伴儿童期创伤健康成人的HPA轴功能以及脑影像学特征

发布时间：2018-04-30 13:45

本文选题：儿童期创伤 + 皮质醇觉醒反应　；参考：《中南大学》2014年博士论文

【摘要】：目的儿童期创伤是儿童时期最常见的心理应激事件,会显著地影响儿童和青少年的身心发展,目前已成为了一个全球广泛关注的重大社会公共卫生问题。大量的流行病学调查显示儿童期创伤与许多精神疾病和不良行为的发生显著相关,但儿童期创伤导致个体对精神疾病易感的生物学机制目前仍不清楚。因此本研究的主要目的是探讨儿童期创伤对健康成人下丘脑-垂体-肾上腺(HPA)轴系统功能以及脑结构和脑功能的影响,试图为儿童期创伤致个体对精神疾病易感的潜在生物学机制提供可能的证据。方法本研究主要分为两个部分：首先采用一般情况表、儿童期创伤问卷、抑郁自评量表、焦虑自评量表、功能失调性态度问卷、社会支持量表以及简版艾森克人格问卷对555名在校大学生人群进行儿童期创伤发生率及其相关心理特征的调查；其次招募24例伴儿童期创伤的健康成人以及24例年龄、性别匹配的不伴儿童期创伤的健康对照,对所有受试者采集晨起觉醒后0、30、45、60分钟时的唾液样本以检测皮质醇觉醒反应,同时采用飞利浦3.OT磁共振仪收集脑结构、弥散张量成像和静息态功能磁共振数据。磁共振数据分析分别采用基于体素的形态学分析法、基于体素的分析法和基于局部一致性的分析法。结果 1.调查显示555名大学生中有103名报告存在儿童期创伤史,占调查总人数的18.6%,其中42.7%的个体报道存在两种或两种以上类型的童年创伤经历,最常见的创伤类型为躯体忽略。儿童期创伤的发生率和创伤的类型无明显的性别差异。伴儿童期创伤的个体抑郁自评量表、焦虑自评量表、功能失调性态度问卷以及艾森克人格问卷的P、N维度分均显著升高；而社会支持量表以及艾森克人格问卷的E维度分则显著降低。2.伴儿童期创伤的个体晨起后30、45分钟时的唾液皮质醇水平显著升高,皮质醇觉醒反应曲线下面积和曲线下增加的面积也显著升高,皮质醇觉醒反应曲线下面积分别与儿童期创伤问卷的情感虐待分和总分呈显著的正相关。3.伴儿童期创伤的受试者右侧中扣带回、左侧额中回、左侧内侧前额叶皮质灰质体积均显著减小,且儿童期创伤问卷总分与右侧中扣带回、左侧额中回灰质体积呈负相关,皮质醇觉醒反应曲线下面积与右侧中扣带回灰质体积呈负相关。4.伴儿童期创伤的个体胼胝体膝部和体部以及左侧枕叶梭状回白质FA值显著降低。5.伴儿童期创伤的受试者双侧岛叶、左侧颞上回、右侧顶下叶ReHo值显著降低；而后扣带回ReHo值显著升高。结论 1.大学生人群中儿童期创伤的发生率为18.6%,伴儿童期创伤的成人存在更多的抑郁、焦虑情绪、歪曲认知和人格缺陷,同时他们的社会支持也更少。2.儿童期创伤可引起个体成年后HPA轴异常激活、脑灰质结构、白质完整性和脑静息态功能异常改变。这些改变即使在健康人中也早已存在,可能反映了伴儿童期创伤个体对精神疾病易感的生物学特征。3.伴儿童期创伤个体扣带回灰质体积的减小可能与皮质醇水平的升高相关。
[Abstract]:objective
Childhood trauma is the most common psychological stress event in childhood, which will significantly affect the physical and mental development of children and adolescents. At present, it has become a major social public health problem worldwide. A large number of epidemiological investigations show that childhood trauma is closely related to the occurrence of many seminal diseases and bad behavior, but The main purpose of this study is to explore the effects of childhood trauma on the function of the hypothalamus pituitary adrenal (HPA) axis system and the brain structure and brain function in healthy adults. The biological mechanism provides possible evidence.
Method
This study was divided into two parts: first, the general table, the childhood trauma questionnaire, the self rating depression scale, the self rating anxiety scale, the dysfunctional attitude questionnaire, the social support scale and the simple Eysenck personality questionnaire were used to investigate the incidence of childhood trauma and their related psychological characteristics in 555 College Students. Secondly, 24 healthy adults with childhood trauma and 24 age, sex matched healthy controls without childhood trauma were recruited to collect saliva samples at 0,30,45,60 minutes after morning awakening to detect the cortisol awakening reaction, and the PHILPS 3.OT magnetic resonance apparatus was used to collect the brain structure, diffuse tensor imaging and Resting state functional magnetic resonance data. The analysis of magnetic resonance data is based on voxel based morphological analysis, based on voxel analysis and analysis based on local consistency.
Result
1. the survey showed that 103 of the 555 college students reported childhood trauma history, accounting for 18.6% of the total number of respondents. 42.7% of them reported two or more than two types of childhood trauma experience, the most common type of trauma was physical neglect. There was no significant gender difference in the incidence of childhood trauma and the type of trauma. Children with children had no significant gender differences. The self rating depression scale, the self rating anxiety scale, the dysfunctional attitude questionnaire and the P personality questionnaire of Eysenck, and the N dimension scores were significantly higher, while the social support scale and the E dimension of the Eysenck personality questionnaire significantly decreased the salivary cortisol level at 30,45 minutes after the morning onset of.2. associated children. The area and the area under the curve under the cortisol awakening response curve increased significantly. The area under the cortisol response curve was significantly correlated with the emotional abuse and total score of the childhood trauma questionnaire. The right median cingulate gyrus, the left middle frontal cortex, the left medial prefrontal cortex were positively correlated with the.3. associated child trauma subjects. The volume of gray matter decreased significantly, and the total score of the childhood trauma questionnaire was negatively correlated with the right middle cingulate gyrus and the left middle frontal gyrus. The area under the cortisol response curve and the right cingulate cortex of the right cingulate gyrus were negatively related to the.4. associated child trauma in the individual corpus callosum and the body part and the left occipital spindle gyrus white matter FA value. The ReHo value of bilateral insula, left superior temporal gyrus, right inferior parietal lobe decreased significantly, while the ReHo value of the cingulate gyrus increased significantly in.5. subjects.
conclusion
1. the incidence of childhood trauma in the college students was 18.6%, and adults with associated child trauma had more depression, anxiety, distortion of cognitive and personality defects, and their social support less.2. childhood trauma could cause abnormal activation of the HPA axis, gray matter structure, white matter integrity and resting state function. These changes, even in healthy people, may have been existed in the healthy people, and may reflect the biological characteristics of the individual traumatized individuals for mental illness. The decrease in the cingulate volume of the cingulate cortex of the individual.3. associated child trauma may be associated with the increase of cortisol levels.

【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R749.4

【参考文献】