肝郁型抑郁症患者与正常人的脑功能影像学差异研究

发布时间：2018-05-07 01:42

本文选题：抑郁症 + 肝郁型　；参考：《北京中医药大学》2014年硕士论文

【摘要】：背景：抑郁症(depression)是情感障碍的一种,多表现为心境低落、思维迟缓、行为减少的“三低”症状,是人群中最为常见的精神障碍之一,它发生于全球各国、社会各阶层和各种环境的各类人群中。目前全世界约有3.4亿人受其影响。在此刻,至少有1/50低于12岁的儿童、1/20的青少年、1/10的男性和1/4的女性成人曾经或正在发生抑郁障碍。近几年来,对于抑郁症发病机理的研究,抑郁症病人的脑功能影像学改变逐渐成为热点。国内外学者利用fMRI技术也取得了一定成果,发现抑郁症是某些脑区代谢障碍所致,额叶、杏仁核、扣带回等处的功能障碍与抑郁有关。但是在中医方面,中医治疗抑郁症是根据辨证分型进行分证论治,证型的差异是否也会存在脑功能影像学方面的差异?各证型的功能影像学与中医理论基础又有什么联系?都亟需我们深入研究。目的：对肝郁型中度抑郁症患者与正常对照组进行fMRI,并通过面孔表情识别研究,比较脑功能区激活情况,从而完成肝郁型抑郁症患者与正常人的脑功能影像学差异的研究。方法：利用3.0T功能核磁共振成像系统观察15例肝郁型患者和15例正常受试者,在识别恐惧、愤怒、高兴、中性四类情绪面孔时的脑功能激活反应,并比较两组间的差异。本研究中行为数据通过SPSS13软件分析,脑功能图像数据经SPM8软件处理和统计分析,获得脑区激活图。结果：1.肝郁型抑郁症患者在反应时间、面孔表情识别正确率方面与正常组无显著差异。2.肝郁型抑郁症患者在识别愤怒与中性面孔时,双侧杏仁核、双侧扣带回比正常对照组脑血流量活动增强,而背外侧前额皮质较正常对照组活动减弱3.肝郁型抑郁症患者在识别恐惧与中性面孔时,双侧杏仁核比正常对照组脑血流量活动增强。4.肝郁型抑郁症患者在识别高兴与中性面孔时：双侧额上回及左侧壳核较正常对照组脑血流量活动过度激活。结论：1.肝郁型抑郁症患者在识别愤怒面孔时,双侧杏仁核、双侧扣带回较正常人激活显著,背外侧前额皮质较正常人激活减弱。因为杏仁核、扣带回管理愤怒情绪,因此肝郁患者相应脑区激活,为“肝在志为怒”的中医理论提供了脑影像学基础。2.肝郁型抑郁症患者在识别恐惧面孔时,双侧杏仁核较正常人激活显著。因为杏仁核与恐惧情绪的识别有关,负责负性情绪的管理,符合“肝气虚则恐实则怒”的理论。3.肝郁型抑郁症患者在识别高兴面孔时,双侧额上回及左侧壳核较正常人激活显著。额上回与壳核是与认知功能有关的脑区,中医理论中人的认知功能是由心神决定的,“肝藏魂,主谋虑”,肝郁型抑郁症患者肝主谋虑功能下降,为了完成正常的认知活动,则需要心神代偿能力的增强,表现为认知脑区的激活,符合中医观点。4.研究提示中医“肝”在情志调节方面可能与边缘环路中的杏仁核、扣带回相关,中医肝气虚、肝郁等症候可能是边缘环路中的杏仁核、扣带回功能的异常表现。
[Abstract]:Background: depression (depression) is one of the affective disorders. It is characterized by low mood, slow thinking, and reduced behavior of "three low" symptoms. It is one of the most common mental disorders in the population. It occurs in all the countries of the world, all classes of society and all kinds of environment. At present, about 340 million people all over the world are affected by it. At least 1/50 children under 12 years of age, 1/20 teenagers, 1/10 men and 1/4 female adults have been or are depressive disorders. In recent years, the brain functional imaging changes of depression patients have gradually become hot spots in the study of the pathogenesis of depression. The domestic and foreign researchers have also achieved some results with fMRI technology and found depression. The dysfunction of the frontal, amygdala and cingulate gyrus is related to depression in some brain areas. But in traditional Chinese medicine, Chinese medicine treatment of depression is based on syndrome differentiation and differentiation, whether the difference of syndrome type also exists in the imaging of brain function? Functional imaging and theoretical basis of traditional Chinese Medicine What's the connection? We need to study deeply.
Objective: to carry out fMRI in patients with depression of liver depression and normal control group, and to compare the activation of brain function area by facial expression recognition, so as to complete the study of brain functional imaging differences between depression patients with liver depression and normal people.
Methods: the 3.0T functional magnetic resonance imaging system was used to observe the brain function activation responses of 15 patients with liver depression and 15 normal subjects in identifying the four emotional faces of fear, anger, happiness and neutral. The difference between the two groups was compared. The behavioral data in this study were analyzed by SPSS13 software and the brain function image data were processed by SPM8 software. And statistical analysis, the activation map of the brain area was obtained.
Results: 1. in patients with depression of liver depression, there was no significant difference in the response time, the correct rate of facial expression recognition was not significantly different from that of the normal group..2. liver depression patients with depressed and neutral faces, bilateral amygdala, bilateral cingulate gyrus increased more than the normal control group, while the dorsolateral prefrontal cortex was less active than the normal control group. In the identification of fear and neutral face in the weak 3. depressive patients, the bilateral amygdala, compared with the normal control group, increased the activity of.4. liver depression in identifying the happy and neutral faces: the activation of the cerebral blood flow activity in the bilateral frontal and left putamen compared with the normal control group.
Conclusion: 1. during the identification of angry faces, bilateral amygdala and bilateral cingulate gyrus were significantly activated and the lateral prefrontal cortex was less activated than normal people. The amygdala and cingulate cortex managed anger, so the corresponding brain areas of the liver depression were activated, providing a brain shadow for the Chinese theory of "liver in Zhi Wrath". When identifying fear faces, the bilateral amygdala is more significant than normal people in identifying fear faces. Because the amygdala is related to the recognition of the fear mood, the management of the negative emotion is responsible for the management of the negative emotion, which is in line with the theory of "liver qi deficiency and the fear of real anger". The.2. liver depression type depression patients have both the upper and the left frontal gyrus and the left side when identifying the happy faces. The putamen is more significant than that of the normal person. The upper frontal gyrus and the putamen are the brain areas related to the cognitive function. The cognitive function of people in Chinese medicine theory is determined by the mind, "the liver is hidden in the soul, the master is concerned", the liver depression of the depressed patients with liver depression is reduced. In order to complete the normal cognitive activity, it needs the enhancement of the mental compensatory ability, which is manifested as cognition. The activation of the brain area is in accordance with the.4. study of traditional Chinese medicine. It is suggested that the "liver" in Chinese medicine may be related to the amygdala and cingulate gyrus in the edge loop. The syndrome of liver qi deficiency and liver depression may be the side of the TCM.
The abnormality of the cingulate gyrus function in the amygdala.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R277.7;R445.2

【参考文献】