未治疗广泛性焦虑障碍患者和惊恐障碍患者脑恐惧环路研究

发布时间：2018-06-03 06:29

本文选题：广泛性焦虑障碍 + 惊恐障碍　；参考：《中南大学》2013年博士论文

【摘要】：目的：从脑网络的角度,研究广泛性焦虑障碍患者和惊恐障碍患者脑恐惧环路的特点,探讨疾病特异性的脑网络生物学标记,为理解疾病的病理机制和临床诊断提供新线索和依据。方法：应用功能核磁共振技术,设计情绪计数Stroop认知任务和静息态杏仁核与全脑功能连接方法,研究广泛性焦虑障碍(Generalized anxiety disorder,GAD)患者,惊恐障碍(Panic disorder, PD)患者和健康对照组(healthy controls,HCs)脑恐惧环路的特点。具体实施由两名精神科主治医生应用《DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查病人版》(即SCID-I/P)诊断工具,筛选符合广泛性焦虑障碍和惊恐障碍诊断标准且无共病、年龄在18-44岁之间、从未接受过临床治疗的患者。GAD组22例,PD组24例,按照年龄以及受教育程度匹配入组健康对照35例,三组均采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)进行评估,GAD患者组评估宾尼法尼亚担心状态问卷(PSQW),PD患者组评估惊恐发作严重程度的量表(PDSS),健康对照组HAMA评分7分/HAMD7分。所有研究对象完成MRI扫描后,排除头动等因素导致有质量问题的数据：1)入组认知任务ecStroop研究的GAD组和PD组各14例,HCs25例,以单因素方差分析检测三组ecStroop任务激活脑区的差异,并以post hoc检验进行组间两两比较。2)入组静息态功能连接的GAD组15例,PD组17例和HCs22例,以双侧杏仁核为种子点,进行全脑功能连接分析。以单因素方差分析检测三组双侧杏仁核与全脑功能连接的差异,并以post hoc检验进行组间两两比较。结果：(1)认知任务ecStroop结果：三组加工中性词汇激活脑区结果：PD组、GAD组相比HCs激活增加的脑区是：左侧杏仁核、右侧顶下小叶、右侧岛叶和左侧丘脑；PD组相比GAD组、HCs激活增加的脑区是左侧脑干。三组加工焦虑词汇激活脑区结果：GAD组、PD组相比HCs激活增加的脑区是左侧丘脑和右侧岛叶；GAD组相比PD组、HCs激活减弱的脑区是右侧额上回Brodman(BA)9区。三组加工焦虑词汇与中性词汇相比较激活脑区结果：GAD组、PD组相比HCs激活减弱的脑区是左侧杏仁核；PD组相比GAD组、HCs激活减弱的脑区是右侧海马。 (2)双侧杏仁核与全脑功能连接结果：GAD组、PD组相比HCs,左侧杏仁核--右侧楔前叶功能连接增强,左侧杏仁核--右侧海马功能连接减弱。PD组相比GAD组、HCs,左侧杏仁核--左侧脑干中脑功能连接增强,左侧杏仁核--右侧海马功能连接减弱。PD组、GAD组相比HCs右侧杏仁核--右侧脑桥功能连接增强,PD组最强；右侧杏仁核--右侧海马功能连接减弱,PD组最弱。GAD组相比PD组、HCs右侧杏仁核--左侧岛叶功能连接增强。结论：1、GAD和PD以杏仁核为核心的大脑恐惧环路敏感、易激活,可能是患者丘脑感觉信息过滤障碍,导致条件恐惧刺激泛化。 2、GAD恐惧环路激活可能是患者前额叶受损引起“自上而下”的认知调控缺陷所致。 3、PD恐惧环路激活可能是患者脑干受损导致警觉性增高和海马受损导致条件恐惧背景信息识别偏差,因而由“自下而上”的情绪调控失调所致。 4、大脑显著性网络,额顶网络,默认网络等功能网络参与了焦虑障碍脑恐惧环路的网络调控。
[Abstract]:Objective: To study the characteristics of brain fear loop in patients with generalized anxiety disorder and panic disorder from the perspective of brain network, and to explore the specific brain network biomarkers of disease, and provide new clues and basis for understanding the pathological mechanism and clinical diagnosis of disease.
Methods: using functional nuclear magnetic resonance (fMRI), the Stroop cognitive task and the resting state amygdala and the whole brain functional connection were designed to study the characteristics of the Generalized anxiety disorder (GAD) patients, Panic disorder, PD patients and the healthy control group (healthy controls, HCs) brain fear loop. The body was carried out by two psychiatric doctors using the All the subjects completed the MRI scan, excluding the head motion and other factors leading to the quality problems: 1) 14 cases in group GAD and PD group, 14 cases in group GAD and HCs25, the difference between three groups of ecStroop tasks was detected by single factor variance analysis, and the resting state work of group 22 compared with post hoc test was carried out. 15 cases of GAD, 17 cases of group PD and HCs22 cases were connected. The whole brain functional connection was analyzed with bilateral amygdala as seed point. The difference between three groups of bilateral amygdala and whole brain function was detected by single factor analysis of variance, and 22 comparison between groups was performed by post hoc test.
Results: (1) the results of cognitive task ecStroop: three groups of processing neutral words activated the brain region: group PD, group GAD compared with HCs activation increased brain area: left amygdala, right apical lobule, right Island leaf and left thalamus; PD group compared to group GAD, HCs activation increased the brain area is left brainstem. Three groups of processing anxiety vocabulary activated brain region results. GAD group, group PD compared with HCs activation increased the left thalamus and right Island lobe; GAD group compared with PD group, HCs activation weakened brain area was the right frontal gyrus Brodman (BA) 9. The three groups of processing anxiety vocabulary compared with neutral vocabulary to activate the brain region results: GAD group, PD group compared to HCs activation of the brain area is left amygdala; PD group compared with those In group D, the weakened brain area of HCs activation was the right hippocampus.
(2) the results of bilateral amygdala and whole brain function connection: group GAD, group PD compared to HCs, left amygdala - right anterior lobe functional connection, left amygdala - the right hippocampal functional connection weakened group.PD compared to the GAD group, HCs, left amygdala - the left brainstem middle brain functional connection increased, left amygdala - right hippocampal functional connection weakened the.PD group. In group GAD, the right amygdala - the right amygdala - the right pontine functional connection was enhanced and the PD group was the strongest; the right amygdala - the right hippocampal functional connection was weakened, and the weakest.GAD group in group PD was compared to the PD group, and the right amygdala in the right amygdala HCs was enhanced in the left Island leaf function.
Conclusion: 1, GAD and PD are sensitive and active in the brain fear loop, which is the core of the amygdala. It may be the disorder of sensory information filtering in the thalamus, which leads to the generalization of conditional fear stimulation.
2, the activation of GAD fear loop may be caused by the "top-down" cognitive deficits caused by frontal lobe damage.
3, the activation of PD fear loop may be caused by impaired brain stem damage resulting in increased alertness and hippocampus damage resulting in conditional fear background information identification bias, resulting from a "bottom-up" emotional disorder.
4, the brain's saliency network, the frontal network, the default network and other functional networks are involved in the network control of the anxiety disorder brain fear loop.
【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】：R749.7

【共引文献】