首发精神分裂症患者不同症状维度多模态磁共振成像研究

发布时间：2018-06-07 15:55

本文选题：精神分裂症 + 动态因果模型　；参考：《中南大学》2013年博士论文

【摘要】：第一章首发高危自杀精神分裂症患者后扣带皮质与内侧前额皮质之间有效连接的研究目的：高危自杀风险的精神分裂症患者具有相应的临床特征,如认知功能良好,阳性症状为主及抑郁症状。迄今为止,精神分裂症患者自杀的神经生物学机制并不清楚。普遍认为,精神分裂症的自杀行为与决策及情感调控缺陷有关,而大脑决策及情感调控功能与与前额扣带环路有关。为了探索精神分裂症自杀行为可能的神经生物学机制,我们运用动态因果模型分析来探讨前额-扣带环路与精神分裂症自杀风险之间的关系。方法：33例首发精神分裂症患者,其中包括自杀高危组14例及自杀低危组19例。与之年龄、性别及教育程度相匹配的健康对照组15例。对所有参与者进行N-back任务状态下功能磁共振数据的采集,并给与动态因果模型分析。结果：相比健康对照组而言,两组患者组在2-back任务状态下左侧后扣带及额内侧皮质显示脑区活动受抑制程度下降。高危自杀组及健康对照组均为双相有效连接。高危自杀组显示从后扣带到额内侧皮质的有效连接增强,相反方向的有效连接减弱；健康对照的有相连接则与高危自杀组完全相反；低危自杀组仅显示从后扣带回到额内侧皮质的单向有效连接增强。结论：后扣带皮质到内侧额叶皮质的有效连接增强可能与精神分裂症的患病风险有关；而相反方向有效连接减弱可能与自杀易感性有关。第二章首发精神分裂症阴性及阳性症状维度多模态磁共振研究目的：克雷佩林认为要真正的了解精神分裂症必须把症状及其潜在的神经病理基础联系起来；但将不同症状维度的精神分裂症症状混为一谈,会掩盖症状的异质性,混淆其病理机制的差异性。克雷佩林、布鲁勒等人认为相同症状表现及病程的患者亦具有相同的病理过程。本研究根据因子分析法将精神分裂症症状划分为阳性及阴性症状群组,运用多模态影像学分析方法来探讨精神分裂症可能的症状相关神经生物学机制,以期为不同临床表现的患者提供个体化治疗措施。方法：52例首发精神分裂症患者,其中包括阳性症状组35例及阴性症状组17例。与之年龄、性别及教育程度相匹配的健康对照组38例。对所有参与者进行3D结构磁共振、静息态及N-back任务态功能磁共振数据采集。采用基于体素的形态测量法分析三组间结构磁共振数据的差异脑区,以差异脑区作为种子区进行静息态全脑功能连接分析,并分析N-back任务态下三组间任务相关脑区活动差异。结果：两组患者组右侧背外侧前额叶灰质体积显著高于健康对照组；两组患者组静息态右侧背外侧前额叶全脑功能连接显著低于健康对照组,三组间差异主要集中右侧背外侧前额叶-右侧内侧前额叶与右侧背外侧前额叶-右侧尾状核间的功能连接；给予N-back工作记忆任务时,三组间激活差异脑区为左侧背外侧前额叶、内侧前额叶/前扣带皮质及后扣带皮质,阳性症状组及阴性症状组内侧前额叶/前扣带皮质及后扣带皮质受抑制程度低于健康对照组,阴性症状组背外侧前额叶激活显著高于阳性症状组及健康对照组。结论：结果提示左侧背外侧前额叶结构及功能障碍在认知功能及阴性症状的病理生理过程中起重要作用,认知功能障碍可能参与阴性症状的形成；而皮质中线结构则在阳性症状(幻觉妄想)的病理生理过程中起重要作用。
[Abstract]:Chapter 1. Effective connections between cingulate cortex and medial prefrontal cortex in first episode high-risk schizophrenic patients.
Objective: the schizophrenic patients with high-risk suicide risk have corresponding clinical characteristics, such as good cognitive function, positive symptoms and depressive symptoms. So far, the neurobiological mechanism of suicide in schizophrenic patients is not clear. It is generally believed that the self killing behavior of schizophrenia is related to decision-making and emotional regulation defects. Brain decision-making and emotional regulation are related to the frontal cingulate loop. In order to explore the possible neurobiological mechanisms of schizophrenia suicidal behavior, we use dynamic causal model analysis to explore the relationship between the frontal cingulate loop and the suicide risk of schizophrenia.
Methods: 33 cases of first episode schizophrenia, including 14 cases of suicide high-risk group and 19 cases of low suicide risk group, 15 cases of healthy control group matched with age, sex and education, were collected and analyzed with dynamic cause and effect model for all participants in the N-back task state.
Results: compared with the healthy control group, the left posterior cingulate zone and the medial frontal cortex in the two groups showed a decrease in the inhibition of activity in the brain area. Both the high-risk suicide group and the healthy control group were both effectively connected. The high risk suicidal group showed an effective connection from the posterior cingulate to the medial frontal cortex, and the opposite direction was found in the two group. The combination of the healthy controls was opposite to the high risk suicide group, and the low risk suicide group only showed the unidirectional effective connection from the posterior cingulate to the medial frontal cortex.
Conclusion: the enhancement of the effective connection between the posterior cingulate cortex and the medial frontal cortex may be associated with the risk of schizophrenia, and the decrease in the effective connection in the opposite direction may be associated with the susceptibility to suicide.
The second chapter is the multimodal MRI study of the negative and positive symptoms of first episode schizophrenia.
Objective: Krey Palin believes that a genuine understanding of schizophrenia must be linked to symptoms and their underlying neuropathic basis; but confusing the symptoms of schizophrenia with different symptoms can mask the heterogeneity of the symptoms and confuse the difference in the pathological mechanism. Klein Palin, Bleuler and others think the same symptoms This study divides the symptoms of schizophrenia into positive and negative symptom groups based on factor analysis, and uses multimodal imaging analysis to explore the possible symptoms related neurobiological mechanisms of schizophrenia in order to provide individualized treatment for patients with different clinical manifestations. Treatment.
Methods: 52 cases of first episode schizophrenia, including 35 cases of positive symptoms and 17 cases of negative symptoms, 38 cases of healthy controls matched with age, sex and education. The 3D structure magnetic resonance, resting state and N-back task state functional magnetic resonance data were collected for all participants. Morphometry based on voxel based morphometry was used. The differential brain region of the three groups of structural magnetic resonance data was analyzed, and the resting state whole brain function connection was analyzed with the difference brain region as the seed region, and the difference of the activity related brain regions between the three groups in the N-back task state was analyzed.
Results: the volume of the right dorsal and lateral prefrontal lobes in the two groups was significantly higher than that in the healthy control group. The two groups were significantly lower than the healthy control group. The difference between the three groups mainly focused on the right dorsolateral prefrontal lobes - the right medial prefrontal lobe and the right lateral prefrontal frontal lobes - right caudate The functional connection between the three groups was given to the N-back working memory task. The activation difference between the two groups was the left dorsolateral prefrontal prefrontal lobe, the medial prefrontal lobe / anterior cingulate cortex and the posterior cingulate cortex. The positive symptom group and the negative symptom group were suppressed in the medial prefrontal cortex and the anterior cingulate cortex and the posterior cingulate cortex than the healthy control group and the negative symptom group. The activation of the dorsolateral prefrontal lobe was significantly higher than that of the positive symptom group and the healthy control group.
Conclusion: the results suggest that the structure and dysfunction of the left dorsolateral prefrontal cortex play an important role in the pathophysiological process of cognitive function and negative symptoms, and cognitive dysfunction may participate in the formation of negative symptoms, while the middle cortical structure plays an important role in the pathophysiological process of positive symptoms (hallucination paranoia).
【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】：R749.3

【共引文献】