遭受多重侵害高职高专学生执行功能特点及脑机制研究

发布时间：2018-07-01 19:54

本文选题：多重侵害 + 生态学执行功能　；参考：《山东大学》2012年硕士论文

【摘要】：背景儿童期侵害是普遍存在的社会公共卫生问题,由此造成的不良临床结果逐渐引起研究者的关注。目前的研究多集中于对单一侵害的发生状况、影响因素的研究,也已有研究者开始进行单一侵害的神经心理和影像学的研究,对多重侵害的研究相对较少。侵害常聚集出现,因此对多重侵害进行研究更具有实际意义。侵害与个体执行功能损伤有关,本研究综合使用生态学和神经心理学测评工具,比较了多重侵害无创伤后应激症状组、多重侵害有创伤后应激症状组、非多重侵害组和正常对照组高职高专学生的执行功能的差异,并使用功能磁共振成像技术探讨了遭受多重侵害的高职高专女生静息态大脑局部一致性的特点、与执行功能相关脑区的静息态功能连接特征以及在执行反应抑制任务时的磁共振成像特征。第一章遭受多重侵害高职高专学生生态学和神经心理学执行功能测试目的探讨遭受多重侵害的高职高专学生的执行功能特征方法在济南某高职高专院校参加过多重侵害调查的学生中选取被试,采用青少年侵害问卷自评版和创伤后应激障碍症状清单平民版量表的评分方法作为分组标准,拟选取299名被试,最终取得270人配合。270名研究对象均完成一般信息问卷,执行功能行为评定量表成人版和瑞文标准推理测试,根据执行功能行为评定量表成人版(BRIEF-A)计分方法,排除效度分量表得分高于划界分的被试,最终获得有效数据259份。其中多重侵害有创伤后应激症状组(a组)53人,多重侵害无创伤后应激症状组(b组)64人,非多重侵害组(c组)68人,对照组(d组)74人。在招募的研究对象中进行神经心理学测试动员,最终参与者为164人,其中多重侵害有创伤后应激症状组(a’组)32人,多重侵害无创伤后应激症状组(b’组)49人,非多重侵害组(c’组)41人,对照组(d’组)42人。神经心理学测验包括两项热身测试和五项与执行功能相关的测试,均来自剑桥神经心理测验。统计分析方法包括描述统计、卡方检验、方差分析,检验水准为a=0.05。结果 1.多变量多因素方差分析得Wilk's lambda为0.794,P0.001,表示四个组组间差异显著。侵害经历不同的四个组高职高专学生在生态学执行功能各维度上的得分随着侵害种类的增加、创伤后应激症状的出现而升高,四个组在抑制、转换、情感控制、任务启动、工作记忆、计划、组织和任务监控八个因子上的差异均有显著意义(P0.01),Scheffe检验显示a组在抑制、转换、情感控制、任务启动、工作记忆、组织和任务监控七个因子上的得分均高于d组,在抑制、转换、情感控制、任务启动、工作记忆五个因子上的得分高于c组,b组在抑制、情感控制、任务启动、计划和任务监控五个因子上的得分高于d组,在工作记忆因子上的得分高于c组,以上差异均具有统计学意义(P0.01)。a组与b组在生态学执行功能各因子上得分的差异无统计学意义(P0.05),c组和d组在生态学执行功能各因子上得分的差异也无统计学意义(P0.05) 2.神经心理学测验发现,侵害经历不同的四个组在停止信号任务中的Go试验的平均正确反应时、停止信号延迟和成功停止的比例及剑桥球袋测试中解决问题的起始思考时间这四个指标的差异有统计学意义(P0.05),内隐外显规则转换测验、空间广度记忆测验、空间工作记忆测验的各指标在四个组之间的差异均无统计学意义(P0.05)。结论 1.遭受多重侵害的高职高专学生生态学执行功能受损,且随着侵害种类的增加、创伤后应激症状的出现,执行功能受损更加明显。 2.遭受多重侵害的高职高专学生在停止信号任务和剑桥球袋测试中的表现较差,表明遭受多重侵害个体的反应抑制能力和计划能力较差。 3.生态学与神经心理学执行功能测试均表明PV经历与执行功能损伤有关。第二章遭受多重侵害高职高专女生静息态和任务态功能磁共振成像研究目的利用功能磁共振技术,探讨静息态和任务态下遭受多重侵害高职高专女生的脑功能区活动情况。方法采用Simens Verio3.0T磁共振扫描仪对15名遭受多重侵害无创伤后应激症状被试(PV无PTSS组)、15名多重侵害有创伤后应激症状被试(PV有PTSS组)和15名正常对照依次进行定位相、静息态脑功能扫描和GO STOP任务态的脑功能扫描。三组年龄、智力、受教育程度匹配。静息态磁共振扫描数据采用国际通用的SPM8软件和静息态功能磁共振数据处理工具包对数据预处理,之后进行ReHo分析或以前额叶背外侧为感兴趣区进行功能连接分析,分别比较PV无PTSS组与其余两组脑功能的差异,采用未校正P0.005,体素范围(K值)≥10认为有统计学意义。将所得的MNI坐标转换为Talairach坐标后,使用Talairach Daemon (TD)软件查看其所代表的脑区。任务态磁共振扫描数据采用组块设计的方法,用GO STOP冲动控制任务软件呈现刺激任务,使用SPM8软件进行预处理、单样本t检验和独立样本t检验,分别比较PV无PTSS组与其余两组脑功能的差异。单样本t检验采用未校正P0.001且体素范围(K值)≥100为差异具有统计学意义,独立样本t检验采用未校正P0.001且体素范围(K值)≥10为差异具有统计学意义。使用xjView软件查看MNI坐标所代表的脑区。结果 1.静息状态下,与对照组相比,PV无PTSS组ReHo值在左侧额下回、左右额内侧回、右侧中央后回、左侧梭状回、左右海马旁回、右侧扣带回、左右豆状核和右侧岛叶低于对照组。ReHo值在左右额上回、左右额中回、左右额下回、左右顶下小叶、左右楔前叶、左右颞上回、左侧颞横回、左右颞中回、右侧舌回和右侧扣带后回高于对照组；与PV有PTSS组相比,PV无PTSS组在右侧额中回和额下回、左侧楔前叶、左侧舌回、左右海马旁回、左侧扣带回和左侧豆状核ReHo值降低；在左右额上回、左右额中回、左侧额内侧回、右侧中央后回、左侧缘上回、左右顶下小叶、左侧梭状回和左侧尾状核ReHo值升高。 2.静息状态下,与对照组相比,PV无PTSS组双侧背外侧前额叶在右侧额上回,左右额中回,左右额内侧回,左侧额下回,右侧楔前叶和右侧扣带回功能连接升高；与PV有PTSS组相比,PV无PTSS组在左侧额中回和左侧扣带回的功能连接升高,而在左右额下回,右侧岛叶和右侧颞上回功能连接降低。 3.执行GO STOP任务时对照组、PV无PTSS组和PV有PTSS组在额叶、颞叶、顶叶和枕叶均有激活,对照组激活强度大且相对集中,随着侵害经历和创伤后应激症状的出现,激活强度变小且区域更为分散。PV无PTSS组与正常对照组GO STOP任务相比,在右侧额上回、左侧顶上小叶和左右岛叶等脑区的激活高于对照组。与PV有PTSS组相比,在执行GO STOP任务时,脑减活的区域主要为左侧楔前叶,左右楔叶,左侧枕中回和右侧海马旁回等。结论 1.遭受多重侵害无创伤后应激症状的高职高专女生在静息状态下脑默认网络以及岛叶、基底神经节、海马旁回均存在局部一致性信号异常。 2.与对照组相比,PV无PTSS组双侧BA46区与额叶、楔前叶和扣带回功能连接升高,这种功能连接升高可能是与认知需要相关的补偿机制或基线水平的升高。扣带回损伤与存在PTSS有关联,多重侵害引起的扣带回的损伤可能尚在代偿阶段。PTSS与颞上回的功能异常有关,多重侵害与颞上回功能的关系仍需进一步验证。 3.执行GO STOP任务时,对照组、PV无PTSS组和PV有PTSS组均有右侧额中回、额下回皮质的功能区的激活,有侵害经历和创伤后应激症状出现后,在执行GO STOP任务时,脑激活区域逐渐变得分散。排除PTSS,遭受多重侵害个体的前额神经网络功能异常,提示其执行功能存在损害。
[Abstract]:background
Childhood invasion is a common social public health problem. The resulting adverse clinical results have gradually aroused the attention of the researchers. The current research focuses on the occurrence of single infringement, the study of the influencing factors, and the research on the neuropsychological and imaging studies of the single infraction, and the multiple infractions. The study is relatively small. Infringing often occurs, so it is of practical significance to study multiple invasion. The study is related to the damage to individual execution function. This study comprehensively uses ecological and neuropsychological assessment tools to compare multiple invasive and non traumatic stress symptoms groups, multiple invasive posttraumatic stress symptoms groups and non multiple invasion. The difference in the executive function of the higher vocational and technical college students in the injury group and the normal control group, and using the functional magnetic resonance imaging technique to explore the characteristics of the resting state of the rest state of the brain, the resting state function connection with the executive function related brain regions and the magnetic resonance in the execution of the response inhibition task. Resemble a feature.
Chapter I suffers from multiple violations of Higher Vocational College Students' ecological and neuropsychological executive function tests.
objective
To explore the executive function characteristics of vocational college students with multiple victimization
Method
Among the students who participated in multiple infringement investigations in a higher vocational college in Ji'nan, the subjects were selected as the standard of the score of the self-assessment questionnaire and the symptom checklist of post-traumatic stress disorder (PTSD). 299 subjects were selected, and the general information questionnaire was completed by 270 people and.270 names. The adult version and raven standard reasoning test of the functional behavior assessment scale, according to the adult edition (BRIEF-A) score method of the executive functional behavior assessment scale, excluding the scores of the validity subscales higher than the demarcation score, and finally obtain 259 valid data. Among them, 53 people with multiple invasive posttraumatic stress symptom group (group A), multiple infraction and non traumatic stress should be taken. 64 patients (group B), 68 non multiple invasion group (Group C) and 74 people in control group (Group D) were recruited by neuropsychological test mobilization, and the final participants were 164, of which 32 were multiple invasive posttraumatic stress symptoms group (a 'group), 49 patients with multiple invasive posttraumatic stress symptom group (B' group), and non multiple invasion group (C '). 41 people, 42 people in the control group (D "group). Neuropsychological tests included two warm-up tests and five tests related to executive function, all from the Cambridge neuropsychological test. Statistical analysis included descriptive statistics, chi square test, ANOVA analysis, and test level of a=0.05.
Result
1. multivariable multi factor variance analysis showed that Wilk's lambda was 0.794 and P0.001, which indicated that there were significant differences among the four groups. The scores of the four higher vocational college students in the various dimensions of the ecological execution function increased with the increase of the types of infraction, the appearance of post-traumatic stress symptoms, and the four groups in inhibition, conversion, and emotional control. There were significant differences between the eight factors of task starting, working memory, planning, organization and task monitoring (P0.01). Scheffe test showed that the scores of the seven factors on inhibition, conversion, emotional control, task starting, working memory, organization and task monitoring in group A were higher than that of group D, in inhibition, conversion, emotional control, task starting, working memory The score of the five factors was higher than that of the C group. The scores of the five factors in the group B were higher than that of the D group, and the scores on the working memory factors were higher than those in the group C. The differences were statistically significant (P0.01) and there was no significant difference in the scores between the group.A and the B group on the various factors of the ecological implementation function. (P0.05) there was no statistically significant difference in scores of ecological execution functions among group C and group D (P0.05).
2. neuropsychological tests found that the average correct response to the Go test of four different groups in the stop signal task, the proportion of stop signal delay and successful stop, and the starting thinking time of solving the problem in Cambridge ball bag test, the difference of the difference of the four indexes: P0.05, implicit explicit rule conversion test There was no significant difference in the spatial breadth memory test and the spatial working memory test between the four groups (P0.05).
conclusion
1. the ecological execution function of the higher vocational college students suffering from multiple invasion is impaired, and with the increase of the type of infringement, the appearance of post-traumatic stress symptoms and the impairment of the executive function are more obvious.
2. the higher vocational college students who suffered multiple violations were poor in the stop signal task and the Cambridge bag test, indicating that the response to multiple infraction individuals was poor and the planning ability was poor.
3. both ecological and neuropsychological executive function tests indicate that PV experience is associated with functional impairment.
The second chapter is on the resting state and task state of female students with multiple victimization.
objective
Functional magnetic resonance imaging (fMRI) was used to explore the activities of brain functional areas in female students with multiple victimization in resting state and task state.
Method
The Simens Verio3.0T magnetic resonance imaging (Simens) scanners were used to examine 15 patients with multiple invasive and non traumatic stress symptoms (group PV without PTSS), 15 multiple multiple invasive posttraumatic stress symptoms (PV PTSS group) and 15 normal controls in sequence, resting state brain function scan and GO STOP task state brain function scan. Three groups of age, intelligence, and subject The degree of education matches.
The rest state magnetic resonance imaging data were pre processed by international SPM8 software and resting state functional magnetic resonance data processing kit, followed by ReHo analysis or the function connection analysis of the anterior lateral frontal lobes for the region of interest. The difference between the PV non PTSS group and the other two groups of brain functions was compared, and the uncorrected P0.005 was used. The element range (K value) > 10 is considered statistically significant. After converting the obtained MNI coordinates to Talairach coordinates, Talairach Daemon (TD) software is used to view the brain region it represents.
The task state magnetic resonance scanning data is designed by block design, using the GO STOP impulse control task software to present a stimulus task, using SPM8 software for preprocessing, single sample t test and independent sample t test, to compare the difference between the PV free PTSS group and the other two groups of brain functions respectively. The single T test uses uncorrected P0.001 and the voxel range (K value). The difference between 100 and 100 was statistically significant. The difference was statistically significant with the independent sample t test using the uncorrected P0.001 and the voxel range (K value) > 10. The xjView software was used to examine the brain regions represented by the MNI coordinates.
Result
At 1. resting state, compared with the control group, there was no ReHo value in PV PTSS group in the left inferior frontal gyrus, left and right lateral frontal gyrus, right and left medial gyrus, right central posterior gyrus, left fusiform gyrus, left and right lateral hippocampus, right cingulate gyrus, left and right lenticular nucleus and right Island leaf lower than the control group,.ReHo value of the upper and right frontal gyrus, left and right frontal gyrus, left and right lower lobules, left and right wedges Leaves, left and right superior temporal gyrus, left temporal gyrus, right and left temporal gyrus, right lingual gyrus and right posterior cingulate band were higher than that of control group. Compared with group PTSS of PV, no PTSS group in PV was in right middle frontal gyrus and lower frontal gyrus, left anterior lobe, left lingual gyrus, left and right lateral hippocampus, left cingulate gyrus and left side lenticular nucleus ReHo value lower; left and right frontal gyrus, middle frontal gyrus. The ReHo value of left frontal medial gyrus, right posterior central gyrus, left superior border, left and right inferior lobules, left fusiform gyrus and left caudate nucleus increased.
At 2. resting state, compared with the control group, the bilateral dorsal and lateral prefrontal lobes in the PV group had no bilateral dorsolateral prefrontal cortex in the right frontal gyrus, left and right frontal gyrus, left and right frontal gyrus, left inferior frontal gyrus, right anterior cuneus and right cingulate gyrus. Compared with the PTSS group in PV, the left middle frontal gyrus and the left cingulate gyrus had a higher function connection, but left in the left PV group, but left in the left side of the PTSS group. The functional connections between the right insula and the right superior temporal gyrus decreased in the right frontal and inferior gyrus.
3. when the GO STOP task was performed, the group of PV without PTSS and PV were activated in the frontal lobe, the temporal lobe, the parietal lobe and the occipital lobe. The activation intensity of the control group was large and relatively concentrated. With the invasion experience and the appearance of posttraumatic stress symptoms, the activation intensity was smaller and the region was more dispersed in the.PV non PTSS group compared with the normal control group GO STOP task, on the right side. In the upper frontal gyrus, the activation of the brain regions, such as the left superior lobule and the left and right Island leaves, was higher than that of the control group. Compared with the PTSS group with PV, the brain subtraction areas were mainly the left anterior lobe of the wedge, the left and right cuneate leaves, the left occipital gyrus and the right parahippocampal gyrus in the GO STOP task.
conclusion
1. there were local conformance signal abnormalities in the brain default network and the insula, basal ganglia and parahippocampal gyrus in the resting state of higher vocational college girls suffering from multiple invasive and non traumatic stress symptoms.
2. compared with the control group, the bilateral BA46 area in the PV PTSS group increased with the frontal lobe, the prefrontal lobe and the cingulate gyrus, which may be a compensation mechanism associated with the cognitive needs or the elevation of the baseline level. The cingulate injury is associated with the existence of PTSS. The damage of the cingulate gyrus caused by multiple encroach may still be in the compensatory phase of.PTSS. Dysfunction of the superior temporal gyrus is related to functional abnormalities. The relationship between multiple lesions and the function of the superior temporal gyrus still needs further verification.
3. when the GO STOP task was performed, the control group, the PV without PTSS group and the PTSS group all had the right frontal gyrus, the activation of the functional area of the inferior frontal cortex, the invasion experience and the posttraumatic stress symptoms, and the brain activation area gradually became scattered when the GO STOP task was executed. It suggests that its execution function is impaired.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.5

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