首发轻中度抑郁症患者认知行为治疗前后的大脑功能磁共振研究

发布时间：2018-03-12 20:47

本文选题：功能磁共振　切入点：局部一致性　出处：《南京医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的检测抑郁症(major depressive disorder)患者在认知行为治疗(cognitive-behavior therapy, CBT)前后的大脑功能活动变化的情况,以初步探索CBT对抑郁症的神经生物学机制。方法 11名首次发病且未经任何系统治疗的抑郁症患者及12名在性别、年龄、教育年限上相匹配的健康对照者,进行静息态与任务态的功能磁共振(function magnetic resonance imaging)扫描。任务态扫描中被试需执行一个对面部表情图片进行性别判断的任务,图片包括中性、负性及正性三种情绪类型。患者在6周的CBT后再次接受相同的功能磁共振扫描。采用Rest和SPM8软件处理影像数据,包括静息态下的局部一致性(Regional homogeneity, ReHo)和任务态下的脑激活强度分析。结果相对于正常对照组,静息态下,治疗前抑郁症患者右缘上回(t=-3.18,P0.05)和右额下回岛盖部(t=-2.99,P0.05)的ReHo值降低。治疗后患者左额中回(t=3.24,P0.05)和右额中回(t=3.06,P0.05)的ReHo值增高；负性刺激下,治疗前患者右小脑(t=-3.53,P0.05)和左中央后回(t=-4.31,P0.05)激活降低,治疗后小脑蚓部激活降低(t=-4.07,P0.05)。相对于治疗前,静息态下,治疗后患者左海马(t=-3.92,P0.05)的ReHo值增高；负性刺激下,患者左梭状回(t=-5.05,P0.05)、右岛叶(t=-4.71,P0.05)、左尾状核(t=-4.13,P0.05)、右额中回(t=-5.96,P0.05)、左顶下小叶(t=-5.08,P0.05)激活较前增高；正性表情刺激下,患者左中央前回(t=4.67,P0.05)、右额下回岛盖部(t=5.10,P0.05)、两侧缘上回(右：t=5.19；左：t=4.81,P0.05)激活降低。结论本研究结果提示短程的CBT治疗以后,一方面,上调情绪加工及认知监控系统,促使患者更好地识别与处理负性情绪；另一方面,下调异常的反应抑制系统,与自身症状无关的外界信息的抑制减少,加工资源得以重新配置,促使患者不再聚焦于症状本身。这两方面相互作用,促进内在情绪与外界环境信息的平衡与稳定,以达到抗抑郁的治疗效果。
[Abstract]:Purpose. The changes of brain function in patients with major depressive before and after cognitive-behavior therapy were detected to explore the neurobiological mechanism of CBT in depression. Method. Eleven first-time depressive patients without any systematic treatment and 12 healthy controls matched in sex, age, and years of education. The rest and task states were scanned by functional magnetic resonance imaging.The subjects were asked to perform a gender judgment task on the facial expression images, which included neutral, neutral, and neutral images. The patients received the same fMRI scan again after 6 weeks of CBT. Rest and SPM8 software were used to process the image data. The regional homogeneity (ReHox) in resting state and the brain activation intensity in task state are analyzed. Results. Compared with the normal control group, the ReHo values of the patients with depression before treatment were significantly lower than those of the normal control group. The ReHo values of the patients with depression before treatment were lower than those of the patients with depression before treatment. The ReHo values of the right inferior frontal gyrus and the right inferior frontal gyrus were significantly lower than those of the patients with depression before treatment. After treatment, the ReHo values of the left middle frontal gyrus and the right middle frontal gyrus were higher than those of the right middle frontal gyrus and the right middle frontal gyrus. Before treatment, the activation of the right cerebellum was decreased, and the activation of the left posterior gyrus was decreased, and the activation of the cerebellar vermis was decreased after treatment. Compared with the patients before and after treatment, the ReHo values of the left hippocampus increased after treatment. In the left fusiform gyrus, the activation was higher in the left fusiform gyrus than in the left fusiform gyrus, and the activation was higher in the right fusiform gyrus, the right precentral gyrus, the right inferior frontal gyrus, the right middle frontal gyrus and the left inferior parietal lobule, and the activation of the left central gyrus t4.67 and the right inferior frontal gyrus was decreased, and the activation of the superior marginal gyrus was 5.19; the left subparietal lobe was 4.81P0.05; and the activation of the right inferior frontal gyrus was decreased in the right inferior frontal gyrus (T5.10P0.05). Conclusion. The results of this study suggest that after short-term CBT therapy, on the one hand, the emotional processing and cognitive monitoring system can be upregulated to promote the patients to better identify and deal with negative emotions; on the other hand, the abnormal response inhibition system can be down-regulated. The inhibition of external information, which is independent of symptoms, is reduced, and processing resources are reconfigured so that patients are no longer focused on the symptoms themselves. These two aspects interact to promote the balance and stability of internal emotions and external environmental information. In order to achieve antidepressant effect.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：B842

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