认知行为治疗作用于抑郁症患者静息态脑功能的追踪研究
发布时间：2018-09-06 12:21
【摘要】：近几年,静息态核磁共振在抑郁症发病机制和治疗的研究中应用广泛,研究一致认为抑郁症的病理学基础不是单个脑区的损伤,而是与不同脑区共同组成的功能相关的神经环路、脑网络之间功能连接的异常有关。认知行为治疗(cognitive behavior therapy,CBT)可带来患者相关病理脑区和功能连接的恢复,临床上患者抑郁症状可以有长期和持续的改变。目前国内外相关研究仅设置治疗前后两个时间点,并不能呈现CBT对抑郁症治疗的神经变化过程,而且当前的研究结果并不一致。本研究主要在南京脑科医院门诊处收取抑郁症病人(数据剔除后,n=18例)并招募与其在性别、年龄、受教育程度相匹配的健康者(数据剔除后,n=15例),入组筛选后,被试填写一般人口学资料表,并使用汉密尔顿抑郁量表(Hamilton Depression Scale, HAMD)进行双盲评分。两组被试在入组48h内进行基线期静息态fMRI扫描,比较抑郁症患者神经自发活动水平的低频波振幅(amplitude of low frequency-fluctuation,ALFF)与健康组的差异。之后对抑郁组进行个体化CBT治疗,设基线期、治疗初期(6周后)、治疗稳定期(24周后)三个时间点,探索不同时间点CBT对抑郁症患者脑活动变化水平的差异。结合以往研究以及本研究初步ALFF值结果,选取CBT治疗6周后、24周后抑郁组的差异脑区左侧楔前叶、右侧楔前叶为感兴趣区点,对抑郁组和健康组的全脑功能连接分析(Functional Connectivity, FC),进一步探索CBT对抑郁症治疗带来的脑功能连接变化。结果如下:1、ALFF结果:(1)抑郁组与健康对照组基线期相比,抑郁患者的右侧舌回ALFF显著增强、左侧枕中回ALFF显著减弱(p0.01);(2)抑郁组6周CBT治疗后与基线期相比,左侧颞中回、左(右)侧额中回ALFF值显著增高;左侧舌回、左侧楔前叶、左侧额下回眶部ALFF值显著降低(p0.01)。(3)抑郁组24周CBT治疗后与基线期相比,左侧额上回ALFF值显著增高;左侧梭状回、左侧额下回眶部、右侧枕中回、右侧楔前叶ALFF值显著降低(p0.01);2、FC结果:(1)抑郁组与健康组基线期对比,左侧楔前叶与辅助运动区的功能连接水平显著低于健康对照组(p0.05);(2)6周治疗后抑郁组与基线期对比,左侧楔前叶与额中回、右侧楔前叶功能连接显著减弱;右侧楔前叶与扣带回的功能连接显著减弱,与右侧中央前回的功能连接显著增强(p0.05);(3)24周治疗后抑郁组与基线期相比,左侧楔前叶与左侧海马旁回、右侧中央前回功能连接降低,与右侧中央前回功能连接增强;右侧楔前叶与右侧中央前回功能连接增强,与颞下回功能连接减弱(p0.05)。本研究发现:(1)6周CBT治疗作用于认知控制网络和突显网络内的相关脑区如额中回、中央前回等,抑制默认网络内脑区如楔前叶的激活,患者对信息的注意转移能力增强;(2)24周CBT治疗能带来认知控制网络脑区的大范围功能修复,患者的反应抑制能力恢复;(3)CBT治疗初期,抑郁症患者病理脑区功能逐步修复,而稳定期是对脑功能正常作用的进一步强化。
[Abstract]:In recent years, resting-state magnetic resonance imaging has been widely used in the study of the pathogenesis and treatment of depression. It is generally accepted that the pathological basis of depression is not the injury of a single brain area, but the abnormality of functional connections between neural circuits and brain networks associated with the function of different brain areas. Ehavior therapy (CBT) can bring about the recovery of the related pathological brain regions and functional connections, and the depressive symptoms of patients can be changed for a long time and persistently. In this study, depression patients (n = 18 after data elimination) were recruited from the outpatient department of Nanjing Brain Hospital and healthy persons matched with their sex, age and education level (n = 15 after data elimination) were enrolled. After enrollment, the subjects filled out the general demographic data sheet and used the Hamilton Depression Scale (Hamilton Depression Sca). Two groups of subjects underwent baseline resting state fMRI within 48 hours to compare the difference of amplitude of low Frequency-fluctuation (ALFF) in depressive patients with healthy controls. To explore the changes of brain activity in depression patients at three time points during the stable period (24 weeks later). Combining with previous studies and preliminary ALFF results of this study, the left anterior cuneiform lobe, right anterior cuneiform lobe were selected as the regions of interest in depression group and healthy group. The results were as follows: 1. ALFF results: (1) Compared with the baseline period of the healthy control group, ALFF in the right lingual gyrus of the depressive group was significantly increased, and ALFF in the left middle occipital gyrus was significantly decreased (p0.01); (2) CBT treatment in the depressive group for 6 weeks resulted in significant changes in the functional connectivity of the brain. Compared with baseline period, ALFF values of left middle temporal gyrus and left (right) middle frontal gyrus were significantly increased, while ALFF values of left lingual gyrus, left anterior cuneate lobe and left inferior frontal gyrus were significantly decreased (p0.01). (3) After 24 weeks CBT treatment, ALFF values of left superior frontal gyrus were significantly increased in depression group, left fusiform gyrus, left inferior frontal gyrus, right middle occipital gyrus and right inferior frontal gyrus were significantly increased. The ALFF value of the anterior cuneiform lobe was significantly decreased (p0.01); 2, FC results: (1) Compared with the healthy group, the functional connectivity between the left anterior cuneiform lobe and the auxiliary motor area was significantly lower in the depressive group than in the healthy group (p0.05); (2) After 6 weeks of treatment, the functional connectivity between the left anterior cuneiform lobe and the middle frontal gyrus, and the right anterior cuneiform lobe was significantly weakened in the depressive group compared with the baseline stage. The functional connection between the anterior cuneate lobe and cingulate gyrus was significantly weakened, and the functional connection with the right anterior central gyrus was significantly enhanced (p0.05); (3) After 24 weeks of treatment, the functional connection between the left anterior cuneate lobe and the left parahippocampal gyrus, the right anterior central gyrus and the right anterior central gyrus was decreased, and the functional connection between the right anterior cuneate lobe and the right anterior central gyrus was enhanced. This study found that: (1) 6-week CBT therapy inhibited the activation of brain regions in the default network, such as the middle frontal gyrus and the anterior central gyrus, and enhanced the patient's ability to shift attention to information; (2) 24-week CBT therapy could bring about the enhancement of the patient's ability to transfer attention to information. In the early stage of CBT treatment, the pathological brain function of depressive patients was gradually restored, while the stable stage was the further strengthening of normal brain function.
【学位授予单位】：南京师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：B842.1
本文编号：2226334
[Abstract]:In recent years, resting-state magnetic resonance imaging has been widely used in the study of the pathogenesis and treatment of depression. It is generally accepted that the pathological basis of depression is not the injury of a single brain area, but the abnormality of functional connections between neural circuits and brain networks associated with the function of different brain areas. Ehavior therapy (CBT) can bring about the recovery of the related pathological brain regions and functional connections, and the depressive symptoms of patients can be changed for a long time and persistently. In this study, depression patients (n = 18 after data elimination) were recruited from the outpatient department of Nanjing Brain Hospital and healthy persons matched with their sex, age and education level (n = 15 after data elimination) were enrolled. After enrollment, the subjects filled out the general demographic data sheet and used the Hamilton Depression Scale (Hamilton Depression Sca). Two groups of subjects underwent baseline resting state fMRI within 48 hours to compare the difference of amplitude of low Frequency-fluctuation (ALFF) in depressive patients with healthy controls. To explore the changes of brain activity in depression patients at three time points during the stable period (24 weeks later). Combining with previous studies and preliminary ALFF results of this study, the left anterior cuneiform lobe, right anterior cuneiform lobe were selected as the regions of interest in depression group and healthy group. The results were as follows: 1. ALFF results: (1) Compared with the baseline period of the healthy control group, ALFF in the right lingual gyrus of the depressive group was significantly increased, and ALFF in the left middle occipital gyrus was significantly decreased (p0.01); (2) CBT treatment in the depressive group for 6 weeks resulted in significant changes in the functional connectivity of the brain. Compared with baseline period, ALFF values of left middle temporal gyrus and left (right) middle frontal gyrus were significantly increased, while ALFF values of left lingual gyrus, left anterior cuneate lobe and left inferior frontal gyrus were significantly decreased (p0.01). (3) After 24 weeks CBT treatment, ALFF values of left superior frontal gyrus were significantly increased in depression group, left fusiform gyrus, left inferior frontal gyrus, right middle occipital gyrus and right inferior frontal gyrus were significantly increased. The ALFF value of the anterior cuneiform lobe was significantly decreased (p0.01); 2, FC results: (1) Compared with the healthy group, the functional connectivity between the left anterior cuneiform lobe and the auxiliary motor area was significantly lower in the depressive group than in the healthy group (p0.05); (2) After 6 weeks of treatment, the functional connectivity between the left anterior cuneiform lobe and the middle frontal gyrus, and the right anterior cuneiform lobe was significantly weakened in the depressive group compared with the baseline stage. The functional connection between the anterior cuneate lobe and cingulate gyrus was significantly weakened, and the functional connection with the right anterior central gyrus was significantly enhanced (p0.05); (3) After 24 weeks of treatment, the functional connection between the left anterior cuneate lobe and the left parahippocampal gyrus, the right anterior central gyrus and the right anterior central gyrus was decreased, and the functional connection between the right anterior cuneate lobe and the right anterior central gyrus was enhanced. This study found that: (1) 6-week CBT therapy inhibited the activation of brain regions in the default network, such as the middle frontal gyrus and the anterior central gyrus, and enhanced the patient's ability to shift attention to information; (2) 24-week CBT therapy could bring about the enhancement of the patient's ability to transfer attention to information. In the early stage of CBT treatment, the pathological brain function of depressive patients was gradually restored, while the stable stage was the further strengthening of normal brain function.
【学位授予单位】：南京师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：B842.1
【参考文献】
相关期刊论文 前6条
1 朱雪玲;陈璐;袁福来;;青年重性抑郁症静息态大脑低频振幅研究[J];中国临床心理学杂志;2016年05期
2 滕昌军;王纯;张宁;马辉;谭雅容;肖朝勇;高帅;李鸿磊;张文tD;张秀娟;;认知行为治疗对首次发病轻中度抑郁症患者膝下前扣带回功能连接的影响[J];中华精神科杂志;2016年04期
3 朱雪玲;袁福来;;基于区域的抑郁症默认网络内部功能连接研究[J];中国临床心理学杂志;2016年02期
4 阎锐;姚志剑;汤浩;韦茂彬;陈建淮;花玲玲;卢青;;首发抑郁症患者脑区低频振幅特征与症状群的相关性[J];中华行为医学与脑科学杂志;2014年08期
5 谭雅容;王阳;张宁;王纯;肖朝勇;曹瑞想;高帅;杨娟;李鸿磊;;首发轻中度抑郁症患者认知行为治疗前后大脑局部变化的功能磁共振研究[J];中华行为医学与脑科学杂志;2014年06期
6 王纯;张亚林;张宁;;抑郁症心理治疗的神经影像学研究[J];国际精神病学杂志;2008年03期
，本文编号：2226334
本文链接：https://www.wllwen.com/shekelunwen/xinlixingwei/2226334.html
