原发性失眠患者静息态脑默认网络及与空间工作记忆相关神经网络fMRI研究

发布时间：2018-06-26 21:50

本文选题：原发性失眠 + 脑功能成像　；参考：《郑州大学》2014年博士论文

【摘要】：第一部分原发性失眠患者静息态脑默认网络fMRI研究目的：本实验利用磁共振脑功能成像技术,通过功能连接相关分析方法,选取双侧后扣带回(BA23/31)为种子点,研究原发性失眠患者静息态默认网络相关脑区神经网络,从神经影像学的角度分析原发性失眠患者默认网络脑功能连接是否存在特异性改变及其发生神经机制,为原发性失眠临床认知功能障碍诊疗提供可能的客观依据；以期用功能影像学方法为原发性失眠患者认知障碍神经生理学发病机制提供一定的科学依据。方法：根据美国美国精神疾病诊断与统计手册第四版(DSM-IV) (Diagnostic and Statistical Manual of Mental Disorders.4th ed DSM-Ⅳ)和国际睡眠障碍分类(International classification of sleep disorders, ICSD)关于原发性失眠(Primary Insomnia, PI)诊断标准,符合原发性失眠入组标准30例,符合正常健康对照(Healthy control, HC)入组标准30例,HC组性别、年龄与PI组一致。在磁共振扫描前,所有被试者均进行临床量表测定,包括：匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index, PSQI)、汉密尔顿抑郁量表(Hamilton Depression Scale, HAMD)、汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA)及空间工作记忆量表。磁共振扫描序列包括：磁共振常规扫描、磁共振静息态脑功能成像扫描,采用双样本t检验对PI、HC组临床量表进行统计学分析。以双侧PCC(BA23/31)为种子点,采用SPM8和Rest软件对磁共振脑功能数据进行预处理,比较PI组、HC组静息态脑默认网络及其差异。结果：1 PI、HC组临床资料分析结果1.1 PI组与HC组对比,PSQI、HAMD、HAMA、空间工作记忆量表有显著统计学差异。1.2 PI组伴轻度抑郁组与PI伴中度抑郁组对比,PSQI旨数、HAMA无明显统计学差异。2 PI、HC组静息态脑默认网络MRI结果2.1 PI、HC组静息态脑默认网络,两组与PCC功能连接脑区主要包括：扣带回、前额叶、双侧顶叶皮层、海马旁回及取侧颞叶、枕叶皮层。2.2 PI、HC组对比,PI组与PCC功能连接增强脑区包括：双侧额上回、双侧中问扣带回；PI组与PCC功能连接减弱脑区包括：左侧枕叶、左侧海马旁回、右侧颞叶。2.3 PI中度抑郁组与轻度抑郁组对比,PI中度抑郁组与PCC功能连接增强脑区包括：中问扣带回、右侧额中回；PI中度抑郁组与PCC功能连接减弱脑区包括；左侧海马旁回。3、结论1、原发性失眠组具有睡眠障碍及认知功能障碍基本临床特征；焦虑、抑郁是原发性失眠患者主要的伴随情感障碍；原发性失眠伴有抑郁程度与焦虑程度无明显相关性；2、原发性失眠组与健康对照组存在脑默认网络；原发性失眠组存在脑默认网络异常,揭示了原发性失眠组存在明显的记忆力下降认知功能障碍及情绪调节失常神经机制,与临床量表存在空问工作记忆认知功能下降及伴有抑郁、焦虑情绪异常相一致。3、中间扣带回是抑郁相关脑区标志,与抑郁程度相关。海马的损害程度与失眠程度相关。第二部分原发性失眠患者与空间工作记忆相关神经网络fMIRI研究目的：本实验利用磁共振脑功能成像技术,通过静息态脑功能连接和空问工作记忆任务态脑功能成像相关分析方法,研究原发性失眠患者与空间工作记忆相关神经网络环路异常及其发生神经机制,探讨右侧顶上小叶(BA7/5)在空问工作记忆中的作用,以期用功能影像学方法为原发性失眠患者认知功能障碍神经生理学发病机制提供一定的科学依据。方法：实验入组标准,实验入组人数、临床量表测定均同第一部分,第二部分实验在第一部分的基础上进行,磁共振空间工任务态fMRI数据扫描在第一部分磁共振常规扫描、磁共振静息态脑功能成像结束后马上进行,脑功能数据预处理过程同第一部分,首先以右侧顶上小叶为种子点,比较PI组、HC组静息态与其相关神经网络及差异,再分析探讨空间工作任务态下,两组脑神经网络及其差异分析,为临床原发性失眠认知功能障碍提供影像学科学依据。结果：1 以右侧顶上小叶(BA7/5)为种子点,静息态与空间工作记忆功能相关神经网络研究1.1 HC组静息态与右侧顶上小叶(BA7/5)功能连接相关主要脑区包括：双侧顶叶皮层、双侧额叶皮层、双侧颞叶皮层、双侧枕叶皮层、右侧小脑半球、右侧海马旁回；右侧半球连接强度及范围高于左侧半球。1.2 PI组与静息态与右侧顶上小叶(BA7/5)功能连接相关主要脑区包括：积侧顶叶皮层、双侧额叶皮层、双侧颞叶皮层、双侧枕叶皮层、双侧小脑半球,左侧楔前叶/左侧后扣带回；右侧半球连接强度及范围高于左侧半球。1.3 PI.HC组对比,PI组与右侧顶上小叶(BA7/5)功能连接增强脑区主要包括：双侧额叶、双侧中央后回、左侧楔前叶：功能连接减弱脑区包括：右侧小脑半球、左侧豆状核、右侧海马旁回、右侧枕叶皮层。2 PI、HC组空间工作记忆任务态fMRI成像结果2.1 HC组空问工作任务态激活脑区主要包括：双侧顶叶、双侧额叶、双侧颞叶、双侧枕叶、桥脑、中脑、小脑半球、双侧丘脑,双侧岛叶。2.2 PI组空间工作任务态激活脑区主要包括：双侧顶叶皮层、双侧额叶皮层、双侧颞叶皮层、双侧枕叶皮层、双侧岛叶、双侧小脑半球、左侧海马旁回、左侧丘脑、右侧桥脑。2.3 PI、HC组对比,PI组空问工作任务态激活增强主要脑区包括：左颞叶、左侧枕叶、右侧额叶； PI组与空问工作记忆任务态激活减弱脑区包括：左侧海马旁回、右侧海马旁回、双侧颥叶皮层、取侧额叶皮层、双侧顶上小叶。结论：1、空问工作记忆任务是多个脑区相互协作完成,具有特定神经网络,主要包括：双侧顶叶皮层、双侧额叶皮层、双侧颞叶皮层、双侧枕叶皮层、双侧岛叶、小脑半球、桥脑、丘脑等脑区；双侧顶叶为空问工作记忆主要功能脑区；空问工作记忆任务具有右半球优势；2、以右侧顶上小叶(BA7/5)为种子点功能连接静息态神经网络,与空间工作任务态澈活脑区主要神经网络一致,证史右侧顶上小叶(BA7/5)是空问工作记忆网络的核心组成部分,可以作为为空间工作记忆的种子点。3、原发性失眠患者存在空问工作记忆相关神经网络异常,揭示原发性失眠患者临床空间工作记忆下降、记忆力下降认知功能障碍及情感障碍发生的神经网络机制。
[Abstract]:The first part of the study of the resting state brain default network fMRI study in primary insomnia patients: this experiment uses magnetic resonance brain functional imaging technology to select the bilateral posterior cingulate gyrus (BA23/31) as the seed point through functional connection correlation analysis, and studies the neural network of the resting state network related brain area of the patients with primary insomnia, from neuroimaging To analyze the specific changes in the default network brain function connection and its neural mechanism in the patients with primary insomnia, and provide the possible objective basis for the diagnosis and treatment of clinical cognitive impairment in primary insomnia. Scientific basis. Methods: according to the United States American psychiatric diagnosis and statistics manual Fourth Edition (DSM-IV) (Diagnostic and Statistical Manual of Mental Disorders.4th ed DSM- IV) and the international classification of sleep disorders (International classification) on the diagnostic criteria for primary insomnia. According to the standard 30 cases of primary insomnia, 30 cases were in the standard of normal health control (Healthy control, HC), and the sex of group HC was the same as that in the PI group. Before the MRI scan, all the subjects were measured by the clinical scale, including the Pittsburgh sleep mass index (Pittsburgh Sleep Quality Index, PSQI), and the Hamilton Depression Scale (Hamilton Depression Scale, HAMD), the Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA) and the spatial working memory scale. The magnetic resonance scanning sequence included magnetic resonance conventional scan, magnetic resonance resting state brain functional imaging scan, and dual sample t test for PI, HC group clinical scale. Seed points, using SPM8 and Rest software to pretreat magnetic resonance brain function data, compare PI, HC group, resting state brain default network and their differences. Results: 1 PI, HC group clinical data analysis results of group 1.1 PI and HC group, PSQI, HAMD, HAMA, spatial working memory scale Compared with the depressive group, there was no significant difference in PSQI tenor, HAMA,.2 PI, the resting state brain default network MRI results in HC group 2.1 PI, HC group resting state brain default network, two groups and PCC functional connection brain areas mainly including cingulate gyrus, prefrontal lobe, bilateral parietal cortex, parahippocampal gyrus and lateral temporal lobe,.2.2 PI in occipital cortex, HC group contrast The ability to connect the enhanced brain area included bilateral upper frontal gyrus and bilateral cingulate gyrus; PI group and PCC functional connection weakened brain area including left occipital lobe, left parahippocampal gyrus, right temporal lobe.2.3 PI moderate depression group compared with mild depression group, PI moderate depression group and PCC functional connection enhanced brain area including middle cingulate gyrus, right frontal gyrus, PI. In the moderate depression group, the functional connection with PCC weakened the brain area, including the left parahippocampal.3. Conclusion 1, the primary insomnia group had the basic clinical characteristics of sleep disorders and cognitive dysfunction; anxiety and depression were the main associated affective disorders in the patients with primary insomnia; there was no significant correlation between the degree of primary insomnia with depression and the degree of anxiety; 2, The primary insomnia group had the brain default network, the primary insomnia group had the brain default network abnormality, which revealed that the primary insomnia group had obvious memory decline cognitive impairment and emotional regulation dysfunction, and the clinical scale had empty work memory cognitive decline, depression and anxiety. The abnormal phase of the mood was.3, and the middle cingulate gyrus was a sign of depression related brain area, related to the degree of depression. The damage degree of the hippocampus was related to the degree of insomnia. The second part of the primary insomnia patients and the spatial working memory related neural network fMIRI research purposes: this experiment uses magnetic resonance brain power imaging technique and the resting state brain function connection. In order to study the function of the right apical lobule (BA7/5) in the empty working memory, the function of the right apical lobule (BA7/5) in the empty work memory is studied. A certain scientific basis is provided for the pathogenesis of neurophysiology. Methods: the experimental group standard, the number of the experimental group and the clinical scale are the same as the first part. The second part of the experiment is carried out on the basis of the first part. The magnetic resonance spatial task state fMRI data scanning is in the first part of the conventional magnetic resonance scanning, the magnetic resonance resting state brain. After functional imaging, the process of brain function data preprocessing is the same as the first part. First, the right apical lobule is the seed point, and the resting state of group PI and HC is compared with its related neural networks and differences, and then the two groups of neural networks and their difference analysis are analyzed and analyzed in the space work task state, which is the cognitive impairment of clinical primary insomnia. Results: 1: 1 on the right top superior lobule (BA7/5) as the seed point, resting state and spatial working memory function neural network study of the 1.1 HC group resting state and the right parietal lobule (BA7/5) functional connection related main brain areas including: bilateral parietal cortex, bilateral frontal cortex, bilateral temporal cortex, bilateral occipital lobe The cortex, right cerebellar hemisphere, right parahippocampal gyrus, the strength and scope of the right hemispherical connection are higher than that of the left hemisphere.1.2 PI group and the resting state and the right superior lobule (BA7/5) functional connection, including the lateral parietal cortex, bilateral frontal cortex, bilateral temporal cortex, bilateral occipital cortex, bilateral cerebellar hemisphere, left anterior lobe / left anterior lobe. The left posterior cingulate gyrus; the strength and scope of the right hemispherical connection were higher than that in the left hemisphere.1.3 PI.HC group. The functional connection between the PI group and the right upper parietal lobule (BA7/5) enhanced brain region mainly included bilateral frontal lobes, bilateral central posterior gyrus, and left anterior wedge lobe: the functional connection weakened the brain area including the right cerebellar hemisphere, left bean nucleus and right parahippocampal. Gyrus, right occipital lobe cortex.2 PI, HC group space working memory task state fMRI imaging results 2.1 HC group vacant task activation brain area mainly include: bilateral parietal lobe, bilateral frontal lobe, bilateral temporal lobe, bilateral occipital lobe, bridge brain, midbrain, cerebellar hemisphere, bilateral thalamus, bilateral insula lobe.2.2 PI group space working task activation brain area mainly include: Double The lateral parietal cortex, bilateral frontal cortex, bilateral temporal cortex, bilateral occipital cortex, bilateral insula, bilateral cerebellar hemisphere, left parahippocampal gyrus, left thalamus, left thalamus, right bridge brain.2.3 PI, HC group were compared. The activation of task state in the PI group enhanced the main brain areas including left temporal lobe, left occipital lobe, right frontal lobe, and PI group and task memory task. The activation of the brain consists of the left parahippocampal gyrus, the right parahippocampal gyrus, bilateral cortex of the lobe, the lateral frontal cortex, and the upper lobule on the bilateral top. Conclusion: 1, the task of working memory is completed by several brain regions, with a specific neural network, including bilateral parietal cortex, bilateral frontal cortex, bilateral temporal cortex, bilateral cortex, bilateral temporal cortex. Occipital cortex, bilateral Island leaves, cerebellar hemispheres, bridge brain, thalamus and other brain regions; bilateral parietal lobe is the main functional brain area for working memory; empty task memory task has the right hemisphere superiority. 2, the right parietal lobule (BA7/5) is the seed point function connection resting state neural network, and the main neural network in the clear brain area of space work task. The right parietal lobule (BA7/5) is the core component of the empty work memory network, and it can be used as the seed point for spatial working memory. It can be used as the seed point for spatial working memory.3. The patients with primary insomnia have the abnormal working memory related neural network, which reveals the decline in the clinical spatial working memory of the patients with primary insomnia, the cognitive impairment and the memory decline. The neural network mechanism of the occurrence of sensory disturbance.
【学位授予单位】：郑州大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.2;R740

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