【摘要】：目的:通過(guò)氫質(zhì)子磁共振波譜成像技術(shù)(1H Magnetic Resonance Spectroscopy,1H-MRS)結(jié)合工作記憶的心理認(rèn)知功能測(cè)試,對(duì)首診強(qiáng)迫癥(Obsessive-Compulsive Disorder,OCD)患者進(jìn)行研究,以期發(fā)現(xiàn)首診強(qiáng)迫癥患者的腦生化代謝及工作記憶特征,為強(qiáng)迫癥的記憶病理機(jī)制研究及早期干預(yù)治療提供依據(jù)。方法:采用與工作記憶相關(guān)的數(shù)字廣度、2-back、視覺(jué)空間位置記憶測(cè)試、Stroop色-詞關(guān)聯(lián)測(cè)試四項(xiàng)神經(jīng)心理測(cè)驗(yàn)分別評(píng)估63例首診強(qiáng)迫癥患者與58名正常對(duì)照的工作記憶容量、語(yǔ)言工作記憶、視覺(jué)空間工作記憶以及中央執(zhí)行系統(tǒng)的抑制功能。運(yùn)用1H-MRS技術(shù)對(duì)其中的30例強(qiáng)迫癥患者及30名正常對(duì)照的額葉、基底節(jié)豆?fàn)詈藘纱髤^(qū)域N-乙酰天門冬氨酸(N-Acetylasparte,NAA)、膽堿復(fù)合物(Choline Compounds,Cho)、肌酸(Creatine,Cr)水平進(jìn)行測(cè)量,比較兩組被試在腦生化代謝功能上存在的差異。同時(shí)對(duì)首診強(qiáng)迫癥患者的工作記憶損害程度與腦代謝水平進(jìn)行相關(guān)分析,考察工作記憶與額葉、基底節(jié)兩大區(qū)域腦生化代謝物含量之間的關(guān)系。結(jié)果:(1)患者組數(shù)字廣度順背、倒背、總分均較正常對(duì)照組差;患者組2-back任務(wù)、視覺(jué)空間位置記憶測(cè)試得分低于正常對(duì)照組,且視覺(jué)空間位置記憶測(cè)試用時(shí)多于正常對(duì)照組;患者組Stroop色-詞測(cè)試中讀字色(Stroop-CW)完成時(shí)間長(zhǎng)于正常對(duì)照組;兩組被試在2-back和Stroop-C測(cè)試的完成時(shí)上未見(jiàn)統(tǒng)計(jì)學(xué)差異。(2)患者組左側(cè)額葉的NAA/Cr值顯著低于正常對(duì)照組;兩組被試在右側(cè)額葉NAA/Cr值、雙側(cè)額葉Cho/Cr值、雙側(cè)豆?fàn)詈薔AA/Cr值及雙側(cè)豆?fàn)詈薈ho/Cr值上均未見(jiàn)明顯差異。(3)患者組2-back反應(yīng)時(shí)與左側(cè)額葉的NAA/Cr值呈顯著負(fù)相關(guān);數(shù)字廣度倒背、總分與受教育年限呈正相關(guān);Stroop-C反應(yīng)時(shí)與受教育年限呈顯著負(fù)相關(guān),與病程呈正相關(guān);Stroop-CW反應(yīng)時(shí)也與受教育年限呈負(fù)相關(guān)�；颊呓M右側(cè)豆?fàn)詈薔AA/Cr值與Y-BOCS總分呈正相關(guān);其他MRS結(jié)果與各臨床癥狀特征變量之間則無(wú)明顯的相關(guān)性。結(jié)論:(1)首診強(qiáng)迫癥患者存在工作記憶損害,且涉及語(yǔ)音環(huán)、視覺(jué)空間模板和中央執(zhí)行系統(tǒng)等多個(gè)子系統(tǒng)功能受損。(2)首診強(qiáng)迫癥患者左側(cè)額葉的神經(jīng)元活性顯著降低,且患者語(yǔ)言工作記憶能力受損或與前額葉神經(jīng)元功能異常密切相關(guān)。(3)首診強(qiáng)迫癥患者受教育程度越低,可能記憶及注意能力越差,抑制功能受損也越嚴(yán)重;病情嚴(yán)重程度則可能與右側(cè)豆?fàn)詈说纳窠?jīng)元功能異常有關(guān)。
[Abstract]:Objective: to study the mental cognitive function of first diagnosed obsessive-compulsive disorder (Obsessive-Compulsive Disorder,OCD) by using 1H Magnetic Resonance Spectroscopy,1H-MRS and working memory test, in order to find out the characteristics of brain biochemical metabolism and working memory in patients with first diagnosed obsessive-compulsive disorder (OCD). To provide evidence for the study of memory pathological mechanism and early intervention treatment of obsessive-compulsive disorder (OCD). Methods: the working memory capacity of 63 patients with first diagnosis obsessive-compulsive disorder (OCD) and 58 normal controls were evaluated by four neuropsychological tests, including the number span 2-backand the Stroop color-word association test of visual spatial location memory. Working memory of language, working memory of visual space and inhibition function of central executive system. The levels of N-Acetylasparte NAA (N-Acetylasparte NAA), choline complex (Choline Compounds,Cho) and creatine (Creatine,Cr) in frontal lobe of 30 patients with obsessive-compulsive disorder and 30 normal controls were measured by 1H-MRS technique. To compare the difference of brain biochemical metabolic function between the two groups. At the same time, the relationship between the degree of working memory impairment and the level of brain metabolism was analyzed, and the relationship between working memory and the contents of biochemical metabolites in frontal lobe and basal ganglia was investigated. Results: (1) the scores of digit span, backward back and total score in the patients group were lower than those in the normal control group, the scores of 2-back task and visual spatial memory test in the patient group were lower than those in the normal control group, and the scores of the visual spatial position memory test were higher than that of the normal control group. The completion time of Stroop-CW in the Stroop color-word test was longer than that in the normal control group, and there was no statistical difference between the two groups when the 2-back and Stroop-C tests were completed. (2) the NAA/Cr value of the left frontal lobe in the patient group was significantly lower than that in the normal control group. There was no significant difference in NAA/Cr value of right frontal lobe, Cho/Cr value of bilateral frontal lobe, NAA/Cr value of bilateral lentiform nucleus and Cho/Cr value of bilateral lenticular nucleus between the two groups. (3) there was a significant negative correlation between 2-back reaction time and NAA/Cr value in left frontal lobe in the patient group. The total score was positively correlated with the number of years of education and the Stroop-C reaction time was negatively correlated with the years of education, and was negatively correlated with the duration of disease and the duration of education during Stroop-CW reaction. There was a positive correlation between the NAA/Cr value of the right lenticular nucleus and the total score of Y-BOCS in the patients group, but there was no significant correlation between the other MRS results and the characteristic variables of clinical symptoms. Conclusion: (1) working memory is impaired in patients with first visit obsessive-compulsive disorder, and the function of several subsystems, such as phonetic ring, visual space template and central executive system, is impaired. (2) the activity of neurons in the left frontal lobe of patients with first diagnosis obsessive-compulsive disorder is significantly decreased. And the language working memory ability is impaired or closely related to the prefrontal neuron function. (3) the lower the education level of the first diagnosis obsessive compulsive disorder, the worse the memory and attention ability may be, the more serious the inhibition function is; The severity of the disease may be associated with abnormal neuronal function in the right lenticular nucleus.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R749.7;B842.3

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