發(fā)布時(shí)間：2019-02-17 09:59

【摘要】：目的： 相關(guān)研究證實(shí)抑郁癥患者前額葉皮層-邊緣系統(tǒng)存在結(jié)構(gòu)上和功能上的異常,Granger預(yù)測(cè)分析(GCA)方法能有效地應(yīng)用于靜息態(tài)功能磁共振(fMRI)效應(yīng)連接研究,我們運(yùn)用該技術(shù)來(lái)研究首發(fā)未服藥抑郁癥患者前額葉皮層-邊緣系統(tǒng)靜息態(tài)下效應(yīng)連接的改變,并探討異常效應(yīng)連接與患者疾病嚴(yán)重程度和認(rèn)知功能的關(guān)系。 方法： 23例符合重性抑郁發(fā)作(MDD)的患者(年齡31.1±1.5歲,全為右利手)參與本研究,對(duì)照組采用20例性別和年齡匹配的正常志愿者,分別使用漢密爾頓抑郁量表(HAMD)、Montgomery-Asberg抑郁量表(MADRS)和漢密爾頓焦慮量表(HAMA)進(jìn)行病情評(píng)定,然后用Stroop色詞測(cè)驗(yàn)(SCWT)和連線測(cè)驗(yàn)(TMT)進(jìn)行認(rèn)知功能測(cè)試。在完成神經(jīng)心理測(cè)驗(yàn)后進(jìn)行靜息態(tài)功能磁共振掃描,數(shù)據(jù)預(yù)處理后,使用REST-GCA軟件包,以MDD的Meta分析中前扣帶回(ACC)結(jié)果做為種子點(diǎn)坐標(biāo)進(jìn)行基于系數(shù)的GCA分析,雙樣本t檢驗(yàn)分析兩組之間的效應(yīng)連接的差異,最后提取MDD中有顯著統(tǒng)計(jì)學(xué)差異的異常效應(yīng)連接改變腦區(qū)的GCA值與臨床量表和認(rèn)知功能成績(jī)做相關(guān)分析。 結(jié)果： 兩組被試的認(rèn)知功能測(cè)驗(yàn)并沒(méi)有顯示出顯著的統(tǒng)計(jì)學(xué)差異,在靜息態(tài)fMRI分析結(jié)果中,相比正常對(duì)照,MDD患者的全腦到ACC的效應(yīng)連接增加的區(qū)域主要有右側(cè)島葉皮層(rAI)、右殼核,而效應(yīng)連接降低的腦區(qū)主要有雙側(cè)背外側(cè)額葉皮層,內(nèi)側(cè)前額葉皮層,左側(cè)眶額皮層(P0.05,Alphasim校正)。ACC到全腦的效應(yīng)連接沒(méi)有發(fā)現(xiàn)顯著的統(tǒng)計(jì)學(xué)差異。在后驗(yàn)性臨床認(rèn)知相關(guān)分析中,MDD患者左、右DLPFC到ACC效應(yīng)連接與TMT-A完成時(shí)間呈負(fù)相關(guān)(r=-0.59,P0.01；r=-0.77,P0.01),MPFC到ACC效應(yīng)連接的GCA值也與TMT-A完成時(shí)間呈負(fù)相關(guān)(r=-0.70,P0.01),右DLPFC的效應(yīng)連接也和TMT-B完成時(shí)間呈弱負(fù)相關(guān)(r=-0.42,P0.05)。 結(jié)論： 雙側(cè)背外側(cè)額葉皮層的效應(yīng)連接的改變驗(yàn)證了MDD存在自上而下認(rèn)知控制功能減低,揭示出MDD患者潛在的執(zhí)行功能和注意功能障礙。rAI到ACC效應(yīng)連接的異常提示靜息態(tài)下SN切換已出現(xiàn)問(wèn)題,加上紋狀體到ACC效應(yīng)連接改變,更進(jìn)一步驗(yàn)證了邊緣系統(tǒng)-皮質(zhì)-紋狀體-蒼白球-丘腦神經(jīng)環(huán)路失調(diào),這些特異的異常連接進(jìn)一步補(bǔ)充了MDD患者PLN動(dòng)態(tài)的活動(dòng)過(guò)程,反映了其非任務(wù)狀態(tài)下神經(jīng)活動(dòng)基線的異常改變,這些發(fā)現(xiàn)能夠幫助我們區(qū)分和理解MDD的病理機(jī)制。
[Abstract]:Objective: to confirm the structural and functional abnormalities of the prefrontal cortex-marginal system in patients with depression. The Granger predictive analysis (GCA) method can be used effectively in the study of resting functional magnetic resonance (fMRI) effect junctions. We used this technique to study the changes of effect junctions in the prefrontal cortex-marginal system in patients with first-episode depression, and to explore the relationship between abnormal effect connections and the severity of disease and cognitive function in patients with first-episode depression. Methods: Twenty-three patients (31.1 鹵1.5 years old, all right-handedness) who were consistent with (MDD) were enrolled in this study. The control group consisted of 20 normal volunteers who matched their sex and age. Hamilton Depression scale (HAMD), Montgomery-Asberg), Depression scale (MADRS) and Hamilton anxiety scale (HAMA) were used to evaluate the patients' condition, and then the cognitive function was tested by Stroop color-word test (SCWT) and wired test (TMT). The rest functional magnetic resonance imaging (fMRI) was performed after the completion of the neuropsychological test. After data preprocessing, the coefficent GCA analysis was carried out using the (ACC) result of the anterior cingulate in the Meta analysis of MDD as the seed point coordinate. Two-sample t-test was used to analyze the difference of effect connection between the two groups. Finally, the significant difference of abnormal effect junction in MDD was extracted to analyze the GCA value of the brain region and the clinical scale and cognitive function scores. Results: there was no significant difference in cognitive function test between the two groups. In resting fMRI analysis, there was no significant difference between the two groups. In patients with MDD, the increase of effectual junctions from the whole brain to ACC was mainly in the right isobaric cortex (rAI), right putamen nucleus, while the decrease of the effect junction mainly included bilateral dorsolateral frontal cortex, medial prefrontal cortex, left orbital frontal cortex (P0.05), and the bilateral dorsolateral frontal cortex, medial prefrontal cortex, left orbital frontal cortex (P0.05). No significant statistical difference was found between Alphasim and the effect junctions of). ACC to the whole brain. In posterior clinical cognitive correlation analysis, there was a negative correlation between left and right DLPFC to ACC effect junctions and TMT-A completion time in MDD patients (r = 0.59, P 0.01). The GCA value of r-0.77), MPFC to ACC effect connection was also negatively correlated with the completion time of TMT-A (r-0.70 P0.01), and the effect connection of right DLPFC was negatively correlated with the completion time of TMT-B (r-0.42). P0.05). Conclusion: the changes of the effect junctions in bilateral dorsolateral frontal cortex confirm that there is a decrease in top-down cognitive control function in MDD. The abnormal connection between rAI and ACC effect suggests that there is a problem with SN switching in resting state, coupled with changes in striatum to ACC effect junctions. It is further demonstrated that the marginal system-cortex-striatum, globus pallidus and colliculus neurologic disorders, these specific abnormal junctions further supplement the dynamic process of PLN activity in patients with MDD. These findings can help us to distinguish and understand the pathological mechanism of MDD.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R749.4;R445.2

【共引文獻(xiàn)】

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