發(fā)布時(shí)間：2018-01-04 12:05

  本文關(guān)鍵詞：基于靜息態(tài)腦功能磁共振成像探討青年抑郁癥自殺未遂的神經(jīng)基礎(chǔ)　出處：《重慶醫(yī)科大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 青年抑郁癥 自殺未遂 靜息態(tài)功能磁共振成像 低頻振幅 沖動(dòng)性 青年抑郁癥 自殺未遂 靜息態(tài) 功能磁共振成像 功能連接 青年抑郁癥 自殺未遂 靜息態(tài)腦網(wǎng)絡(luò) 功能網(wǎng)絡(luò)連接 獨(dú)立成分分析

【摘要】：第一部分青年抑郁癥自殺未遂的腦局部活動(dòng)研究目的:采用靜息態(tài)功能磁共振成像探討局部腦功能活動(dòng)的異常與青年抑郁癥患者自殺未遂之間的相關(guān)性。方法:對(duì)35例自殺未遂的青年抑郁癥患者(SU組)、18例不伴自殺未遂的青年抑郁癥患者(NSU組)以及47名性別、年齡和受教育年限相匹配的健康對(duì)照者(HC組)進(jìn)行臨床心理量表評(píng)估和靜息態(tài)f MRI掃描。采用低頻振幅(Amplitude of low-frequency fluctuations,ALFF)的分析方法比較三組間z ALFF值的差異,并將SU組和NSU組z ALFF存在顯著差異的腦區(qū)作為感興趣區(qū)(regions-of-interest,ROIs),與臨床行為量表之間進(jìn)行相關(guān)性分析,同時(shí)采用受試者操作特征(Receiver Operating Characteristics,ROC)曲線評(píng)價(jià)上述腦區(qū)異常的z ALFF值作為影像標(biāo)記對(duì)青年抑郁癥患者自殺自殺行為的預(yù)測(cè)價(jià)值。結(jié)果:1、人口學(xué)資料和臨床心理量表分析結(jié)果顯示,SU、NSU和HC三組在性別(P=0.513)、年齡(P=0.584)和受教育年限(P=0.289)方面無(wú)統(tǒng)計(jì)學(xué)差異,但是SU組和NSU組在QSA、BIS-11、HAMD、BDI、BHS和SSI得分上顯著高于HC組,三組得分之間的差異具有統(tǒng)計(jì)學(xué)意義(P0.001),post-hoc分析顯示SU組與NSU組在QSA(P=0.219)、HAMD(P=0.089)、BDI(P=0.263)、BHS(P=0.125)和SSI(P=0.836)總分上無(wú)統(tǒng)計(jì)學(xué)差異,而在BIS-11得分上,SU組顯著高于NSU組(P=0.036)。2、低頻振幅分析發(fā)現(xiàn),與NSU組和HC組相比,SU組在右側(cè)顳上回(R-STG)、左側(cè)顳中回(L-MTG)和左側(cè)枕中回(L-MOG)的z ALFF值升高;此外,SU組左側(cè)額上回(L-SFG)和左側(cè)額中回(L-MFG)的z ALFF值較NSU組顯著降低,同時(shí)SU組左側(cè)額上回(L-SFG)和左側(cè)額中回(L-MFG)的z ALFF值與BIS呈顯著負(fù)相關(guān)(r=-0.36,P=0.03)。3、ROC曲線分析的結(jié)果顯示左側(cè)額上回(L-SFG)和左側(cè)額中回(L-MFG)的z ALFF值在鑒別SU和NSU時(shí)敏感性為71.4%,特異性為83.3%。結(jié)論:左側(cè)額上回(L-SFG)和左側(cè)額中回(L-MFG)的活動(dòng)降低引起其沖動(dòng)性增高,進(jìn)而介導(dǎo)了青年抑郁癥患者自殺行為的發(fā)生。L-SFG/MFG的內(nèi)在自發(fā)神經(jīng)活動(dòng)的異常是自殺的神經(jīng)易感性因素。第二部分青年抑郁癥自殺未遂的腦功能連接分析目的:靜息態(tài)功能磁共振成像(resting-state functional magnetic resonance imaging,rs-f MRI)將有助于更好地理解青年抑郁癥患者自殺未遂所潛在的神經(jīng)生物機(jī)制。本研究將探尋伴有自殺未遂的青年抑郁癥患者靜息態(tài)腦功能連接(resting-state functional connectivity,RSFC)的異常及其與自殺未遂的關(guān)系,探索其在自殺未遂發(fā)生中可能潛在的神經(jīng)生物學(xué)作用。方法:使用基于種子點(diǎn)的功能連接分析方法(seed-based functional connectivity)將第一部分SU和NSU組z ALFF存在顯著差異的左側(cè)額中回(l-MFG)和左側(cè)額上回(L-SFG)作為種子點(diǎn),進(jìn)行基于全腦體素的種子點(diǎn)功能連接分析,并采用spearman相關(guān)分析探尋青年抑郁癥自殺未遂患者異常腦功能連接與臨床心理量表之間的相關(guān)性。結(jié)果:1、基于種子點(diǎn)功能連接分析發(fā)現(xiàn),以左側(cè)額中回(L-MFG)作為感興趣區(qū)分析時(shí)發(fā)現(xiàn),與NSU組相比,SU組左側(cè)額中回(L-MFG)與左側(cè)頂上回(L-SPL)的功能連接降低,與HC組相比,SU組左側(cè)額中回與左側(cè)島回(L-insular)和左側(cè)頂上回(L-SPL)的功能連接均降低,NSU組較HC組在左側(cè)額中回與右側(cè)額中回(R-MFG)和額下回眶部(R-IFG-orbit)的功能連接降低,與左側(cè)島回(L-Insula)功能連接增強(qiáng)。以左側(cè)額上回(L-SFG)作為感興趣區(qū)分析時(shí)結(jié)果顯示,SU組較NSU組左側(cè)額上回(L-SFG)與右側(cè)額上回(R-SFG)的功能連接增強(qiáng),較HC組左側(cè)額上回(L-SFG)與右側(cè)前扣帶回(R-ACC)的功能連接減弱,NSU組較HC組左側(cè)額上回(L-SFG)和左側(cè)額下回眶部(L-MFG-orbit)的功能連接增強(qiáng)。2、腦區(qū)功能連接與臨床量表相關(guān)分析發(fā)現(xiàn),SU組左側(cè)額中回(L-MFG)與左側(cè)頂上小葉(L-SPL)的功能連接值與SSI(r=-0.4056,P=0.0156)和BIS(r=-0.3498,P=0.0394)量表總分呈顯著負(fù)相關(guān)。左側(cè)額上回(L-SFG)與右側(cè)前扣帶回(R-ACC)的功能連接與BIS(r=-0.3472,P=0.0410)量表總分呈顯著負(fù)相關(guān),與SSI(r=-0.2602,P=0.1312)無(wú)相關(guān)性。結(jié)論:本研究結(jié)果顯示左側(cè)眶額葉與左側(cè)頂葉和右側(cè)前扣帶回功能連接的改變與青年抑郁癥自殺未遂行為相關(guān)。我們的結(jié)果為臨床抑郁癥青年自殺未遂的靜息態(tài)功能連接(RSFC)提供了新的認(rèn)識(shí),并且認(rèn)為青年抑郁癥患者的額-頂網(wǎng)絡(luò)和額-邊緣網(wǎng)絡(luò)功能連接異常可能是其發(fā)生自殺未遂的一個(gè)影像學(xué)預(yù)測(cè)因子。第三部分青年抑郁癥自殺未遂的腦功能網(wǎng)絡(luò)連接分析目的:探討自殺未遂青年抑郁癥患者靜息態(tài)腦網(wǎng)絡(luò)(resting-state network,RSN)內(nèi)和網(wǎng)絡(luò)間功能連接的差異,分析神經(jīng)網(wǎng)絡(luò)之間的相互作用,從而了解青年抑郁癥自殺未遂所潛在的神經(jīng)機(jī)制。方法:采用基于群組的獨(dú)立成分分析方法將靜息態(tài)f MRI數(shù)據(jù)分解為不同的RSNs,并提取CEN、DMN和SN三大核心認(rèn)知腦網(wǎng)絡(luò),比較SU、NSU和HC三個(gè)RSNs內(nèi)在腦活動(dòng)特征以及腦網(wǎng)絡(luò)功能連接(functional network connectivity,FNC)的差異。結(jié)果:1、識(shí)別出5個(gè)靜息態(tài)腦網(wǎng)絡(luò)(resting state networks,RSNs)作為感興趣的成分,分別為左側(cè)額頂網(wǎng)絡(luò)(IC8:L-FPN)、凸顯網(wǎng)絡(luò)(IC12:SN)、默認(rèn)網(wǎng)絡(luò)前部(IC14:a DMN)、右側(cè)額頂網(wǎng)絡(luò)(IC16:R-FPN)和默認(rèn)網(wǎng)絡(luò)后部(IC32:p DMN)。單樣本t檢驗(yàn)顯示三組具有典型的RSN空間分布模式,三組腦網(wǎng)絡(luò)進(jìn)行ANOVA分析顯示,三組間5個(gè)靜息態(tài)腦網(wǎng)絡(luò)內(nèi)自發(fā)活動(dòng)存在顯著差異。2、三組間FNC分析發(fā)現(xiàn),SU組前默認(rèn)網(wǎng)絡(luò)(a DMN)與凸顯網(wǎng)絡(luò)(SN)和右側(cè)額頂網(wǎng)絡(luò)(R-FPN)的功能網(wǎng)絡(luò)連接較NSU組降低,而凸顯網(wǎng)絡(luò)與右側(cè)額頂網(wǎng)絡(luò)(R-FPN)的功能網(wǎng)絡(luò)連接增強(qiáng);與HC組相比,SU組前默認(rèn)網(wǎng)絡(luò)與左側(cè)額頂網(wǎng)絡(luò)(L-FPN)以及后默認(rèn)網(wǎng)絡(luò)(p DMN)的功能網(wǎng)絡(luò)連接降低,而凸顯網(wǎng)絡(luò)與左側(cè)額頂網(wǎng)絡(luò)的功能網(wǎng)絡(luò)連接增加;NSU組后默認(rèn)網(wǎng)絡(luò)與右側(cè)額頂網(wǎng)絡(luò)的功能網(wǎng)路連接下降。結(jié)論:青年抑郁癥自殺未遂行為與DMN、SN和CEN三大核心神經(jīng)認(rèn)知網(wǎng)絡(luò)功能連接異常有關(guān),廣泛涉及網(wǎng)絡(luò)的多個(gè)節(jié)點(diǎn)。本研究為探尋青年抑郁癥自殺未遂的大腦功能組織模式提供了新的證據(jù)。
[Abstract]:The first part of the youth depression objective to study regional cerebral activity Dutch act: correlation between attempted attempted Dutch act with abnormal youth depression patients using resting state functional magnetic resonance imaging to investigate the function of local brain activity. Methods: 35 cases of young patients with depression Dutch act attempted (SU group), 18 cases of young patients with depression without Dutch act attempted (NSU group) and 47 healthy controls were gender, age and education matched (group HC) clinical psychological assessment and resting state f MRI scan. The amplitude of low frequency (Amplitude of low-frequency fluctuations, ALFF) the difference of the method of comparative analysis between the three groups in Z ALFF, and the brain there are significant differences between SU group and NSU group Z ALFF as a region of interest (regions-of-interest, ROIs), and the correlation analysis between clinical behavior scale, at the same time using receiver operating characteristic (Receiver Opera Ting Characteristics, ROC) in the brain abnormal curve to evaluate the Z value ALFF as a marker for young patients with depression image value Dutch act behavior prediction Dutch act. Results: 1, surface analysis showed that the SU demographic data and clinical psychology, NSU and HC of the three groups in gender, age (P=0.513) and Education (P=0.584) age (P=0.289) had no significant difference, but the SU group and NSU group in QSA, BIS-11, HAMD, BDI, BHS and SSI score was significantly higher than that in HC group, the difference was statistically significant between the three groups score (P0.001), post-hoc analysis showed that SU group and NSU group in QSA (P=0.219), HAMD (P=0.089), BDI (P=0.263), BHS (P=0.125) and SSI (P=0.836) had no significant difference in the total score, and BIS-11 score, SU group was significantly higher than that of group NSU (P=0.036).2, low-frequency amplitude analysis found that, compared with NSU group and HC group, SU group in the right superior temporal gyrus (R-STG), left temporal in the back and left occipital (L-MTG) In (L-MOG) Z ALFF value increased; in addition, the SU group of left superior frontal gyrus (L-SFG) and the left middle frontal gyrus (L-MFG) of the Z ALFF value decreased significantly compared with NSU group, SU group and left superior frontal gyrus (L-SFG) and the left middle frontal gyrus (L-MFG) of the Z ALFF value was negatively correlated with BIS (r=-0.36, P=0.03).3, ROC curve analysis showed that the left superior frontal gyrus (L-SFG) and the left middle frontal gyrus (L-MFG) of Z ALFF SU and NSU value in the differential sensitivity was 71.4%, specificity was 83.3%. conclusion: the left superior frontal gyrus (L-SFG) and the left middle frontal gyrus (L-MFG). The impulse activity decreased and then increased, the abnormal mediated behaviors in patients with depression in young Dutch act.L-SFG/MFG intrinsic spontaneous neural activity is the nerve susceptibility factors Dutch act. The second part Dutch act attempted youth depression of brain functional connectivity analysis objective: resting state functional magnetic resonance imaging (resting-state functional magnetic Resonance imaging, rs-f MRI) will have the neurobiological mechanism to contribute to a better understanding of the young patients with depression Dutch act attempted potential. This study will explore the young patients with depression accompanied by Dutch act attempted resting brain functional connectivity (resting-state functional connectivity, RSFC) and the relationship between abnormal and Dutch act attempted to explore its role in neurobiology, Dutch act the occurrence of attempted potential. Methods: using the connection analysis method based on the function of the seed point (seed-based functional connectivity) will be the first part of the SU and NSU group Z ALFF significant difference between the left middle frontal gyrus (l-MFG) and left superior frontal gyrus (L-SFG) as the seed point, connectivity analysis of seed points of whole brain body function Plain Based on Spearman correlation analysis was used to explore the connection and youth depression Dutch act attempted in patients with abnormal brain function table correlation and clinical psychology. 緇撴灉:1,鍩轟簬縐嶅瓙鐐瑰姛鑳借繛鎺ュ垎鏋愬彂鐜，

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