首发未用药青少年抑郁症患者认知控制网络功能连接与疾病严重程度及执行功能损害的相关性

发布时间：2018-02-28 10:03

  本文关键词： 青少年 抑郁症 执行功能 脑网络 功能连接　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的影像学研究已发现大型脑网络功能失衡与抑郁症病理特性相关。但是脑网络功能异常与青少年抑郁症患者临床症状及认知功能之间的关联仍不清楚。本研究旨在探索首发未用药青少年抑郁症患者脑网络功能连接的特点及其与抑郁严重程度和执行功能的相关性。方法1.2014年9月-2016年12月在浙江大学医学院附属第一医院精神科门诊及住院部入组首发未用药青少年抑郁症患者28例,在当地社区入组年龄、性别及文化程度与患者相匹配的健康青少年24例作为对照。2.采用儿童抑郁评定量表(Children's Depression Rating Scale-Revised,CDRS-R)和汉密尔顿抑郁量表(Hamilton Depression Rating Scale-17 items,HAMD-17)结合与家属面对面访谈评估研究对象的抑郁症状。采用威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)、持续操作测试(Continuous Performance Test,CPT)、彩色连线测验(Trail Making Test,TMT)和 STROOP 卡片测验(Stroop Word-Color Interference Test,SCWT)来评估研究对象的执行功能。3.对两组研究对象进行静息态功能磁共振扫描,采用基于种子点的感兴趣区功能连接分析法,分别以双侧背外侧前额叶(认知控制网络),双侧膝下前扣带回(情感网络)和双侧楔前叶(默认网络)为种子点研究上述三个脑网络的静息态功能连接。比较抑郁组与对照组脑网络功能连接的组间差异,并将异常的脑区间功能连接强度与抑郁组患者症状严重程度及执行功能进行相关分析。结果1.经多重矫正后发现青少年抑郁症患者在STROOP卡片测验中表现较正常对照差,表明青少年抑郁症患者执行功能中选择性注意,信息处理速度和抑制功能受损 Stroop B(t=3.33,P0.01),Stroop C(t=2.826,P0.01)。2.抑郁组在认知控制网络、情感网络及默认网络均存在静息态功能连接异常,具体表现为:在认知控制网络中,位于双侧背外侧前额叶皮质的种子点与右侧颞叶,扣带回中部,右侧额下回,右侧岛叶等脑区的功能连接减弱;在情感网络中,位于双侧膝下前扣带回皮质的种子点与左侧梭状回、小脑后叶、舌回、右侧颞上回、右侧颞中回等脑区的功能连接增强;在默认网络中,位于双侧楔前叶的种子点与小脑后叶,右侧岛叶的功能连接减弱。3.相关分析发现左侧背外侧前额叶皮质与右侧额下回的功能连接与HAMD得分呈负相关,右侧背外侧前额叶皮质与双侧扣带回中部的功能连接与Stroop测试得分呈负相关(Stroop B,StroopC)。右侧膝下前扣带回皮质与左侧小脑后叶的功能连接与与HAMD得分呈负相关。结论1.青少年抑郁症患者执行功能以及认知控制网络、情感网络和默认网络的静息态功能连接存在异常.2.认知控制网络的功能异常与抑郁严重程度及执行功能受损相关,可能揭示了青少年抑郁症的神经病理生理机制。同时,这些研究结果可能为青少年抑郁症的治疗提供新的靶点。
[Abstract]:Objective Imaging studies have found that large brain network dysfunction is associated with the pathological characteristics of depression, but the association between brain network dysfunction and clinical symptoms and cognitive function in adolescent depression patients is still unclear. The purpose of this study was to explore the characteristics of brain network functional connection in first-episode untreated adolescents with depression and its correlation with depression severity and executive function. 1. From September to December 2016, 2014, the first affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University. Twenty-eight patients with untreated adolescent depression were enrolled in psychiatric outpatient department and inpatient department. Age in local communities, 24 healthy adolescents matched with gender and education as control .2.Child Depression Rating Scale-Revised CDRS-R) and Hamilton Depression Rating Scale-17 Scale-17 Hamd 17) were used to evaluate the subjects with face-to-face interviews with family members. Wisconsin Card Sorting test, continuous Performance test, color wired test, and STROOP card test Stroop Word-Color Interference test were used to evaluate the executive function of the subjects. The image is scanned by resting functional magnetic resonance, The method of functional connection analysis of region of interest based on seed point is used. The resting functional connections of the above three brain networks were studied with bilateral dorsolateral prefrontal lobe (cognitive control network), bilateral subgenu cingulate gyrus (emotional network) and bilateral wedge prefrontal lobe (default network) as seed points. The difference of functional connections of brain network between depression group and control group, Results 1. After multiple correction, it was found that the performance of adolescent depression patients in STROOP card test was worse than that in normal controls. 2. The results showed that the patients with adolescent depression had selective attention, impaired information processing speed and inhibitory function (Stroop Bt) 3.33 ~ 3 ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~ (3) ~. In the cognitive control network, the functional connections of the right temporal lobe, the middle cingulate gyrus, the right inferior frontal gyrus, the right insular lobe, and so on are weakened in the bilateral dorsolateral prefrontal cortex. The functional connections between the seed points in the bilateral anterior cingulate gyrus cortex and the left fusiform gyrus, the posterior cerebellar lobe, the lingual gyrus, the right superior temporal gyrus, the right middle temporal gyrus, and the right middle temporal gyrus are enhanced; in the default network, the seed points located in the bilateral anterior cuneate lobe are associated with the posterior lobe of the cerebellum. The functional connections between the left dorsolateral prefrontal cortex and the right inferior frontal gyrus were negatively correlated with HAMD scores. The functional connections between the right dorsolateral prefrontal cortex and the middle cingulate gyrus were negatively correlated with the Stroop scores. The functional connections between the right subgenu anterior cingulate cortex and the left posterior cerebellar lobe were negatively correlated with the HAMD score. Conclusion 1. The executive function and cognitive control network of adolescent depression patients, 2. The abnormal function of cognitive control network is related to the severity of depression and the impairment of executive function, which may reveal the neuropathophysiological mechanism of adolescent depression. These findings may provide new targets for the treatment of adolescent depression.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.4
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本文编号：1546830