基于静息态脑功能磁共振成像探讨青年抑郁症自杀未遂的神经基础

发布时间：2018-01-04 12:05

  本文关键词：基于静息态脑功能磁共振成像探讨青年抑郁症自杀未遂的神经基础　出处：《重庆医科大学》2017年博士论文　论文类型：学位论文

  更多相关文章： 青年抑郁症 自杀未遂 静息态功能磁共振成像 低频振幅 冲动性 青年抑郁症 自杀未遂 静息态 功能磁共振成像 功能连接 青年抑郁症 自杀未遂 静息态脑网络 功能网络连接 独立成分分析

【摘要】：第一部分青年抑郁症自杀未遂的脑局部活动研究目的:采用静息态功能磁共振成像探讨局部脑功能活动的异常与青年抑郁症患者自杀未遂之间的相关性。方法:对35例自杀未遂的青年抑郁症患者(SU组)、18例不伴自杀未遂的青年抑郁症患者(NSU组)以及47名性别、年龄和受教育年限相匹配的健康对照者(HC组)进行临床心理量表评估和静息态f MRI扫描。采用低频振幅(Amplitude of low-frequency fluctuations,ALFF)的分析方法比较三组间z ALFF值的差异,并将SU组和NSU组z ALFF存在显著差异的脑区作为感兴趣区(regions-of-interest,ROIs),与临床行为量表之间进行相关性分析,同时采用受试者操作特征(Receiver Operating Characteristics,ROC)曲线评价上述脑区异常的z ALFF值作为影像标记对青年抑郁症患者自杀自杀行为的预测价值。结果:1、人口学资料和临床心理量表分析结果显示,SU、NSU和HC三组在性别(P=0.513)、年龄(P=0.584)和受教育年限(P=0.289)方面无统计学差异,但是SU组和NSU组在QSA、BIS-11、HAMD、BDI、BHS和SSI得分上显著高于HC组,三组得分之间的差异具有统计学意义(P0.001),post-hoc分析显示SU组与NSU组在QSA(P=0.219)、HAMD(P=0.089)、BDI(P=0.263)、BHS(P=0.125)和SSI(P=0.836)总分上无统计学差异,而在BIS-11得分上,SU组显著高于NSU组(P=0.036)。2、低频振幅分析发现,与NSU组和HC组相比,SU组在右侧颞上回(R-STG)、左侧颞中回(L-MTG)和左侧枕中回(L-MOG)的z ALFF值升高;此外,SU组左侧额上回(L-SFG)和左侧额中回(L-MFG)的z ALFF值较NSU组显著降低,同时SU组左侧额上回(L-SFG)和左侧额中回(L-MFG)的z ALFF值与BIS呈显著负相关(r=-0.36,P=0.03)。3、ROC曲线分析的结果显示左侧额上回(L-SFG)和左侧额中回(L-MFG)的z ALFF值在鉴别SU和NSU时敏感性为71.4%,特异性为83.3%。结论:左侧额上回(L-SFG)和左侧额中回(L-MFG)的活动降低引起其冲动性增高,进而介导了青年抑郁症患者自杀行为的发生。L-SFG/MFG的内在自发神经活动的异常是自杀的神经易感性因素。第二部分青年抑郁症自杀未遂的脑功能连接分析目的:静息态功能磁共振成像(resting-state functional magnetic resonance imaging,rs-f MRI)将有助于更好地理解青年抑郁症患者自杀未遂所潜在的神经生物机制。本研究将探寻伴有自杀未遂的青年抑郁症患者静息态脑功能连接(resting-state functional connectivity,RSFC)的异常及其与自杀未遂的关系,探索其在自杀未遂发生中可能潜在的神经生物学作用。方法:使用基于种子点的功能连接分析方法(seed-based functional connectivity)将第一部分SU和NSU组z ALFF存在显著差异的左侧额中回(l-MFG)和左侧额上回(L-SFG)作为种子点,进行基于全脑体素的种子点功能连接分析,并采用spearman相关分析探寻青年抑郁症自杀未遂患者异常脑功能连接与临床心理量表之间的相关性。结果:1、基于种子点功能连接分析发现,以左侧额中回(L-MFG)作为感兴趣区分析时发现,与NSU组相比,SU组左侧额中回(L-MFG)与左侧顶上回(L-SPL)的功能连接降低,与HC组相比,SU组左侧额中回与左侧岛回(L-insular)和左侧顶上回(L-SPL)的功能连接均降低,NSU组较HC组在左侧额中回与右侧额中回(R-MFG)和额下回眶部(R-IFG-orbit)的功能连接降低,与左侧岛回(L-Insula)功能连接增强。以左侧额上回(L-SFG)作为感兴趣区分析时结果显示,SU组较NSU组左侧额上回(L-SFG)与右侧额上回(R-SFG)的功能连接增强,较HC组左侧额上回(L-SFG)与右侧前扣带回(R-ACC)的功能连接减弱,NSU组较HC组左侧额上回(L-SFG)和左侧额下回眶部(L-MFG-orbit)的功能连接增强。2、脑区功能连接与临床量表相关分析发现,SU组左侧额中回(L-MFG)与左侧顶上小叶(L-SPL)的功能连接值与SSI(r=-0.4056,P=0.0156)和BIS(r=-0.3498,P=0.0394)量表总分呈显著负相关。左侧额上回(L-SFG)与右侧前扣带回(R-ACC)的功能连接与BIS(r=-0.3472,P=0.0410)量表总分呈显著负相关,与SSI(r=-0.2602,P=0.1312)无相关性。结论:本研究结果显示左侧眶额叶与左侧顶叶和右侧前扣带回功能连接的改变与青年抑郁症自杀未遂行为相关。我们的结果为临床抑郁症青年自杀未遂的静息态功能连接(RSFC)提供了新的认识,并且认为青年抑郁症患者的额-顶网络和额-边缘网络功能连接异常可能是其发生自杀未遂的一个影像学预测因子。第三部分青年抑郁症自杀未遂的脑功能网络连接分析目的:探讨自杀未遂青年抑郁症患者静息态脑网络(resting-state network,RSN)内和网络间功能连接的差异,分析神经网络之间的相互作用,从而了解青年抑郁症自杀未遂所潜在的神经机制。方法:采用基于群组的独立成分分析方法将静息态f MRI数据分解为不同的RSNs,并提取CEN、DMN和SN三大核心认知脑网络,比较SU、NSU和HC三个RSNs内在脑活动特征以及脑网络功能连接(functional network connectivity,FNC)的差异。结果:1、识别出5个静息态脑网络(resting state networks,RSNs)作为感兴趣的成分,分别为左侧额顶网络(IC8:L-FPN)、凸显网络(IC12:SN)、默认网络前部(IC14:a DMN)、右侧额顶网络(IC16:R-FPN)和默认网络后部(IC32:p DMN)。单样本t检验显示三组具有典型的RSN空间分布模式,三组脑网络进行ANOVA分析显示,三组间5个静息态脑网络内自发活动存在显著差异。2、三组间FNC分析发现,SU组前默认网络(a DMN)与凸显网络(SN)和右侧额顶网络(R-FPN)的功能网络连接较NSU组降低,而凸显网络与右侧额顶网络(R-FPN)的功能网络连接增强;与HC组相比,SU组前默认网络与左侧额顶网络(L-FPN)以及后默认网络(p DMN)的功能网络连接降低,而凸显网络与左侧额顶网络的功能网络连接增加;NSU组后默认网络与右侧额顶网络的功能网路连接下降。结论:青年抑郁症自杀未遂行为与DMN、SN和CEN三大核心神经认知网络功能连接异常有关,广泛涉及网络的多个节点。本研究为探寻青年抑郁症自杀未遂的大脑功能组织模式提供了新的证据。
[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. 缁撴灉:1,鍩轰簬绉嶅瓙鐐瑰姛鑳借繛鎺ュ垎鏋愬彂鐜，

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