儿童期创伤相关抑郁症的静息态脑功能网络研究

发布时间：2018-06-02 18:54

本文选题：抑郁症 + 儿童期创伤　；参考：《中南大学》2013年博士论文

【摘要】：背景：抑郁症是一类最常见的精神障碍,抑郁症的高患病率、高致残率、高致死率给患者及家人、社会带来严重的危害和极大的负担,在疾病负担研究中,抑郁症在全世界致残疾病中排名第一,在总疾病负担中排名第四,并预计到2020年会跃居至疾病总负担排名的第二。抑郁症的相关机制研究是现在精神疾病研究中的热点与前沿问题。目前认为抑郁症的发生是遗传因素和环境因素相互作用的结果,双生子和家系研究显示遗传因素在抑郁症发生中的作用约为三分之一,而环境因素的作用则约为三分之二。儿童创伤是环境因素影响抑郁症发生的主要方式之一,临床样本研究、社区人群研究以及流行病学研究一致显示儿童期创伤和抑郁症显著相关。儿童期创伤不仅影响抑郁症的发生,而且是影响抑郁症的病程和预后的重要因素。然而,有儿童期创伤经历的抑郁症患者的生物学特征尚不清楚。目的：本研究的研究目的是采用静息态功能磁共振技术,使用基于图论的脑功能网络的数据分析方法,研究有儿童期创伤的抑郁症患者的脑功能网络特征。方法：共有18例有儿童期创伤经历的抑郁症患者、20例没有儿童期创伤经历的抑郁症患者和20例正常对照进行静息态脑功能磁共振扫描。采用基于体素的全脑功能连接网络分析方法,研究有儿童期创伤经历的抑郁症患者的脑功能网络连接的特性,并使用多元回归分析方法探讨脑功能连接网络改变与儿童期创伤的关系。结果：以年龄、性别、受教育程度为协变量,对三组的脑功能连接网络图进行方差分析发现三个组在双内侧前额皮质、双外侧前额叶皮质、内侧颞叶、岛叶、丘脑等多个脑区存在显著差异。Post hoc组间两两比较发现,与正常对照相比,没有儿童期创伤经历的抑郁症患者组双侧腹内侧前额叶/腹侧前扣带的功能连接强度减低,而有儿童期创伤经历的抑郁症患者双侧腹内侧前额叶/腹侧前扣带、双侧外侧前额叶、背内侧前额叶、岛叶、尾状核、丘脑、海马旁回、海马、杏仁核、小脑等广泛脑区功能连接强度减低。值得注意的是,两组抑郁症患者都显示出双侧腹内侧前额叶/腹侧前扣带功能连接强度的减低,而两抑郁症组的直接比较发现有儿童期创伤经历的抑郁症患者许多脑区的功能连接强度较没有儿童期创伤经历的抑郁症患者减低,这些脑区中大部分(双侧腹内侧前额叶/腹侧前扣带除外)在有儿童期创伤经历的抑郁症患者与正常对照比较时也得到发现。基于体素的多元回归分析显示有儿童期创伤经历的抑郁症患者双侧内侧前额叶、双侧背外侧前额叶、双侧丘脑、前扣带以及左侧岛叶与儿童期创伤呈显著负相关。结论：有儿童期创伤经历的抑郁症患者和没有儿童期创伤经历的抑郁症患者存在共同的脑功能连接强度的减低：两组抑郁症患者均显示出双侧腹内侧前额叶/腹侧前扣带功能连接强度的减低。广泛的前额叶-边缘系-丘脑-小脑环路脑区的功能连接强度减低是有儿童期创伤经历的抑郁症患者的特征性改变,且功能连接强度的减低与儿童期创伤显著相关。
[Abstract]:Background: depression is the most common mental disorder, the high incidence of depression, high disability rate, high mortality rate to the patients and family, and the great burden of society. In the study of the burden of disease, depression is ranked first in the worldwide disabling disease, and is ranked fourth in the total disease burden, and is expected to be in 2020. The study on the related mechanism of depression is second. The research on the mechanism of depression is a hot and front issue in the study of mental illness. The occurrence of depression is considered as a result of the interaction of genetic and environmental factors. The study of double birth and family studies shows that the role of genetic factors in the occurrence of depression is about 1/3. The effect of environmental factors is about 2/3. Children's trauma is one of the main ways of environmental factors affecting depression. Clinical sample studies, community population studies and epidemiological studies show a significant correlation between childhood trauma and depression. Childhood trauma not only affects the occurrence of depression, but also affects depression. However, the biological characteristics of depressive patients with childhood trauma are unclear.
Objective: the purpose of this study was to use the resting state functional magnetic resonance (fMRI) technique and the data analysis method based on the graph based brain functional network to study the brain function network characteristics of the patients with childhood traumatic depression.
Methods: a total of 18 depressive patients with childhood traumatic experience, 20 depressive patients without childhood trauma and 20 normal controls were performed resting brain functional magnetic resonance imaging (fMRI). The whole brain functional connection network analysis based on voxel was used to study the brain function network of the depressive patients with childhood traumatic experience. The relationship between brain functional connectivity network and childhood trauma was explored by multiple regression analysis.
Results: with age, sex and education as covariates, the analysis of variance analysis of the three groups of brain functional connection networks found that there were significant differences between the three groups in the double medial prefrontal cortex, the double lateral prefrontal cortex, the medial temporal lobe, the insula, and the thalamus, which were significantly different between the.Post hoc groups. Compared with the normal control, no children were found. The functional connection intensity of bilateral ventral medial prefrontal lobes / ventral anterior cingulate bands, bilateral ventral medial prefrontal lobes / ventral anterior cingulate bands, bilateral lateral prefrontal lobes, medial prefrontal lobes, insula, caudate nucleus, thalamus, parahippocampal gyrus, hippocampus, amygdala, cerebellum, and other depressive patients with childhood traumatic experience were reduced. It is worth noting that the two groups of depressive patients show a reduction in bilateral ventral prefrontal prefrontal / ventral anterior cingulate functional connection intensity, while the two depressive group directly compares the functional connection intensity of many brain areas with children with childhood traumatic experience. Most depression patients in these regions (except for bilateral ventral medial prefrontal lobes / ventral anterior cingulate bands) were also found in children with childhood traumatic experience. Multiple regression analysis of voxel based regression analysis showed bilateral medial prefrontal lobes and bilateral dorsal parts of patients with childhood traumatic experience. The lateral prefrontal cortex, bilateral thalamus, anterior cingulate and left insula are negatively correlated with childhood trauma.
Conclusion: depressive patients with childhood traumatic experience and depressive patients without childhood traumatic experience have a common reduction in the intensity of brain function connection: two groups of depressive patients show a reduction in bilateral ventral prefrontal / ventral anterior cingulate functional connection intensity. The decrease of functional connectivity in the area is a characteristic change in the patients with childhood traumatic experience, and the reduction of functional connection intensity is significantly associated with childhood trauma.
【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R749.4

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