抑郁首发双相障碍的静息态fMRI研究

发布时间：2018-07-06 12:58

本文选题：双相障碍 + 功能磁共振　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的用局部一致性(ReHo)和低频振幅(ALFF)为数据处理方法,探究首次抑郁发作期的抑郁障碍和双相障碍脑功能的差异,以及首次抑郁期的双相障碍脑功能与临床特征的关系,以期为双相障碍的早期识别提供新的依据。方法(1)病例追踪:随访2006年1月至2014年6月期间所收集的处于首次抑郁发作期的心境障碍患者,根据临床追踪结局分为单相抑郁组和双相抑郁组。(2)数据处理:提取两组在首次抑郁发作期的脑功能磁共振数据及相关资料,以ReHo和ALFF为影像数据处理方法。使用独立样本t检验比较两组ReHo、ALFF差异(Alphasim矫正,P0.01),再用ROC分析验证差异脑区的异质性程度;对于双相抑郁组,做全脑体素的ReHo、ALFF与临床特征相关量表的相关。结果(1)与正常对照相比,单相抑郁组:ReHo值升高的脑区:右侧额中回、右内侧额上回、右侧楔叶、左侧枕中回、左侧缘上回。ReHo值降低的脑区:左侧眶部额中回、右侧额盖区。ALFF值升高的脑区:右侧额中回、右侧背外侧额上回、左侧眶部额下回、右侧脑岛、右侧楔叶、左侧枕上回、左侧顶上回。ALFF值降低的脑区:左侧眶内额上回。(2)与正常对照相比,双相抑郁组:ReHo值升高的脑区:右侧额中回、右内侧额上回、左侧三角部额下回、右侧梭状回。ReHo值降低的脑区:左侧颞上回、右侧枕中回。ALFF值升高的脑区:右侧中央前回、左侧三角部额下回、右侧脑岛。ALFF值降低的脑区:右侧颞上回、左侧海马旁回。(3)与单相抑郁组相比,双相抑郁组:ReHo值降低的脑区:右侧额盖区、左侧梭状回。右侧额盖区的ReHo值识别双相抑郁障碍的敏感度为0.667,特异度为0.810,曲线下面积为0.769;左侧梭状回的ReHo值识别双相抑郁障碍的敏感度为0.619,特异度为0.905,曲线下面积为0.780。ALFF值升高的脑区:左侧颞上回。ALFF值识别双相抑郁障碍的敏感度为0.714,特异度为0.952,曲线下面积为0.862。(4)双相抑郁组脑功能与临床量表相关分析:汉密尔顿焦虑量表总分:正相关:左侧颞中回、左侧舌回、左侧楔叶ReHo值。负相关:左侧额上回的ReHo值;右侧背外侧额上回、左侧补充运动区ALFF值。汉密尔顿抑郁量表总分:正相关:左侧颞下回、左侧枕中回ReHo值;右侧颞中回ALFF值。负相关:左侧中央前回ReHo值;右侧中央前回ALFF值。(5)双相抑郁组脑功能与认知功能测验相关分析:正相关:左侧额中回、右侧背外侧额上回、右侧三角部额下回、右侧颞下回ReHo值;右内侧和旁扣带脑回、右侧脑岛ALFF值。负相关:右侧中央旁小叶、右侧楔前叶ReHo值。结论(1)与正常对照相比,单相抑郁障碍和双相抑郁障碍均在额中回、内侧额上回、枕中回存在异常,这预示着抑郁障碍和双相障碍的病理机制有一定的相似性,可能属于同一疾病的不同状态。(2)单相抑郁障碍和双相抑郁障碍在右侧额盖区、左侧梭状回的局部一致性以及左侧颞上回的低频振幅存在差异,经过ROC分析,差异脑区相应指标有较好的特异性,有可能作为双相障碍早期识别的脑功能指标。(3)双相抑郁障碍额叶局部活动特性与临床症状及认知功能密切相关。
[Abstract]:Objective to explore the difference between depressive disorder and biphasic dysfunction in the first depressive episode and the relationship between the biphasic dysfunction and clinical characteristics during the first depressive period, with local consistency (ReHo) and low frequency amplitude (ALFF) as data processing methods, so as to provide a new basis for the early recognition of bipolar disorder. Method (1) follow up: follow up: The patients who were collected during the first depression period from January 2006 to June 2014 were divided into single phase depression group and bipolar depression group according to the clinical outcome. (2) data processing: extracting two groups of brain functional magnetic resonance data and related data in the first depressive episode, using ReHo and ALFF as image data processing methods. The independent sample t test was used to compare the two groups of ReHo, ALFF difference (Alphasim correction, P0.01), and then ROC analysis was used to verify the degree of heterogeneity in the differential brain region; for the bipolar depression group, the ReHo, ALFF and the clinical characteristic correlation scale were related to the whole brain voxel. (1) compared with the normal control, the single phase depression group: the brain area of the higher ReHo value: right frontal gyrus, right The medial frontal gyrus, the right cuneate lobe, the left occipital gyrus, the lower.ReHo value of the left margin of the brain: the left orbital frontal gyrus and the.ALFF value in the right frontal cortex: the right frontal gyrus, the right dorsal lateral frontal gyrus, the left orbital frontal gyrus, the right insula, the right cuneate, the left occipital upper gyrus, and the left superior.ALFF value in the left orbital area: the left orbital region: the left orbital region: the left orbital area: the left orbital region: the left orbital region of the left apex upper gyrus: the left orbital region: the left orbital area left to the left apical gyrus: the left orbital region: the left orbital region: the left orbital region with the left superior.ALFF value of the left apex (2) compared with the normal control, the diphasic depression group: the brain area of the ReHo value increased: the right frontal gyrus, the right medial upper frontal gyrus, the left triangle of the frontal gyrus, the lower.ReHo value of the right fusiform gyrus, the left lateral temporal gyrus and the.ALFF value in the right occipital gyrus, the right anterior central gyrus, the left trigone inferior frontal gyrus, and the right insula.ALFF value drop. The lower brain area: right right temporal gyrus and left parahippocampal gyrus. (3) compared with the single phase depression group, the bipolar depression group: the ReHo value decreased in the brain area: the right frontal cortex, the left fusiform gyrus. The sensitivity of the ReHo value of the right frontal cortex to identify the bipolar depressive disorder was 0.667, the specificity was 0.810, the area under the curve was 0.769, and the ReHo value of the left fusiform gyrus was biphasic. The sensitivity of depression was 0.619, the specificity was 0.905, the area under the curve was 0.780.ALFF. The sensitivity of the.ALFF value of the left temporal gyrus was 0.714, the specificity was 0.952, the area under the curve was 0.862. (4) in the bipolar depression group, the brain function and the clinical scale related analysis: the Hamilton Anxiety Scale total score: positive phase The left temporal gyrus, left lingual gyrus, left cuneate ReHo value. Negative correlation: the ReHo value of the left upper frontal gyrus, the upper lateral lateral frontal gyrus, and the left supplementary motor area ALFF value. The Hamilton Depression Scale total score: the left temporal gyrus, the left middle occipital gyrus ReHo value; the right temporal gyrus ALFF value; the negative left central anterior gyrus; the right central precentral ReHo; right central anterior gyrus. Back ALFF value. (5) correlation analysis of brain function and cognitive function test in bipolar depression group: positive correlation: left middle frontal gyrus, right dorsolateral frontal and lateral frontal gyrus, right trigonometric lower frontal gyrus, right temporal gyrus ReHo value; right medial and paranasal cingulate gyrus, right insula ALFF value. Negative correlation: right paraventricular lobule, right anterior lobe ReHo value. Conclusion (1) and normal control In comparison, monophasic depressive disorder and bipolar depressive disorder were both in the middle frontal gyrus, the medial superior frontal gyrus and the middle occipital gyrus, which indicated that the pathological mechanism of depressive disorder and bipolar disorder had a certain similarity, and may belong to the different state of the same disease. (2) the single phase depressive disorder and bipolar depressive disorder in the right frontal cortex and left fusiform gyrus There was a difference in the low frequency amplitude of the left temporal gyrus and the consistency of the left temporal gyrus. After ROC analysis, the corresponding index of the different brain regions had a good specificity. (3) the local activity of the frontal lobe of the bipolar depressive disorder was closely related to the clinical symptoms and cognitive function.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R749.4

【参考文献】