產(chǎn)后抑郁癥患者靜息態(tài)和任務(wù)態(tài)下腦區(qū)激活與情緒反應(yīng)特征
發(fā)布時間：2018-07-26 07:01
【摘要】：產(chǎn)后抑郁癥是產(chǎn)褥期發(fā)生的,以抑郁情緒為主的常見的圍生期精神疾病。目前,對該疾病的研究停留在社會心理因素和激素等水平,其發(fā)病機(jī)制尤其是腦機(jī)制仍不明確,近十幾年來腦科學(xué)研究和功能影像學(xué)技術(shù)的飛速發(fā)展,使我們研究其腦神經(jīng)病理學(xué)基礎(chǔ)成為可能。 本研究采用腦功能磁共振、量表、內(nèi)分泌測定等研究方法,對產(chǎn)后抑郁癥患者靜息態(tài)和任務(wù)態(tài)下(正、負(fù)性刺激和應(yīng)激任務(wù))的腦激活和情緒反應(yīng)特征進(jìn)行研究。本研究分3個部分：(1)產(chǎn)后抑郁組與產(chǎn)后對照組靜息態(tài)下腦功能磁共振差異的研究。(2)產(chǎn)后抑郁癥的負(fù)性情緒偏向及其腦機(jī)制的研究。(3)產(chǎn)后抑郁組與產(chǎn)后對照組在應(yīng)激任務(wù)下主觀應(yīng)激評價、皮質(zhì)醇水平變化及腦功能磁共振的差異的研究。本研究通過對產(chǎn)后抑郁癥靜息態(tài)下和任務(wù)態(tài)下腦功能的變化探討,為產(chǎn)后抑郁癥的腦病理機(jī)制的研究提供進(jìn)一步的實驗依據(jù)。 實驗方法：(1)12名產(chǎn)后抑郁癥患者與11名產(chǎn)后對照組被試在靜息態(tài)下接受6分鐘功能磁共振掃描,以Reho法對影像學(xué)數(shù)據(jù)進(jìn)行局部一致性分析,比較產(chǎn)后抑郁組與產(chǎn)后對照組腦局部一致性的差異。(2)11名產(chǎn)后抑郁癥患者與11名產(chǎn)后對照組被試接受正、負(fù)性音樂刺激下腦功能磁共振掃描,以SAM量表評價收聽音樂時的主觀愉悅度,比較兩組主觀愉悅度和腦功能差異。(3)10名產(chǎn)后抑郁癥患者與10名產(chǎn)后對照組被試接受三個水平的心算應(yīng)激下的腦功能磁共振掃描,以應(yīng)激量表評價主觀應(yīng)激水平,以酶聯(lián)免疫法測定唾液皮質(zhì)醇水平,比較兩組主觀應(yīng)激評價、應(yīng)激前后皮質(zhì)醇水平和腦功能差異。 研究數(shù)據(jù)采用方差分析、t檢驗、卡方檢驗、相關(guān)分析等統(tǒng)計方法,經(jīng)過分析討論,本研究得出以下主要結(jié)論： (1)產(chǎn)后抑郁癥患者存在靜息態(tài)下局部一致性異常的腦區(qū),主要表現(xiàn)在左右后扣帶回、右前扣帶回、右前額葉、右側(cè)頂葉局部等腦區(qū)一致性增高；右顳上回、右顳中回、右顳下回、左、右島葉等腦區(qū)局部一致性降低。這些異常腦區(qū)多處于默認(rèn)網(wǎng)絡(luò)中,提示產(chǎn)后抑郁癥患者默認(rèn)網(wǎng)絡(luò)存在異常。 (2)產(chǎn)后抑郁癥患者存在負(fù)性情緒偏向。與產(chǎn)后對照組相比,在正性音樂刺激下激活增強(qiáng)的腦區(qū)為右側(cè)尾狀核、右側(cè)頂下小葉、左側(cè)顳下回等,表現(xiàn)出正性情緒減弱。在負(fù)性音樂刺激下,激活增強(qiáng)的腦區(qū)為雙側(cè)海馬、右側(cè)島葉、右側(cè)尾狀核、殼核、左側(cè)頂下小葉和左側(cè)顳下回等,表現(xiàn)出負(fù)性情緒增強(qiáng),并且,負(fù)性音樂下,產(chǎn)后抑郁癥患者的右側(cè)海馬的異常激活與主觀愉悅度評價呈負(fù)相關(guān)。這些腦區(qū)的異常激活,可能是其負(fù)性情緒偏向的腦病理基礎(chǔ)。 (3)產(chǎn)后抑郁組對低水平的心算應(yīng)激的主觀應(yīng)激評價與產(chǎn)后對照組沒有差異；而對中等水平和高水平心算應(yīng)激的主觀應(yīng)激評價均高于對照組；產(chǎn)后抑郁組基線皮質(zhì)醇水平高于產(chǎn)后對照組,應(yīng)激任務(wù)下,皮質(zhì)醇升高水平低于產(chǎn)后對照組。產(chǎn)后抑郁組與產(chǎn)后對照組相比較,應(yīng)激任務(wù)下激活增強(qiáng)的腦區(qū)為左、右側(cè)殼核、左側(cè)額葉(BA44、45)、左側(cè)海馬等,并且,應(yīng)激下產(chǎn)后抑郁癥患者的左側(cè)殼核的激活與主觀應(yīng)激體驗呈現(xiàn)正相關(guān)。產(chǎn)后抑郁癥這種應(yīng)激下的心理、內(nèi)分泌和腦功能的異常,可能是應(yīng)激在其疾病中發(fā)揮作用的病理基礎(chǔ)。 (4)產(chǎn)后抑郁癥靜息態(tài)和任務(wù)態(tài)下腦激活和情緒反應(yīng)存在的異常,并且與普通(非產(chǎn)后)抑郁癥不完全相同,提示產(chǎn)后抑郁癥患者具有自身獨(dú)特的腦功能變化特征。
[Abstract]:Postpartum depression is a common perinatal mental disease occurring in the puerperium, mainly with depressive mood. At present, the study of the disease remains at the level of psychosocial factors and hormones. The pathogenesis, especially the brain mechanism, is still unclear. The rapid development of brain science and functional imaging technology in the past decade has made us study The basis of brain neuropathology is possible.
The purpose of this study was to study the brain activation and emotional response characteristics of postpartum depression patients in resting state and task state (positive, negative stimulation and stress task) by brain functional magnetic resonance (fMRI), scale and endocrine assay. The study was divided into 3 parts: (1) the difference between postpartum depression group and postpartum control group at resting state brain functional magnetic resonance (fMRI) Study. (2) the study of negative emotional bias and its brain mechanism of postpartum depression. (3) the study of subjective stress assessment, cortisol level and brain functional MRI in postpartum depression group and postpartum control group. The study on the changes of brain function under the resting state and task state of postpartum depression was studied for postpartum. The study of brain pathology mechanism of depression provides further experimental evidence.
Experimental methods: (1) 12 postpartum depression patients and 11 postpartum control groups were subjected to 6 minute functional magnetic resonance imaging (fMRI) at resting state. The Reho method was used to analyze the local conformance of the imaging data. (2) 11 postpartum depression patients and 11 postpartum control groups were compared. The subjects received positive, negative music stimuli, and the SAM scale was used to evaluate the subjective pleasure of listening to music. Two groups of subjective pleasures and brain function differences were compared. (3) 10 postpartum depression patients and 10 postpartum controls received three levels of brain functional MRI scan under the stress of three levels, with a stress scale The level of subjective stress was assessed. The level of cortisol in saliva was measured by ELISA. The subjective stress assessment, cortisol level and brain function before and after stress were compared between the two groups.
The data were analyzed by ANOVA, t test, chi square test and correlation analysis. After analysis and discussion, the following conclusions were drawn:
(1) the patients with postpartum depression had the brain region with local conformance in resting state, mainly in the posterior cingulate gyrus, right anterior cingulate gyrus, right prefrontal lobe and right parietal lobe, and other brain regions increased, right temporal gyrus, right temporal gyrus, right temporal gyrus, left, right Island lobe and other brain regions decreased. Most of these abnormal brain regions were in default. The network indicates that the default network of patients with postnatal depression is abnormal.
(2) there was negative emotional bias in postpartum depression. Compared with the postpartum control group, the enhanced brain area activated by positive music stimulation was the right caudate nucleus, the right apical lobule, the left temporal gyrus, and the positive mood weakened. Under negative music stimulation, the activation of the brain was bilateral hippocampus, right Island leaf, right caudate nucleus, and shell. The nucleus, left parietal lobule and left temporal gyrus showed negative emotional enhancement, and the abnormal activation of the right hippocampus in the patients with postpartum depression was negatively correlated with the subjective pleasure evaluation under negative music. The abnormal activation of these brain regions may be the pathological basis of the negative emotional bias.
(3) the subjective stress evaluation of postpartum depression group had no difference with the postpartum control group, but the subjective stress evaluation was higher than that of the control group. The baseline cortisol level of postpartum depression group was higher than that of the postpartum control group. The level of cortisol increased under stress task was lower than that of the postpartum control group. The postpartum depression group was compared with the postpartum control group. The activation of the brain area under the stress task was left, right putamen, left frontal lobe (BA44,45), left hippocampus, etc., and the activation of the left putamen in postpartum depression was positively correlated with the subjective stress experience. Abnormality may be the pathological basis for stress to play a role in its disease.
(4) the abnormality of the brain activation and emotional response in the resting state and the task state of postpartum depression, and not exactly the same as that of the general (non postpartum) depression, suggests that the patients with postpartum depression have their own unique brain function changes.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R749.4
本文編號：2145226
[Abstract]:Postpartum depression is a common perinatal mental disease occurring in the puerperium, mainly with depressive mood. At present, the study of the disease remains at the level of psychosocial factors and hormones. The pathogenesis, especially the brain mechanism, is still unclear. The rapid development of brain science and functional imaging technology in the past decade has made us study The basis of brain neuropathology is possible.
The purpose of this study was to study the brain activation and emotional response characteristics of postpartum depression patients in resting state and task state (positive, negative stimulation and stress task) by brain functional magnetic resonance (fMRI), scale and endocrine assay. The study was divided into 3 parts: (1) the difference between postpartum depression group and postpartum control group at resting state brain functional magnetic resonance (fMRI) Study. (2) the study of negative emotional bias and its brain mechanism of postpartum depression. (3) the study of subjective stress assessment, cortisol level and brain functional MRI in postpartum depression group and postpartum control group. The study on the changes of brain function under the resting state and task state of postpartum depression was studied for postpartum. The study of brain pathology mechanism of depression provides further experimental evidence.
Experimental methods: (1) 12 postpartum depression patients and 11 postpartum control groups were subjected to 6 minute functional magnetic resonance imaging (fMRI) at resting state. The Reho method was used to analyze the local conformance of the imaging data. (2) 11 postpartum depression patients and 11 postpartum control groups were compared. The subjects received positive, negative music stimuli, and the SAM scale was used to evaluate the subjective pleasure of listening to music. Two groups of subjective pleasures and brain function differences were compared. (3) 10 postpartum depression patients and 10 postpartum controls received three levels of brain functional MRI scan under the stress of three levels, with a stress scale The level of subjective stress was assessed. The level of cortisol in saliva was measured by ELISA. The subjective stress assessment, cortisol level and brain function before and after stress were compared between the two groups.
The data were analyzed by ANOVA, t test, chi square test and correlation analysis. After analysis and discussion, the following conclusions were drawn:
(1) the patients with postpartum depression had the brain region with local conformance in resting state, mainly in the posterior cingulate gyrus, right anterior cingulate gyrus, right prefrontal lobe and right parietal lobe, and other brain regions increased, right temporal gyrus, right temporal gyrus, right temporal gyrus, left, right Island lobe and other brain regions decreased. Most of these abnormal brain regions were in default. The network indicates that the default network of patients with postnatal depression is abnormal.
(2) there was negative emotional bias in postpartum depression. Compared with the postpartum control group, the enhanced brain area activated by positive music stimulation was the right caudate nucleus, the right apical lobule, the left temporal gyrus, and the positive mood weakened. Under negative music stimulation, the activation of the brain was bilateral hippocampus, right Island leaf, right caudate nucleus, and shell. The nucleus, left parietal lobule and left temporal gyrus showed negative emotional enhancement, and the abnormal activation of the right hippocampus in the patients with postpartum depression was negatively correlated with the subjective pleasure evaluation under negative music. The abnormal activation of these brain regions may be the pathological basis of the negative emotional bias.
(3) the subjective stress evaluation of postpartum depression group had no difference with the postpartum control group, but the subjective stress evaluation was higher than that of the control group. The baseline cortisol level of postpartum depression group was higher than that of the postpartum control group. The level of cortisol increased under stress task was lower than that of the postpartum control group. The postpartum depression group was compared with the postpartum control group. The activation of the brain area under the stress task was left, right putamen, left frontal lobe (BA44,45), left hippocampus, etc., and the activation of the left putamen in postpartum depression was positively correlated with the subjective stress experience. Abnormality may be the pathological basis for stress to play a role in its disease.
(4) the abnormality of the brain activation and emotional response in the resting state and the task state of postpartum depression, and not exactly the same as that of the general (non postpartum) depression, suggests that the patients with postpartum depression have their own unique brain function changes.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R749.4
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