【摘要】：目的:通過靜息態(tài)功能磁共振成像(functional magnetic resonance imaging,fMRI)中比率低頻振幅(fractional amplitude of low-frequency fluctuations,fALFF)與功能連接(functional connectivity,FC)的分析方法探討早發(fā)精神分裂癥與成人精神分裂癥發(fā)病的共性與特異性,并探索精神分裂癥(Schziphrenia,SZ)兩種時間段下的神經(jīng)影像學標記以及病理生理學機制。方法:收集首次發(fā)作未經(jīng)治療的早發(fā)精神分裂癥(early onset schizophrenia,EOS)與成人精神分裂癥(adult onset schizophrenia,AOS)患者各32例,符合美國精神障礙診斷與統(tǒng)計手冊第4版的診斷標準(Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition,DSM-Ⅳ),同時在學校和社區(qū)張貼志愿者招募書收集健康被試,健康受試者要求一般人口學信息與病例組相匹配。健康受試者入組前經(jīng)由專業(yè)心理測評人員對其心理情況進行評估并進行90項癥狀自查清單量表(Symptom checklist 90,SCL-90)評測,以排除近期重大事件影響導致腦影像學的差異改變,經(jīng)入排標準排除不合格健康被試后,健康受試者成人與小孩組各37例。病例組受試者均由兩名精神衛(wèi)生科副主任及以上級別醫(yī)師確認診斷,同時采用陽性與陰性癥狀量表(Positive and Negative Symptom Scale,PANSS)評估精神病性癥狀的嚴重程度并記錄存檔。通過篩選后的患者與健康受試者分別通過靜息態(tài)fMRI檢測,圖像后處理采取DPABI軟件進行預處理,排除頭動三維平移2mm的被試,采用REST軟件進行fALFF、基于體素的FC統(tǒng)計分析,結(jié)果采用AlphaSim校正,校正后p0.05為差異有統(tǒng)計學意義(單個體素p0.005、集群的大小67voxel、體積1809mm3、18個體素邊緣連接),結(jié)果通過DPABI_VIEW計算出自由度值,并根據(jù)腦區(qū)t值對照t值表查找出相應的p值,圖像結(jié)果通過BrianNet Viewer進行顯示。結(jié)果:1.早發(fā)精神分裂癥患者組與其匹配的健康被試的fALFF、FC值差異:兩樣本t檢驗結(jié)果顯示患者組在左側(cè)角回、左側(cè)背外側(cè)額上回、右側(cè)島葉、右側(cè)舌回、右側(cè)楔前葉、左側(cè)顳上回處與健康被試存在差異。提取上述的差異腦區(qū)的時間序列作為感興趣區(qū)域(Region of interest,ROI)進行全腦體素的FC分析,結(jié)果發(fā)現(xiàn)左側(cè)角回與左側(cè)眼眶部額下回FC增高;左側(cè)背外側(cè)額上回與右側(cè)島葉、左側(cè)島蓋部額下回、右側(cè)額中回FC增高;右側(cè)島葉與右側(cè)背外側(cè)額上回FC增高;右側(cè)舌回與右側(cè)額中回、兩側(cè)蒼白球、右側(cè)島蓋部額下回、右側(cè)內(nèi)側(cè)額上回FC增高;右側(cè)楔前葉與左側(cè)顳中回FC增高;左側(cè)顳上回未發(fā)現(xiàn)差異的FC值。2.成人精神分裂癥患者組與其匹配的健康被試的fALFF、FC值差異:兩樣本t檢驗結(jié)果顯示患者組在右側(cè)楔前葉處與健康被試存在差異。以右側(cè)楔前葉為ROI采取FC分析發(fā)現(xiàn)其與左側(cè)內(nèi)側(cè)眶部額上回、右側(cè)三角部額下回的FC增高。結(jié)論:(1)經(jīng)fALFF分析發(fā)現(xiàn)EOS與AOS患者均存在右側(cè)楔前葉功能紊亂,提示右側(cè)楔前葉腦區(qū)可能是導致精神分裂癥發(fā)病的核心區(qū)域之一,同時該區(qū)域可能是精神分裂癥診斷的神經(jīng)影像學標記之一。(2)經(jīng)fALFF分析發(fā)現(xiàn)早發(fā)精神分裂癥感覺運動網(wǎng)絡(包括言語和聽覺區(qū)域)存在神經(jīng)活性增加,同時發(fā)現(xiàn)視覺皮層存在神經(jīng)活性紊亂。(3)通過功能連接分析方法發(fā)現(xiàn)早發(fā)精神分裂癥的視覺—前額葉皮層神經(jīng)環(huán)路異常激活,成人精神分裂癥的右側(cè)楔前葉與背外側(cè)前額葉皮層存異常的功能連接。
[Abstract]:Objective: To explore the generality and specificity of early onset schizophrenia and adult schizophrenia through the analysis of the low frequency amplitude (fractional amplitude of low-frequency fluctuations, fALFF) and functional connectivity in functional magnetic resonance imaging (fMRI). Sex, and explore the neuroimaging markers and pathophysiology mechanisms under two time periods of Schziphrenia (SZ). Methods: 32 cases of early onset schizophrenia (EOS) and adult schizophrenia (adult onset schizophrenia, AOS) were collected for the first time, and they were conformed to American mental disability. The diagnostic criteria for the fourth edition of the diagnostic and Statistical Manual (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM- IV), and volunteers recruited in schools and communities to collect healthy subjects, and healthy subjects to require general demographic information to match the case group. The assessment staff assessed their psychological conditions and evaluated the 90 symptom checklist (Symptom Checklist 90, SCL-90) to exclude the changes in brain imaging results from the impact of recent major events. After the exclusion criteria were excluded from unqualified health subjects, 37 healthy subjects and 37 children. All the cases were two. Positive and Negative Symptom Scale (PANSS) was used to assess the severity and record of psychiatric symptoms by the deputy director of the Department of mental health and the above level physician, and the patient was examined by the resting state fMRI by the selected patients and the healthy subjects, and the post-processing of the image took DPABI. The software is pretreated, the subjects that remove the three dimensional shift 2mm of the head move, using the REST software for fALFF, based on the FC statistical analysis of voxel, the results are corrected by AlphaSim, and the corrected P0.05 is statistically significant (single individual P0.005, cluster size 67voxel, volume 1809mm3,18 individual element edge connection), and the results are calculated by DPABI_VIEW. The values of the degree of freedom were found and the corresponding P values were found according to the T value of the brain area of the brain. The image results were displayed by BrianNet Viewer. Results: 1. the group of early onset schizophrenia patients was different from those of the matched healthy subjects, fALFF, FC. The two sample t test showed the left lateral angle, the left lateral dorsal frontal gyrus, the right Island leaf, the right side, and the right side. Lingual gyrus, right anterior lobe, left superior temporal gyrus and healthy subjects were different from those of the healthy subjects. The time series of the different brain regions were extracted as the region of interest (Region of interest, ROI) for FC analysis of all brain voxels. The results showed that the left angular gyrus and the left orbital part of the lower frontal gyrus FC increased; the left lateral dorsal lateral frontal gyrus and the right Island leaf, the left Island cover were found. In the lower frontal gyrus, the FC of the right middle frontal gyrus increased, the right Island lobe and the right dorsal lateral frontal gyrus increased FC, the right lingual gyrus and the right frontal gyrus, the two sides of the pallidus, the right medial frontal gyrus, the upper right medial frontal gyrus FC increased, the right anterior lobe and the left middle temporal gyrus FC increased, and the left temporal upper gyrus did not find the difference FC value of.2. adult schizophrenic patients. The fALFF, FC value difference between the group and the matched healthy subjects: the two sample t test showed that the patient group was different from the healthy subjects at the right anterior wedge. With the right anterior wedge of ROI, the FC analysis was used to detect the upper frontal gyrus in the left medial orbit and the FC in the right trigonometric lower frontal gyrus. Conclusion: (1) the fALFF analysis showed that both EOS and AOS patients were found. There is a dysfunction of the right anterior lobe, suggesting that the right anterior lobe of the wedge may be one of the core regions that lead to schizophrenia, and this area may be one of the neuroimaging markers for the diagnosis of schizophrenia. (2) fALFF analysis shows that the neural network of early onset schizophrenia (including speech and auditory regions) has nerves. The activity increased and there was a neuroactivity disorder in the visual cortex. (3) the visual prefrontal cortex of early schizophrenia was abnormal activation by functional connection analysis, and the functional connection between the right anterior lobe of the adult schizophrenia and the dorsolateral prefrontal cortex was found in adult schizophrenia.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.3

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