發(fā)布時間：2018-09-02 07:14

【摘要】：背景：共情(empathy)是一個多維的心理學概念,包括情感共情(affective empathy,AE)與認知共情(cognitive empathy, CE),前者是體驗、分享他人的情緒：后者則是理解和推測他人的情感狀態(tài)。共情對個體情感體驗和社會活動至關(guān)重要。島葉位于大腦外側(cè)裂的深部,被額葉、顥葉、頂葉形成的島蓋所覆蓋,與周圍眾多結(jié)構(gòu)連接,這種高度復雜的聯(lián)系使得其解剖結(jié)構(gòu)和功能也較為復雜。目前對島葉參與高級認知功能研究甚少,尤其對島葉參與共情過程的研究。目的：利用人際反應(yīng)指數(shù)量表及共情行為學范式,對局限于島葉膠質(zhì)瘤患者的共情能力進行評價,探索島葉膠質(zhì)瘤患者是否存在情感共情和認知共情能力缺陷以及初步探究左右側(cè)島葉在共情作用方面是否存在差異。并希望運用認知神經(jīng)科學的相關(guān)理論及方法,為臨床開展腦高級功能監(jiān)測提供參考,進一步為提高腦膠質(zhì)瘤的研究和治療水平提供前瞻性的指導。方法：募集2014年3月-2015年12月就診于安徽醫(yī)科大學附屬省立醫(yī)院神經(jīng)外科的15例島葉腫瘤患者,18例非島葉膠質(zhì)瘤及24例健康成人。收集一般資料(性別、年齡、教育程度等信息)。所有被試者均行常規(guī)MRI掃描,并進行基本認知功能、基本智力、情感交流及表達、人格特征和負面情緒幾個主要方面評估,包括：蒙特利爾認知評估量表(MoCA,中文版)、瑞文標準推理測驗(SPM)、多倫多20項述情障礙量表(TAS-20)、五大人格分析(NEO-FFI-60)和抑郁自評量表(SDS)。采用戴維斯人際反應(yīng)指數(shù)量表(IRI-C)、情感識別范式、疼痛共情范式及情感采擇范式綜合評價被試的共情能力,包括情感共情和認知共情。結(jié)果：①背景資料：各組間性別、年齡、受教育年限、SPM、MoCA、 NEO-FFI-60和SDS分均無統(tǒng)計學差異(Ps0.05)。②TAS-20和IRI-C:各組間TAS-20(F=23.360,Ps＜0.001)、PT(F=6.139,Ps=0.004)、EC(F=6.112,Ps=0.004)、AE(F=5.423,Ps=0.007)、CE(F=5.137,Ps=0.009)和共情總分(F=11.677,Ps＜0.001)差異具有統(tǒng)計學意義,且島葉膠質(zhì)瘤患者TAS-20、觀點采擇、共情性關(guān)心和共情總分低于其他兩組；而各組間PD和FS得分差異無統(tǒng)計學意義(Ps＞0.05)。③共情行為學范式：各組間情緒識別范式、疼痛共情范式及情感采擇范式正確率差異均有統(tǒng)計學意義(F=63.190,Ps＜0.001；F=15.035,Ps＜0.001；F=13.301,Ps＜0.001),島葉膠質(zhì)瘤患者正確率顯著低于其他兩組；島葉膠質(zhì)瘤組的疼痛共情任務(wù)反應(yīng)時間較健康對照組顯著延長,各組間其他共情范式的反應(yīng)時間差異無統(tǒng)計學差異。④情感共情和認知共情指標：島葉膠質(zhì)瘤組中,情感識別行為學任務(wù)與IRI-C量表中的AE得分及其EC得分呈正相關(guān)(r=0.890,Ps＜0.001；r=0.643,Ps=0.010)；疼痛共情行為學任務(wù)與IRI-C量表中的AE得分呈正相關(guān)(r=0.646,Ps=0.009)；情感采擇行為學任務(wù)與IRI-C量表中的CE得分及其PT得分呈正相關(guān)(r=0.687,Ps=0.005；r=0.591,Ps=0.020)。與病例對照組和健康對照組相比,島葉膠質(zhì)瘤組的AE和CE指標顯著低于其他兩組,差異具有統(tǒng)計學意義。但是,在本組病例中,左側(cè)島葉膠質(zhì)瘤與右側(cè)島葉膠質(zhì)瘤患者的AE(Ps=0.89)和CE指標(Ps=0.14)差異無明顯統(tǒng)計學意義。結(jié)論：各組被試中,島葉膠質(zhì)瘤組患者的一般智力、基本認知功能、人格和負面情緒未見明顯影響,但存在一定程度的述情障礙,而且情感共情和認知共情能力均明顯受損。所以,島葉膠質(zhì)瘤對患者的社會情感功能造成了一定的損害。島葉膠質(zhì)瘤組中,左、右側(cè)島葉膠質(zhì)瘤患者在情感共情和認知共情能力方面未見明顯差異。綜上可以得出,島葉不僅在情感共情功能方面發(fā)揮重要作用,可能在認知共情功能方面也具有一定的作用；且左、右側(cè)島葉可能對共情的影響不具有差異性。本試驗也證實了利用認知神經(jīng)科學的方法能夠反應(yīng)顱內(nèi)相關(guān)病變與高級認知功能的關(guān)系,具有一定的臨床實用價值。
[Abstract]:BACKGROUND: Empathy is a multi-dimensional psychological concept, including affective empathy (AE) and cognitive empathy (CE). The former is experience, sharing others'emotions; the latter is understanding and speculating others' emotional state. Empathy is essential to individual emotional experience and social activities. The insular lobe is located in the brain. The deep part of the lateral fissure, which is covered by the frontal lobe, the hiatus lobe, and the parietal lobe, connects with many structures around it. This highly complex connection makes its anatomical structure and function more complex. Appearance and empathic behavior paradigm were used to evaluate empathy ability of insular glioma patients, to explore whether there are deficiencies in empathy and cognitive empathy in insular glioma patients, and to explore whether there are differences in empathy between left and right insular lobes. Methods: From March 2014 to December 2015, 15 patients with insular tumors, 18 patients with non insular gliomas and 24 healthy adults were enrolled. All subjects were scanned by conventional MRI and assessed in terms of basic cognitive function, basic intelligence, emotional communication and expression, personality characteristics and negative emotions, including: Montreal Cognitive Assessment Scale (MoCA, Chinese version), Raven's Standard Reasoning Test (SPM), Doran's. More than 20 items of Alexithymia Scale (TAS-20), five personality analysis (NEO-FFI-60) and self-rating depression scale (SDS) were used to evaluate the empathy ability of the subjects, including emotional empathy and cognitive empathy. Results: Background data: Each group was assessed by Davis interpersonal response index (IRI-C), emotion recognition paradigm, pain empathy paradigm and emotion selection paradigm. (2) TAS-20 and IRI-C: TAS-20 (F = 23.360, Ps < 0.001), TAS-20 (F = 23.360, Ps < 0.001), PT (F = 6.139, Ps = 0.004), EC (F = 6.112, Ps = 0.004), EC (F = 6.112, Ps = 0.004), AE (F = 5.423, Ps = 0.423, Ps = 0.007, CE (F = 5.137, Ps = 0.137, Ps = 0.Ps = 0.009) and total empathy (F = 0.009) and total empathy (F = 0.009), EC (EC (F = 6.112, P = 6.112, P = 6.112, Ps = 0.Ps 11.677, Ps < 0.001) the difference was statistically significant, and TAS-20 scores of patients with insular glioma were lower than those of the other two groups, but there was no significant difference in PD and FS scores among the three groups (Ps > 0.05). 3 Empathic behavior paradigm: There were significant differences in the correct rates of emotion recognition paradigm, pain empathy paradigm and emotion selection paradigm among the three groups (F = 63.190, Ps < 0.05). The correct rate of insular glioma patients was significantly lower than that of the other two groups; the response time of pain empathy task in insular glioma group was significantly longer than that of the healthy control group, and there was no significant difference in the response time of other empathy paradigms among the groups. In glioma group, emotional recognition behavior task was positively correlated with AE score and EC score of IRI-C scale (r = 0.890, Ps < 0.001; r = 0.643, Ps = 0.010); pain empathy behavior task was positively correlated with AE score of IRI-C scale (r = 0.646, Ps = 0.009); affective choice behavior task was positively correlated with CE score and PT score of IRI-C scale. There was a positive correlation (r = 0.687, Ps = 0.005; r = 0.591, Ps = 0.020). Compared with the case control group and the healthy control group, the AE and CE indexes of insular glioma group were significantly lower than those of the other two groups, and the difference was statistically significant. Conclusion: The general intelligence, basic cognitive function, personality and negative emotions of insular glioma patients were not significantly affected, but there was a certain degree of alexithymia, and emotional empathy and cognitive empathy were significantly impaired. In the insular glioma group, there was no significant difference in the ability of emotional empathy and cognitive empathy between left and right insular glioma patients. Empathy has no difference. This study also confirmed that cognitive neuroscience can reflect the relationship between intracranial lesions and advanced cognitive function. It has a certain clinical value.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R739.41

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