【摘要】：目的： 采用基于體素的形態(tài)學(xué)分析(Voxel-based morphometry, VBM)方法探討首次發(fā)病未服藥女性抑郁障礙患者腦灰質(zhì)體積變化特點(diǎn),并探討認(rèn)知事件相關(guān)電位P300潛伏期和波幅與腦灰質(zhì)體積以及臨床特點(diǎn)之間的關(guān)系,以發(fā)現(xiàn)影響首次發(fā)病未服藥女性抑郁障礙患者認(rèn)知功能的神經(jīng)病理基礎(chǔ)。 方法： 對(duì)昆明醫(yī)科大學(xué)第一附屬醫(yī)院25例符合DSM-Ⅳ診斷標(biāo)準(zhǔn)的首次發(fā)病未服藥女性抑郁障礙患者(患者組)和28例年齡、文化程度匹配的健康對(duì)照(對(duì)照組)分別進(jìn)行頭部3D結(jié)構(gòu)磁共振掃描,并對(duì)患者組進(jìn)行認(rèn)知事件相關(guān)電位P300檢查。所得到的結(jié)構(gòu)磁共振數(shù)據(jù)采用基于Matlab2009a軟件平臺(tái)上的VBM5軟件進(jìn)行自動(dòng)化分割處理,分別分割出患者組和對(duì)照組的腦灰質(zhì)體積；采用兩樣本t檢驗(yàn)來(lái)觀察MDD患者相對(duì)于健康對(duì)照腦灰質(zhì)體積異常的區(qū)域：將認(rèn)知事件相關(guān)電位P300的波幅和潛伏期與腦灰質(zhì)體積進(jìn)行相關(guān)分析,尋找與認(rèn)知事件相關(guān)電位P300相關(guān)的特異腦區(qū)；采用Spearman相關(guān)分析探討認(rèn)知事件相關(guān)電位P300與臨床特點(diǎn)的相關(guān)性。 結(jié)果： 1.與健康常模比較,首次發(fā)病未服藥女性抑郁障礙患者P2潛伏期延長(zhǎng),P3波幅增高(p0.05),其他成分差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),P300各成分與HAMD總分和各因子分相關(guān)性無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。 2.與對(duì)照組相比,首次發(fā)病未服藥女性抑郁障礙患者右側(cè)額下回島蓋部,右側(cè)中央前回灰質(zhì)體積減小。 3.患者組認(rèn)知事件相關(guān)電位P300中的不同成分分別與不同腦區(qū)灰質(zhì)體積相關(guān),其中P3、N2潛伏期均與雙側(cè)殼核正相關(guān)；P3潛伏期還與雙側(cè)顳中回、左側(cè)額中回、左側(cè)梭狀回正相關(guān),而P3波幅則僅與左側(cè)角回、右側(cè)額上回負(fù)相關(guān)；N2潛伏期與左側(cè)后扣帶回、右側(cè)梭狀回、枕葉、左側(cè)小腦正相關(guān)。N1潛伏期主要與左側(cè)小腦正相關(guān),與左側(cè)顳下回、海馬旁回和右側(cè)顳上回、顳中回負(fù)相關(guān)；P2潛伏期主要與雙側(cè)顳上回、左側(cè)楔前葉、舌回、后扣帶回、中央旁小葉和右側(cè)顳中回正相關(guān),與左側(cè)前扣帶回負(fù)相關(guān)。 4.患者的抑郁量表總分及因子分分別與不同腦區(qū)灰質(zhì)體積存在相關(guān)。HAMD總評(píng)分主要與右側(cè)枕上回負(fù)相關(guān)；焦慮/軀體化因子分與左側(cè)梭狀回、右側(cè)尾狀核、小腦蚓和兩側(cè)小腦負(fù)相關(guān)；遲滯因子分與左側(cè)額葉、中央前回、前扣帶回、顳上回、顳中回和雙側(cè)眶額部皮質(zhì)、雙側(cè)額下回三角部正相關(guān),與雙側(cè)枕葉負(fù)相關(guān)；認(rèn)知障礙因子分與左側(cè)額下回島蓋部、中央后回正相關(guān),與右側(cè)枕上回負(fù)相關(guān)；睡眠障礙因子分與左側(cè)顳極顳上回、右側(cè)中央后回正相關(guān)；而體重因子分與雙側(cè)海馬旁回負(fù)相關(guān)。 結(jié)論： 1.與健康對(duì)照比較,首次發(fā)病未服藥女性抑郁障礙患者存在腦灰質(zhì)體積減小,提示未經(jīng)治療女性抑郁患者存在特征性腦灰質(zhì)體積異常。 2.患者的抑郁量表總分及因子分分別與不同腦區(qū)體積存在相關(guān),提示這些不同的抑郁癥狀可能有不同的腦結(jié)構(gòu)基礎(chǔ)。 3.患者認(rèn)知事件相關(guān)電位P300存在異常,但是與抑郁嚴(yán)重程度無(wú)關(guān)；認(rèn)知事件相關(guān)電位P300的各成分分別與多個(gè)灰質(zhì)體積具有相關(guān)性,提示不同腦區(qū)灰質(zhì)體積分別對(duì)認(rèn)知事件相關(guān)電位P300不同成分具有不同影響,即女性抑郁患者的認(rèn)知功能障礙受多個(gè)腦區(qū)或神經(jīng)環(huán)路的共同影響,尤以顳葉、基底神經(jīng)節(jié)的影響較為明顯。支持女性抑郁障礙患者的認(rèn)知功能障礙相對(duì)獨(dú)立,且與抑郁癥狀存在不同的腦結(jié)構(gòu)基礎(chǔ)。
[Abstract]:Objective:
Voxel-based morphometry (VBM) was used to investigate the changes in the volume of gray matter volume in the first onset of untreated women with depressive disorder, and the relationship between the latency and amplitude of the cognitive event related potential and the amplitude of the cerebral gray matter, the volume of gray matter and the clinical characteristics of the patients were investigated in order to find the influence of the first onset of untreated women. Neuropathological basis of cognitive function in patients with depressive disorder.
Method:
In the First Affiliated Hospital of Kunming Medical University, 25 cases of female depressive disorder (patient group) and 28 age and healthy controls (control group) with DSM- IV diagnostic criteria were performed on the head 3D structure magnetic resonance imaging (MRI), and the cognitive event related potential P300 examination of the patients was performed. The structural magnetic resonance data were automatically divided by VBM5 software based on the Matlab2009a software platform to separate the volume of cerebral gray matter in the patient group and the control group, and the two sample t test was used to observe the area of the MDD patients relative to the healthy control brain gray matter volume abnormality: the amplitude and potential of the cognitive event related potential P300. The correlation analysis between the volt period and the volume of cerebral gray matter was carried out to find the specific brain regions associated with the cognitive event related potential P300, and the correlation between the P300 and the clinical characteristics was investigated by Spearman correlation analysis.
Result:
1. compared with the normal health model, the P2 latency of the first onset untreated women with depressive disorder was prolonged, the amplitude of P3 increased (P0.05), and the differences in other components were not statistically significant (P0.05). There was no statistically significant correlation between the components of P300 and the total score of HAMD and the factors of each factor (P0.05).
2. Compared with the control group, the gray matter volume of right inferior frontal gyrus and right anterior central gyrus decreased in the first-onset female depressive disorder.
The different components of the cognitive event related potential P300 in the 3. patients were related to the volume of gray matter in different brain regions, and the latency of P3 and N2 was positively correlated with the bilateral putamen, and the latency of P3 was correlated with bilateral temporal gyrus, left middle frontal gyrus and left fusiform gyrus, while the P3 amplitude was negatively correlated with the left lateral gyrus and the right frontal gyrus, and N2 latency and left The posterior cingulate gyrus, right fusiform gyrus, occipital lobe and left cerebellum related.N1 latency are mainly related to the left cerebellum, which are negatively related to the left temporal gyrus, parahippocampal gyrus, right temporal gyrus and temporal gyrus, and the P2 latency is mainly related to the bilateral superior temporal gyrus, the left anterior lobe, the lingual gyrus, the posterior cingulate gyrus, the parapara lobule and the right temporal gyrus, and the left side. The anterior cingulate gyrus was negatively correlated.
4. the total score and factor score of 4. patients were negatively correlated with the right occipital gyrus on the right, and the scores of anxiety / somatization factor were negatively correlated with the left fusiform gyrus, right caudate nucleus, cerebellar vermis and bilateral cerebellum, and the lag factor was associated with the left frontal lobe, the anterior central gyrus, the anterior cingulate gyrus, and the upper temporal gyrus. The middle temporal gyrus and bilateral orbital frontal cortex, bilateral inferior frontal gyrus and bilateral occipital lobe are negatively correlated with bilateral occipital lobe; cognitive impairment factor is related to the left inferior frontal gyrus, the posterior central gyrus and the right occipital gyrus, and the sleep barrier factor is related to the left temporal superior temporal gyrus and right posterior central gyrus; and the body weight factor and bilateral side are both bilateral and bilateral. The parahippocampal gyrus was negatively correlated.
Conclusion:
1. compared with the health control, the volume of brain gray matter decreased in the first untreated women with depressive disorder, suggesting that the untreated women with depression have the characteristic gray matter volume abnormality.
2. The total score and factor score of depression scale were correlated with different brain area volume, suggesting that these different depressive symptoms may have different brain structure basis.
3. patients with cognitive event related potential P300 were abnormal, but had nothing to do with the severity of depression; the components of the cognitive event related potential P300 were related to the volume of multiple gray matter respectively, suggesting that the volume of gray matter in different brain regions had different effects on the different components of the cognitive event related potential P300, namely, the cognitive work of women with depression. The disturbance of energy is influenced by multiple brain regions or nerve loops, especially in the temporal lobe and the basal ganglia. The cognitive dysfunction of the patients with depressive disorder is relatively independent, and there are different brain structural bases from the depressive symptoms.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R749.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 張璐璐;鄭洪波;鄧河晃;何柱國(guó);;首發(fā)抑郁障礙認(rèn)知功能與兒茶酚氧位甲基轉(zhuǎn)移酶基因多態(tài)性的關(guān)聯(lián)分析[J];實(shí)用醫(yī)學(xué)雜志;2009年13期

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