本文關(guān)鍵詞： 被動前注意力 偏側(cè)忽略 神經(jīng)心理機(jī)制 視空間注意力 失匹配負(fù)波 藥物過度使用性頭痛　出處：《浙江大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：背景 藥物過度使用性頭痛(Medication Overuse Headache, MOH)是一種臨床上常見的慢性繼發(fā)性頭痛,其發(fā)病機(jī)制至今尚不明確。既往研究已經(jīng)從分子遺傳、生物化學(xué)、功能影像學(xué)、心理等多個(gè)角度對MOH的發(fā)病機(jī)制進(jìn)行了探討,而與疼痛感知、藥物過度使用緊密相關(guān)的注意力并未得到重視。此外,既往針對原發(fā)性頭痛的研究大多顯示患者存在主動注意力損傷,針對物質(zhì)使用障礙的研究顯示患者存在視空間注意力的損傷,提示MOH可能亦存在注意力的受損。但是,這些研究很少關(guān)注被動注意力,多集中于主動注意力的某個(gè)種類或局部,而缺少局部結(jié)合整體的研究。而且大多數(shù)研究既未排除頭痛本身對研究結(jié)果的影響,也很少控制焦慮、抑郁等共病因素。因此,本研究通過評價(jià)MOH的被動注意力和視空間注意力,希望從局部和整體、時(shí)間和空間上,多層次、多角度地探明MOH是否存在特征性注意力損傷。 目的 1.明確MOH患者是否存在被動前注意力的損傷； 2.探明MOH患者是否存在視空間注意力的損傷； 3.將MOH患者注意力損傷的結(jié)果與慢性緊張型頭痛(Chronic Tension-type Headache, CTTH)患者進(jìn)行比較,并評估與焦慮、抑郁的相關(guān)性,對MOH的發(fā)病機(jī)制進(jìn)行初步探討。 方法 1.在41名健康被試、22名CTTH患者和26名MOH患者中進(jìn)行事件相關(guān)電位(Event-related Potentials, ERPs)的失匹配負(fù)波(Mismatch Negativity, MMN)測試。對MMN測試中三組被試所測得的N1及MMN的波幅和潛伏期進(jìn)行Two-way ANOVA統(tǒng)計(jì)分析。當(dāng)檢測出主效應(yīng)時(shí),運(yùn)用LSD檢驗(yàn)法進(jìn)行事后檢驗(yàn),評估相關(guān)參數(shù)在每兩組間的差異； 2.在22名健康被試、26名CTTH患者和21名MOH患者中進(jìn)行線段中分試驗(yàn),對三組被試所測得的線等分誤差指數(shù)(the Index of the Line Bisection Error, Index)和線等分誤差凈值(the Net of Line Bisection Errors, Net)進(jìn)行One-way ANOVA統(tǒng)計(jì)分析。當(dāng)檢測出主效應(yīng)時(shí),運(yùn)用LSD檢驗(yàn)法進(jìn)行事后檢驗(yàn),評估二者在每兩組之間的差異； 3.運(yùn)用Self-rating Anxiety Scale (SAS)和Self-rating Depression Scale (SDS)測量所有被試的焦慮和抑郁水平,運(yùn)用One-way ANOVA進(jìn)行統(tǒng)計(jì)分析,當(dāng)檢測出主效應(yīng)時(shí),運(yùn)用LSD檢驗(yàn)法進(jìn)行事后檢驗(yàn),評估二者在每兩組之間的差異。運(yùn)用Spearman等級相關(guān)分析MMN潛伏期/波幅、Index/Net與被試的年齡、教育水平、焦慮水平、抑郁水平和頭痛持續(xù)時(shí)間之間可能的相關(guān)關(guān)系。 結(jié)果 1.MMN測試中所有被試在接受標(biāo)準(zhǔn)刺激和新奇刺激時(shí)均能在三個(gè)中線電極位點(diǎn)(Fz, Cz, Pz)得到清晰的N1成分和MMN成分；不論是標(biāo)準(zhǔn)刺激還是新奇刺激,其引發(fā)的N1潛伏期和波幅在三個(gè)組之間的差異沒有統(tǒng)計(jì)學(xué)意義；而MOH組的MMN潛伏期與健康對照組和CTTH組比較均顯著地縮短,MMN波幅與健康對照組和CTTH組比較均顯著地降低； 2.在線段中分試驗(yàn)中,MOH組Index和Net均向左偏,而健康對照組和CTTH組輕度向右偏； 3.MOH組的焦慮和抑郁水平均顯著高于健康對照組,但不論是MMN的潛伏期和波幅,還是Index和Net均與被試的焦慮、抑郁水平無相關(guān)性。 結(jié)論 1.我們在MOH患者中發(fā)現(xiàn)了顯著縮短的MMN潛伏期和顯著降低的MMN波幅,說明MOH患者被動前注意力轉(zhuǎn)移的敏感性增高,但轉(zhuǎn)移過程中所分配到的認(rèn)知資源減少； 2.在線段中分試驗(yàn)中我們發(fā)現(xiàn)MOH患者主觀中點(diǎn)呈現(xiàn)了顯著的左側(cè)偏移,說明MOH患者存在對右側(cè)空間的偏側(cè)忽略,提示MOH患者右側(cè)大腦半球功能優(yōu)勢或左側(cè)大腦半球功能低下或者二者兼而有之； 3.MOH患者的焦慮水平、抑郁水平顯著升高,但MMN潛伏期/波幅的變化、線段中分試驗(yàn)主觀中點(diǎn)的偏移結(jié)果與患者的焦慮和抑郁水平、頭痛本身及頭痛持續(xù)時(shí)間長短無關(guān),提示結(jié)果具有疾病的特異性,間接提示MOH可能與物質(zhì)使用障礙存在共同的神經(jīng)心理機(jī)制。
[Abstract]:background
Medication overuse headache (Medication Overuse, Headache, MOH) is a common clinical chronic secondary headache, its pathogenesis is still not clear. It is from molecular genetics, biochemistry, functional imaging, multi angle psychology on MOH pathogenesis are discussed, and the pain drug overuse is closely related to perception, attention is not taken seriously. In addition, the previous research on primary headache patients showed mostly active attention on injury, substance use disorders that exist in patients with visual spatial attention injury, suggesting that MOH may also have attention damage. However, these studies rarely focus on passive attention. A kind of multi focus on active attention or local, and the lack of overall Research on local combination. And most of the research did not exclude headache itself to the node Few factors such as anxiety, depression and other co morbidities are also controlled. Therefore, this study is to evaluate the passive attention and spatial attention of MOH. We hope to explore whether MOH has characteristic attention deficit from different angles and angles.
objective
1. it was clear whether there was a passive pre attention injury in MOH patients.
2. to find out whether MOH patients had visual impairment of attention.
3., we compared the results of MOH patients' attention deficit with those of Chronic Tension-type Headache (CTTH) patients, and evaluated the correlation with anxiety and depression, and discussed the pathogenesis of MOH.
Method
1. in 41 healthy subjects, the event-related potentials of 22 CTTH patients and 26 MOH patients (Event-related, Potentials, ERPs) mismatch negativity (Mismatch Negativity, MMN N1 and MMN) test. The test of MMN test in three subjects the amplitude and latency were analyzed by Two-way ANOVA statistics. When detecting the main effect, we use LSD test post test to assess differences of related parameters in each of the two groups;
2. in 22 healthy subjects, 26 CTTH patients and 21 MOH patients were divided into test line, the three groups of subjects were measured by the line bisection error index (the Index of the Line Bisection Error, Index) and line bisection error (the Net of Line Bisection net Errors, Net) were One-way ANOVA statistical analysis. When detecting the main effect, we use LSD test to post test differences in assessment of the two in each of the two groups;
3. using Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) measurement of all subjects in levels of anxiety and depression, the use of One-way ANOVA for statistical analysis, when detecting the main effect, we use LSD test to post test differences in assessment of the two in each of the two groups using Spearman MMN rank correlation analysis. The latency of Index/Net / amplitude, and subjects of age, educational level, anxiety level, possible correlation between depression level and duration of headache.
Result
The 1.MMN test in all subjects received standard stimulation and novel stimuli were in three loci (Fz, midline electrodes Cz, Pz) N1 and MMN components clearly; whether the standard stimulus or novelty, the latency and amplitude of N1 between the three groups the difference was not statistically significant MOH; group MMN group and CTTH group compared with control latency was significantly shortened, MMN group and CTTH group were compared with control were significantly reduced;
2. in the segment test, the Index and Net in group MOH were left to the left, while the healthy control group and the CTTH group were slightly to the right.
The level of anxiety and depression in group 3.MOH was significantly higher than that in healthy control group, but no matter the latency and amplitude of MMN, or Index and Net, there was no correlation with anxiety and depression level of subjects.
conclusion
1., we found significantly shortened MMN latency and significantly reduced MMN amplitude in MOH patients, indicating that the sensitivity of MOH to passive attention is higher, but the cognitive resources allocated during transfer are reduced.
2. in the line segment trials, we found that the subjective midpoint of MOH patients showed a significant left lateral deviation, indicating that MOH patients had a partial neglect of the right side space, suggesting that the right hemisphere function advantage or left hemisphere function of MOH patients is low or the two have both.
3.MOH patients' anxiety level and depression levels were significantly increased, but the latency of MMN / amplitude changes, offset results test and subjective midpoint line with the level of anxiety and depression, headache and headache duration has showed with disease specificity, suggesting that MOH may be indirect and substance use disorders are neuropsychological a common mechanism.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R741

【相似文獻(xiàn)】

相關(guān)期刊論文 前4條

1 魏學(xué)霞;;腦損傷早期精神癥狀分析的神經(jīng)心理機(jī)制與鎮(zhèn)靜[J];中國醫(yī)藥指南;2013年03期

2 陳瑞君;秦啟文;;樂觀偏差研究概況[J];心理科學(xué)進(jìn)展;2010年11期

3 劉銜華;;慢性疼痛患者的記憶功能損傷及其神經(jīng)心理機(jī)制[J];中國康復(fù)醫(yī)學(xué)雜志;2013年11期

4 ;[J];;年期

相關(guān)重要報(bào)紙文章 前1條

1 廈門大學(xué)法學(xué)院法律與認(rèn)知神經(jīng)科學(xué)研究中心、廈門大學(xué)知識論與認(rèn)知科學(xué)研究中心 吳旭陽;從“自私”到“快樂地利他”[N];中國社會科學(xué)報(bào);2013年

相關(guān)博士學(xué)位論文 前1條

1 張錦華;藥物過度使用性頭痛的注意力損傷：神經(jīng)生理與行為學(xué)證據(jù)[D];浙江大學(xué);2015年

，

本文編號：1529179