广泛性焦虑障碍与脑血流自动调节关系的研究

发布时间：2018-05-04 16:12

本文选题：广泛性焦虑障碍 + 脑血流自动调节　；参考：《吉林大学》2017年硕士论文

【摘要】：目的广泛性焦虑障碍(generalized anxiety disorder,GAD)一直被认为是功能性病变,患者时常感到紧张、不安、过分担心、甚至感到惊恐,头晕、心悸、睡眠障碍,易激惹、警觉性增高等也是常见症状,严重影响患者的生活质量。近年来大量研究表明GAD与躯体疾病相关,特别是心脑血管疾病,有学者认为GAD患者的器质性改变可能与自主神经功能异常、内分泌功能改变、神经内分泌异常之间存在关联。近年来GAD的脑血流动力学逐渐受到重视,有研究表明焦虑组患者维持脑血流量(cerebral blood flow,CBF)可发生改变,也有研究者认为CBF的改变与焦虑程度相关,焦虑患者CBF对二氧化碳分压变化的敏感性下降,进而造成脑血流自动调节的受损。我们此前进行的卧立位脑血流的研究发现焦虑症患者由卧位转立位后脑血流速度下降、心率增快,提示脑血流自动调节功能以及自主神经功能受损。目前对于广泛性焦虑障碍患者动态脑血流自动调节的研究鲜有报道,通过进一步研究广泛性焦虑障碍与动态脑血流自动调节的关系,有望寻找到治疗广泛性焦虑障碍的新靶点。方法本研究共纳入112名广泛性焦虑障碍患者,均为2016年3月至2016年3月期间于吉林大学第一医院神经门诊就诊患者,我们对患者行汉密尔顿焦虑量表(Hamilton Rating Scale for Anxiety,HAMA)及汉密尔顿抑郁评定量表(Hamilton Depression Rating Scale,HAMD)评分,并行经颅多普勒超声(transcranial Doppler ultrasound,TCD)检查,同时联合使用指尖血压检测法,得到脑血流速度(cerebral blood flow velocity,CBFV)及动脉血压,然后通过传递函数分析(transfer function analysis,TFA)得到脑血流自动调节自动调节参数:相位差、增益、相关性。同时收集患者基本信息,通过统计学分析得到广泛性焦虑障碍与动态脑血流自动调节的关系。结果广泛性焦虑障碍患者双侧大脑半球相位差明显低于健康对照组,差异有统计学意义,而双侧大脑半球的增益与健康对照组无统计学差异;轻度、中度、重度广泛性焦虑障碍各组间相位差及增益的差异没有统计学意义,HAMA评分与广泛性焦虑患者双侧大脑半球相位差及增益无明显相关性;焦虑伴抑郁组的患者与单纯焦虑组患者相位差及增益无显著性差异,HAMD评分与脑血流自动调节参数无明显相关性。结论广泛性焦虑障碍患者动态脑血流自动调节功能受损;本研究为发现广泛性焦虑障碍患者动态脑血流自动调节与焦虑程度相关;广泛性焦虑障碍是否伴有抑郁对动态脑血流自动调无明显影响。
[Abstract]:Objective Generalized anxiety disorder has always been considered as a functional disorder. Patients often feel nervous, restless, overworried, or even panic, dizziness, palpitations, sleep disorders, irritability, increased alertness, etc. Seriously affect the quality of life of patients. In recent years, a large number of studies have shown that GAD is related to somatic diseases, especially cardiovascular and cerebrovascular diseases. Some scholars believe that the organic changes of GAD patients may be related to the abnormality of autonomic nervous function, endocrine function and neuroendocrine abnormality. In recent years, the cerebral hemodynamics of GAD has been paid more and more attention. Some studies have shown that cerebral blood flow can be changed in patients with anxiety, and some researchers believe that the change of CBF is related to the degree of anxiety. The sensitivity of CBF to the change of carbon dioxide partial pressure is decreased, and the cerebral blood flow automatic regulation is impaired. Our previous study of cerebral blood flow in patients with anxiety disorder in supine position showed that the velocity of cerebral blood flow decreased and the heart rate increased in patients with anxiety disorder, suggesting that the automatic regulation of cerebral blood flow and autonomic nervous function were impaired. At present, there are few reports on automatic regulation of dynamic cerebral blood flow in patients with generalized anxiety disorder. By further studying the relationship between generalized anxiety disorder and automatic regulation of dynamic cerebral blood flow, we hope to find a new target for the treatment of generalized anxiety disorder. Methods A total of 112 patients with generalized anxiety disorder were enrolled in this study. All of them were admitted to the first Hospital of Jilin University from March 2016 to March 2016. The patients were evaluated with Hamilton Rating Scale for anxiety scale (Hamilton Rating Scale for scale) and Hamilton Depression Rating scale (Hamma). The patients were examined by transcranial Doppler ultrasound (transcranial Doppler ultrasound) and combined with fingertip blood pressure test. Cerebral blood flow velocity1 (CBFV) and arterial blood pressure (ABP) were obtained, and then the parameters of automatic regulation of CBFV, gain and correlation were obtained by means of transfer function analysis (TFAA). At the same time, the basic information of patients was collected, and the relationship between generalized anxiety disorder and automatic regulation of dynamic cerebral blood flow was obtained by statistical analysis. Results the phase difference of bilateral cerebral hemispheres in patients with generalized anxiety disorder was significantly lower than that in healthy controls (P < 0.05), but the gain of bilateral hemispheres was not significantly different from that of healthy controls. There was no significant difference in phase difference and gain between severe generalized anxiety disorder groups and there was no significant correlation between Hama score and bilateral cerebral hemispheric phase difference and gain in patients with generalized anxiety. There was no significant difference in phase difference and gain between anxiety and depression group and simple anxiety group. There was no significant correlation between Hamd score and cerebral blood flow automatic regulation parameters. Conclusion the automatic regulation of dynamic cerebral blood flow in patients with generalized anxiety disorder is impaired, and it is found that the automatic regulation of dynamic cerebral blood flow in patients with generalized anxiety disorder is related to the degree of anxiety. Whether generalized anxiety disorder is accompanied by depression has no significant effect on automatic cerebral blood flow regulation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.72

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