交通伤后应激障碍的多模态磁共振脑功能成像研究

发布时间：2018-06-04 22:33

本文选题：创伤后应激障碍 + 磁共振脑功能成像　；参考：《第三军医大学》2012年博士论文

【摘要】：研究背景和目的创伤后应激障碍(Post traumatic stress disorder, PTSD)指在遭遇或对抗重大压力后，人的心理状态失调产生的后遗症。主要症状包括过度警觉、恶梦、回避等。随着汽车大量进入家庭，每年车祸伤的发生较自然灾害更加普遍，当事故发生后，创伤后应激障碍的发病率可达到38%,说明车祸事件创伤后应激障碍的发生十分常见。根据创伤应激事件,结合临床症状和创伤后应激障碍量表检测诊断创伤后应激障碍并不困难，但目前早期诊断和发病机制尚待进一步研究。随着磁共振功能神经影像学的发展，有关创伤后应激障碍的脑功能研究越来越多。借助磁共振脑功能成像技术，可以在整体、系统、环路、功能柱、细胞以及分子水平上对患者脑的结构与功能及其相互关系进行深入研究。因此，本项研究运用多模态磁共振功能成像技术及方法，研究交通伤后应激障碍患者重要脑区皮层结构、白质纤维传导束及脑区神经元功能的改变，揭示其产生的原因及神经生物学机制。材料和方法 1.20例因经历车祸所致的创伤后应激障碍患者年龄18-40岁，平均32.92岁，病程在6至12个月。经临床精神科医师及心理咨询师检查，所有患者创伤后应激障碍的诊断成立，符合临床医生专用创伤后应激障碍评估量表评分。同时募集20名健康对照组，年龄20-38岁，平均，31.53岁，与创伤后应激障碍患者组在年龄、性别、受教育年限方面的差异均无统计学意义。 2.采集两组被试者的头部高分辨率磁共振T1加权像数据，运用Freesurfer软件处理大脑的磁共振T1加权像数据，自动重建大脑皮层的表面，分析和计算大脑皮质的厚度、面积和容积等指标。通过Qdec插件进行创伤后应激障碍和健康对照两组间各个脑区的组分析和比较。 3.采集两组被试者的静息态功能磁共振成像数据，运用的Matlab平台的REST1.5和SPM5处理和分析静息态磁共振数据，分析和比较患者组和健康对照组的全脑低频振幅图和重要脑区的低频振幅值。 4.采集两组被试者的磁共振弥散张量成像数据，采用FSL软件进行DTI数据处理及统计分析。分别提取各脑区的FA和MD值，分析各个脑区FA和MD值与PCL-C评分之间的相关性。结果 1.皮层厚度分析结果显示，创伤后应激障碍患者在其左侧大脑半球的扣带回体部、额下回岛盖部、额下回眶部、额下回三角部及中央前回均存在大脑皮层厚度的变薄。运用qdec插件进行组分析也清楚地显示两组被试在左侧半球多个脑区皮质厚度显著变薄，具体显示为创伤后应激障碍患者的前扣带皮层(BA33)、内侧前额叶皮质(BA10)、额下回眶部(BA47)、岛盖部(BA44)及三角部(BA45)等脑区与健康对照组相比具有显著性差异。 2.比较两组被试者之间的低频振幅值，结果显示创伤后应激障碍组相对于健康对照组在左侧额中回(BA10)和前扣带回(BA32)低频振幅值显著升高。各脑区低频振幅与皮层厚度的结果进行线性相关统计结果显示，左侧额中回(BA10)的低频振幅升高与皮层厚度变薄具有显著相关。对各脑区低频振幅值的变化与CAPS量表评分进行相关分析，结果显示在左侧额中回(BA10)的低频振幅值增加与CAPS评分呈现显著的正相关。 3.对两组被试的脑结构弥散张量成像进行比较，创伤后应激障碍患者相较于对照组在双侧额中回、右侧额上回、左侧壳核的FA值显著降低。创伤后应激障碍患者在双侧额中回、左侧杏仁核、前扣带、左侧脑岛、左侧苍白球的MD值显著高于对照组。对两组被试的全脑网络连接有效性进行比较，，结果显示，两组人群网络均显示出很高的全局和局部脑区连接效率，表明这些脑网络具有小世界网络属性。非参数秩和检验的结果显示，两组被试者的脑网络特征之间存在差异显著。结论交通伤后应激障碍患者的脑内结构、功能及脑网络改变涉及多个脑区，其中包括扣带回、额中回、额下回、海马旁回和杏仁核等区域。因此可以推断此类创伤后应激障碍是一种多脑区结构和功能同时发生改变所引起的精神疾病。在本项多模态研究中观察到，额中回和前扣带回是此类创伤后应激障碍发生的关键脑区域。额中回和扣带回脑区的结构和功能变化从神经解剖学角度解释了患者常发生的几种典型临床症状。这一研究结果为交通伤后应激障碍的预防、治疗和评估发生提供了磁共振功能影像证据。
[Abstract]:Background and purpose of the study

Post traumatic stress disorder is the sequelae of post traumatic stress disorder . The main symptoms include excessive alertness , nightmares , avoidance , etc . The incidence of post - traumatic stress disorder is more common . As the accident occurs , the incidence of post - traumatic stress disorder can be up to 38 % . It is not difficult to diagnose post - traumatic stress disorder according to the event of traumatic stress . However , the early diagnosis and pathogenesis are still to be further studied .

With the development of magnetic resonance functional neuroimaging , more and more research on the brain function of post - traumatic stress disorder is more and more . With the aid of magnetic resonance brain functional imaging technique , the structure and function of the brain of the patient and their relationship are studied in the whole , system , loop , functional column , cell and molecular level .

Materials and Methods

1 . 20 patients with post - traumatic stress disorder caused by car accident ranged from 18 to 40 years old , mean 32.92 years old , and the course was 6 to 12 months .

2 . The high - resolution magnetic resonance T1 weighted image data of two groups of subjects were collected , the magnetic resonance T1 weighted image data of the brain was processed by Freesurfer software , the surface of cerebral cortex was reconstructed automatically , the thickness , area and volume of cerebral cortex were analyzed and calculated .

3 . To acquire the static state functional magnetic resonance imaging data of two groups of subjects , and to process and analyze the static state magnetic resonance data by the REST1.5 and SPM5 of the Matlab platform , and analyze and compare the whole brain low frequency amplitude map of the patient group and the healthy control group and the low frequency amplitude value of the important brain region .

4 . The magnetic resonance diffusion tensor imaging data of two groups were collected , and the data were analyzed by using FSL software . The FA and MD values of each brain region were extracted respectively , and the correlation between FA and MD values and PCL - C score was analyzed .

Results

1 . The thickness of cortex in the left hemisphere of patients with post - traumatic stress disorder showed that the thickness of cortex in the left hemisphere was significantly thinner than that in healthy control group .

2 . Comparing the low - frequency amplitude values between the two groups of subjects , the results showed that the low - frequency amplitude of the left frontal gyrus ( BA10 ) was significantly higher than that of the healthy control group . The results showed that the low - frequency amplitude of the left frontal gyrus ( BA10 ) was significantly correlated with the thickness thinning .

3 . Compared with the control group , the MD values of the two groups were significantly lower than those in the control group . The results showed that the network of the two groups showed high global and local brain area connection efficiency . The results showed that these brain networks had small global network attributes . The results of non - parametric rank and test showed that there was a significant difference between the two groups .

Conclusion

The brain structure , function and brain network change of patients with post - traumatic stress disorder involve multiple brain regions , including the gyrus , the frontal gyrus , the frontal gyrus , the parahippocampal gyrus , and the almond kernel . Therefore , it can be concluded that the post - traumatic stress disorder is a key brain region after such traumatic stress disorder .
【学位授予单位】：第三军医大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R749.5

【参考文献】