惊恐障碍心跳知觉异常的脑功能机制对照及系统综述研究

发布时间：2018-05-01 07:46

  本文选题：焦虑障碍 + 惊恐障碍　； 参考：《上海交通大学》2013年博士论文

【摘要】：【背景】惊恐障碍(PD)是焦虑障碍的常见类型,其对心跳知觉的异常感受及其“灾难性”理解是最典型症状,但迄今为止PD心跳知觉异常的脑功能机制仍未阐明。【目的】1.研究PD患者心跳知觉敏感度特征及相关心理学影响因素;2.分析PD患者脑结构、静息态和任务态影像学特征,寻找其心跳知觉异常的神经病理学机制;3.系统评价重复经颅磁刺激(rTMS)治疗PD的疗效,确定PD患者功能异常脑区。【方法】1.行为学和脑影像部分采用病例对照研究设计,入组PD患者,同期收集广泛性焦虑症(GAD)和健康志愿者为病例对照和正常对照组,使用心跳知觉追踪范式评定三组被试的心跳感知敏感性,并评估焦虑症状、躯体感知敏感性、述情障碍和人格特征。MRI扫描采用3.0T磁共振成像系统,使用VBM8软件分析三组间脑结构差异;任务态采用Block设计的心跳知觉任务范式,应用AFNI软件分析心跳知觉(内感知)和计数纯音(外感知)任务下的脑激活特征;将脑结构和功能异常区作为感兴趣区(ROI),分析静息态下ROI与全脑的功能连接特征。2.系统综述:检索r TMS治疗PD的随机对照研究(RCT),按照纳入与排除标准选择文献、提取资料和文献质量评估。【结果】1.行为学研究。共纳入pd患者45例,gad患者141例,健康对照组56例。pd患者心跳知觉敏感性高于健康对照组(p=0.000),也高于gad患者(p=0.011),但未发现gad与健康对照者之间的差异(p=0.78)。2.磁共振成像研究。纳入pd和gad患者各19例,健康对照组20例。(1)心跳知觉功能磁共振结果:在感知心跳任务下,pd患者左侧扣带回激活增强;在计数纯音任务下,pd患者双侧楔前叶、左侧内侧前额叶、右侧缘上回、左侧顶下小叶、左侧中央后回和颞中回激活增强,并且左侧内侧前额叶bold变化均值与bpq问卷的应激反应方式Ⅰ评分呈正相关(r=0.540;p=0.031);在内外感知交互作用条件下,pd患者的左侧中央后回、左侧额中回(包括sma区)、左侧扣带回、双侧额内侧、双侧枕中回、左侧额下回和左侧岛叶显著负激活。在相同的检验标准下,均未发现gad患者的异常活动脑区,探索性分析发现(单体素设为p=0.005)发现,gad患者右侧额中回激活增强(内感知)。(2)脑结构影像结果:pd患者在双侧壳、胼胝体下回、尾状核、前扣带回和右侧上眶额回、左侧岛叶和杏仁核的灰质体积增加。(3)静息态功能磁共振:pd患者左侧扣带回与双侧中央后回、双侧岛叶、双侧颞上回连接增强。3.共纳入2项rct研究,40例患者,治疗参数均采用1hz频率刺激右侧背外侧前额区。治疗次数20次时,rtms真刺激组疗效优于伪刺激组(t=3.04,p=0.007)。【结论】1.pd患者心跳感知敏感性异常增加。2.pd患者存在多个脑区结构和功能异常,尤其是同时调控内感知和恐惧条件反射通路的皮层和核团。GAD患者右侧额中回功能相对增强,可能对心跳知觉异常有部分代偿作用。3.低频rTMS刺激背外侧前额叶可能有效,但仍需进一步证明。
[Abstract]:[background] panic disorder (PDD) is a common type of anxiety disorder. Its abnormal feeling of heartbeat perception and its "catastrophic" understanding are the most typical symptoms, but the brain function mechanism of PD abnormal heartbeat perception has not been elucidated up to now. [objective] 1. To study the characteristics of heart rate sensitivity and related psychological factors in PD patients. The imaging features of brain structure, resting state and task state in PD patients were analyzed to find out the neuropathological mechanism of abnormal heartbeat perception. To evaluate the efficacy of repetitive transcranial magnetic stimulation (RTMS) in the treatment of PD, and to determine the abnormal brain area in PD patients. [methods] 1. The behavioral and brain images were designed in a case-control study. GADs were collected from patients with generalized anxiety disorder (GAD) and healthy volunteers as case control group and normal control group. The sensitivity of heartbeat perception was assessed by the heartbeat perception tracking paradigm. Anxiety symptoms, somatic sensitivity, alexithymia and personality characteristics were assessed using 3.0T magnetic resonance imaging system. VBM8 software was used to analyze the diencephalon structure differences among the three groups, and the task-mode of heartbeat perception designed by Block was used to analyze the brain activation characteristics under the tasks of heartbeat perception (internal perception) and counting pure tone (external perception) using AFNI software. The abnormal areas of brain structure and function were regarded as the regions of interest to analyze the functional connections between ROI and the whole brain in resting state. 2. Systematic review: a randomized controlled study of r TMS therapy for PD was searched. According to the criteria of inclusion and exclusion, the literature was selected, the data extracted and the quality of literature evaluated. [results] 1. Behavioral research. A total of 45 patients with PD and 141 patients with Gad were included. The sensitivity of heartbeat perception in 56 patients with PD in healthy control group was higher than that in healthy control group. It was also higher than that in patients with gad. However, there was no difference between gad and healthy controls. Magnetic resonance imaging. Results: activation of left cingulate gyrus was enhanced in PD patients with perceived heartbeat task, bilateral precuneiform lobe and left medial prefrontal lobe in PD patients, and left medial prefrontal lobe in PD patients under pure tone counting task. The activation of right superior marginal gyrus, left inferior parietal lobule, left posterior central gyrus and middle temporal gyrus were enhanced. The mean value of bold in left medial prefrontal lobe was positively correlated with the stress response mode 鈪，

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