by neuropsychological test mobilization, and the final participants were 164, of which 32 were multiple invasive posttraumatic stress symptoms group (a 'group), 49 patients with multiple invasive posttraumatic stress symptom group (B' group), and non multiple invasion group (C '). 41 people, 42 people in the control group (D "group). Neuropsychological tests included two warm-up tests and five tests related to executive function, all from the Cambridge neuropsychological test. Statistical analysis included descriptive statistics, chi square test, ANOVA analysis, and test level of a=0.05.
Result
1. multivariable multi factor variance analysis showed that Wilk's lambda was 0.794 and P0.001, which indicated that there were significant differences among the four groups. The scores of the four higher vocational college students in the various dimensions of the ecological execution function increased with the increase of the types of infraction, the appearance of post-traumatic stress symptoms, and the four groups in inhibition, conversion, and emotional control. There were significant differences between the eight factors of task starting, working memory, planning, organization and task monitoring (P0.01). Scheffe test showed that the scores of the seven factors on inhibition, conversion, emotional control, task starting, working memory, organization and task monitoring in group A were higher than that of group D, in inhibition, conversion, emotional control, task starting, working memory The score of the five factors was higher than that of the C group. The scores of the five factors in the group B were higher than that of the D group, and the scores on the working memory factors were higher than those in the group C. The differences were statistically significant (P0.01) and there was no significant difference in the scores between the group.A and the B group on the various factors of the ecological implementation function. (P0.05) there was no statistically significant difference in scores of ecological execution functions among group C and group D (P0.05).
2. neuropsychological tests found that the average correct response to the Go test of four different groups in the stop signal task, the proportion of stop signal delay and successful stop, and the starting thinking time of solving the problem in Cambridge ball bag test, the difference of the difference of the four indexes: P0.05, implicit explicit rule conversion test There was no significant difference in the spatial breadth memory test and the spatial working memory test between the four groups (P0.05).
conclusion
1. the ecological execution function of the higher vocational college students suffering from multiple invasion is impaired, and with the increase of the type of infringement, the appearance of post-traumatic stress symptoms and the impairment of the executive function are more obvious.
2. the higher vocational college students who suffered multiple violations were poor in the stop signal task and the Cambridge bag test, indicating that the response to multiple infraction individuals was poor and the planning ability was poor.
3. both ecological and neuropsychological executive function tests indicate that PV experience is associated with functional impairment.
The second chapter is on the resting state and task state of female students with multiple victimization.
objective
Functional magnetic resonance imaging (fMRI) was used to explore the activities of brain functional areas in female students with multiple victimization in resting state and task state.
Method
The Simens Verio3.0T magnetic resonance imaging (Simens) scanners were used to examine 15 patients with multiple invasive and non traumatic stress symptoms (group PV without PTSS), 15 multiple multiple invasive posttraumatic stress symptoms (PV PTSS group) and 15 normal controls in sequence, resting state brain function scan and GO STOP task state brain function scan. Three groups of age, intelligence, and subject The degree of education matches.
The rest state magnetic resonance imaging data were pre processed by international SPM8 software and resting state functional magnetic resonance data processing kit, followed by ReHo analysis or the function connection analysis of the anterior lateral frontal lobes for the region of interest. The difference between the PV non PTSS group and the other two groups of brain functions was compared, and the uncorrected P0.005 was used. The element range (K value) > 10 is considered statistically significant. After converting the obtained MNI coordinates to Talairach coordinates, Talairach Daemon (TD) software is used to view the brain region it represents.
The task state magnetic resonance scanning data is designed by block design, using the GO STOP impulse control task software to present a stimulus task, using SPM8 software for preprocessing, single sample t test and independent sample t test, to compare the difference between the PV free PTSS group and the other two groups of brain functions respectively. The single T test uses uncorrected P0.001 and the voxel range (K value). The difference between 100 and 100 was statistically significant. The difference was statistically significant with the independent sample t test using the uncorrected P0.001 and the voxel range (K value) > 10. The xjView software was used to examine the brain regions represented by the MNI coordinates.
Result
At 1. resting state, compared with the control group, there was no ReHo value in PV PTSS group in the left inferior frontal gyrus, left and right lateral frontal gyrus, right and left medial gyrus, right central posterior gyrus, left fusiform gyrus, left and right lateral hippocampus, right cingulate gyrus, left and right lenticular nucleus and right Island leaf lower than the control group,.ReHo value of the upper and right frontal gyrus, left and right frontal gyrus, left and right lower lobules, left and right wedges Leaves, left and right superior temporal gyrus, left temporal gyrus, right and left temporal gyrus, right lingual gyrus and right posterior cingulate band were higher than that of control group. Compared with group PTSS of PV, no PTSS group in PV was in right middle frontal gyrus and lower frontal gyrus, left anterior lobe, left lingual gyrus, left and right lateral hippocampus, left cingulate gyrus and left side lenticular nucleus ReHo value lower; left and right frontal gyrus, middle frontal gyrus. The ReHo value of left frontal medial gyrus, right posterior central gyrus, left superior border, left and right inferior lobules, left fusiform gyrus and left caudate nucleus increased.
At 2. resting state, compared with the control group, the bilateral dorsal and lateral prefrontal lobes in the PV group had no bilateral dorsolateral prefrontal cortex in the right frontal gyrus, left and right frontal gyrus, left and right frontal gyrus, left inferior frontal gyrus, right anterior cuneus and right cingulate gyrus. Compared with the PTSS group in PV, the left middle frontal gyrus and the left cingulate gyrus had a higher function connection, but left in the left PV group, but left in the left side of the PTSS group. The functional connections between the right insula and the right superior temporal gyrus decreased in the right frontal and inferior gyrus.
3. when the GO STOP task was performed, the group of PV without PTSS and PV were activated in the frontal lobe, the temporal lobe, the parietal lobe and the occipital lobe. The activation intensity of the control group was large and relatively concentrated. With the invasion experience and the appearance of posttraumatic stress symptoms, the activation intensity was smaller and the region was more dispersed in the.PV non PTSS group compared with the normal control group GO STOP task, on the right side. In the upper frontal gyrus, the activation of the brain regions, such as the left superior lobule and the left and right Island leaves, was higher than that of the control group. Compared with the PTSS group with PV, the brain subtraction areas were mainly the left anterior lobe of the wedge, the left and right cuneate leaves, the left occipital gyrus and the right parahippocampal gyrus in the GO STOP task.
conclusion
1. there were local conformance signal abnormalities in the brain default network and the insula, basal ganglia and parahippocampal gyrus in the resting state of higher vocational college girls suffering from multiple invasive and non traumatic stress symptoms.
2. compared with the control group, the bilateral BA46 area in the PV PTSS group increased with the frontal lobe, the prefrontal lobe and the cingulate gyrus, which may be a compensation mechanism associated with the cognitive needs or the elevation of the baseline level. The cingulate injury is associated with the existence of PTSS. The damage of the cingulate gyrus caused by multiple encroach may still be in the compensatory phase of.PTSS. Dysfunction of the superior temporal gyrus is related to functional abnormalities. The relationship between multiple lesions and the function of the superior temporal gyrus still needs further verification.
3. when the GO STOP task was performed, the control group, the PV without PTSS group and the PTSS group all had the right frontal gyrus, the activation of the functional area of the inferior frontal cortex, the invasion experience and the posttraumatic stress symptoms, and the brain activation area gradually became scattered when the GO STOP task was executed. It suggests that its execution function is impaired.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R749.5

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