【摘要】：研究背景及目的抑郁癥(MDD)是一種情感性精神障礙性疾病，臨床以心境低落為主要特征的精神疾病綜合癥。抑郁癥發(fā)病率及患病率存在性別差異，男女之比約為1:2。抑郁癥性別差異的認知神經(jīng)機制已成為國內(nèi)外神經(jīng)學和腦科學研究熱點之一。正常人性別差異的腦區(qū)結(jié)構(gòu)和功能已被諸多研究證實，用功能磁共振研究發(fā)現(xiàn)情緒記憶相關(guān)的杏仁核激活存在性別差異，這種性別差異與抑郁癥患者性別差異是否存在關(guān)聯(lián)，有待進一步研究。目前國內(nèi)外有少數(shù)關(guān)于抑郁癥患者腦結(jié)構(gòu)和靜息態(tài)功能磁共振成像性別差異的研究報導，但很少有運用任務態(tài)功能磁共振腦成像研究抑郁癥情緒記憶加工性別差異的報道。本研究運用組塊－事件相關(guān)混合設(shè)計功能磁共振成像研究單相抑郁癥患者情緒記憶相關(guān)腦機制，并結(jié)合認知行為學檢測，進一步探討抑郁癥情緒記憶相關(guān)性別差異的認知神經(jīng)機制。 材料和方法抑郁癥39名，其中男16名（平均38.4±2.57歲），女23名（平均37.2±2.32歲）。正常對照組44名，其中男23名（平均年齡22.43±0.31歲），女21名（平均年齡21.85±0.34歲）。實驗材料包括120幅彩色情景圖片，實驗包括編碼和立即提取兩個階段，編碼階段采用組塊/事件相關(guān)混合設(shè)計方法。用3.0T MRI掃描并采集任務態(tài)功能數(shù)據(jù)，記錄行為學成績。利用MATLAB7.12、SPM、MRIcro和SPSS13.0統(tǒng)計軟件包分別對fMRI數(shù)據(jù)及行為學數(shù)據(jù)進行相關(guān)統(tǒng)計分析。 結(jié)果(1)行為學結(jié)果顯示：抑郁組男女對恐懼圖片的平均反應正確率無顯著性差異；女性對中性圖片平均反應正確率明顯低于男性（P0.05）。正常組對兩種圖片（恐懼或中性）的平均反應正確率沒有性別的顯著性差異。(2)功能磁共振成像結(jié)果：①抑郁癥女性以瞬時效應為主，較男性主要激活腦區(qū)有：左側(cè)額下回三角部、距狀回、枕中回、右側(cè)角回、尾狀核、顳上回、枕中回及扣帶回后部；男性以持續(xù)效應為主，較女性主要激活腦區(qū)有：雙側(cè)額下回島蓋，左側(cè)內(nèi)側(cè)額上回、尾狀核、島回，右側(cè)顳中回及內(nèi)側(cè)和旁扣帶回。②交互作用分析顯示：女性較男性瞬時效應顯著增強腦區(qū)包括枕頂部皮層；男性較女性持續(xù)效應顯著增強腦區(qū)包括額葉、扣帶回及島蓋部。 結(jié)論 (1)抑郁癥患者記憶認知功能下降，，情緒記憶增強效應仍保持。女性對中性事件記憶力顯著下降，情緒記憶增強效應有所增加，而男性較正常人有所減弱。 (2)抑郁癥情緒記憶相關(guān)腦區(qū)激活存在性別差異。女性瞬時效應相對增強，主要涉及枕頂部皮層；男性持續(xù)效應相對增強，主要涉及額葉、扣帶回及島蓋部。
[Abstract]:Background and objective Depression (MDD) is an affective disorder characterized by depression. There is a gender difference in the incidence and prevalence of depression, with a ratio of about 1: 2. The cognitive neuromechanism of gender difference in depression has become one of the hotspots in neurology and brain science research at home and abroad. The structure and function of the brain area of gender difference in normal people have been confirmed by many studies. Using functional magnetic resonance imaging (fMRI), we found that there is a gender difference in the activation of amygdala associated with emotional memory, and whether this gender difference is related to the gender difference in patients with depression. Further study is needed. There are few reports at home and abroad on the gender differences in brain structure and resting functional magnetic resonance imaging (fMRI) in patients with depression, but there are few reports on the gender differences of emotional memory processing in depression using task-based functional magnetic resonance imaging (TfMRI). In this study, the motion-memory related brain mechanism of monophasic depression patients was studied by using block-event-related mixed design functional magnetic resonance imaging (fMRI), and cognitive behavior was measured. To further explore the cognitive neural mechanism of emotional memory related gender differences in depression. Materials and methods 39 patients with depression, including 16 males (mean 38.4 鹵2.57 years) and 23 females (mean 37.2 鹵2.32 years), were enrolled in this study. There were 44 normal controls, including 23 males (mean age 22.43 鹵0.31) and 21 females (mean age 21.85 鹵0.34). The experiment consists of 120 color scene images. The experiment consists of two stages: coding and immediate extraction. The coding stage adopts the mixed design method of block / event correlation. The functional data of task state were scanned with 3.0 T MRI and the behavioral scores were recorded. FMRI data and behavioral data were analyzed by MATLAB 7.12 SPSS13.0 MRIcro and SPSS13.0 software package respectively. Results (1) Behavioral results showed that there was no significant difference in the average correct rate of response to fear picture between male and female in depression group, and the average correct rate of response to neutral image in female was significantly lower than that in male (P0.05). There was no significant gender difference in the average correct rate of response to the two images (fear or neutral) in the normal group. (2) the results of functional magnetic resonance imaging showed that the transient effect was dominant in women with depression. The main activation areas were left inferior frontal gyrus, talar gyrus, middle occipital gyrus, right angular gyrus, caudate nucleus, superior temporal gyrus, middle occipital gyrus and posterior cingulate gyrus. The main activation areas in women were bilateral inferior frontal gyrus, left medial superior frontal gyrus, caudate nucleus, island gyrus, bilateral inferior frontal gyrus, left medial superior frontal gyrus, caudate nucleus, island gyrus. The interaction analysis of right middle temporal gyrus and medial and accessory cingulate gyrus showed that the transient effect of female was significantly enhanced than that of male, including occipital parietal cortex, and the sustained effect of male was significantly enhanced than that of female, including frontal lobe, cingulate gyrus and tegmental area. Conclusion (1) the memory cognitive function of depression patients decreased, while the effect of emotional memory enhancement remained. Female memory for neutral events decreased significantly, emotional memory increased, while male was weaker than normal. (2) there was a gender difference in the activation of depression emotional memory related brain area. The transient effect of female was relatively enhanced, mainly involving the occipital parietal cortex, while the male sustained effect was relatively enhanced, mainly involving the frontal lobe, cingulate gyrus and the tegmental part of the island.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R445.2;R749.4

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1 陳小靜;呂厚超;李丹;敖靈敏;郭靖;;抑郁性別差異的新理論:ABC模型[J];中國健康心理學雜志;2010年11期

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