产后抑郁症患者静息态和任务态下脑区激活与情绪反应特征
发布时间：2018-07-26 07:01
【摘要】：产后抑郁症是产褥期发生的,以抑郁情绪为主的常见的围生期精神疾病。目前,对该疾病的研究停留在社会心理因素和激素等水平,其发病机制尤其是脑机制仍不明确,近十几年来脑科学研究和功能影像学技术的飞速发展,使我们研究其脑神经病理学基础成为可能。 本研究采用脑功能磁共振、量表、内分泌测定等研究方法,对产后抑郁症患者静息态和任务态下(正、负性刺激和应激任务)的脑激活和情绪反应特征进行研究。本研究分3个部分：(1)产后抑郁组与产后对照组静息态下脑功能磁共振差异的研究。(2)产后抑郁症的负性情绪偏向及其脑机制的研究。(3)产后抑郁组与产后对照组在应激任务下主观应激评价、皮质醇水平变化及脑功能磁共振的差异的研究。本研究通过对产后抑郁症静息态下和任务态下脑功能的变化探讨,为产后抑郁症的脑病理机制的研究提供进一步的实验依据。 实验方法：(1)12名产后抑郁症患者与11名产后对照组被试在静息态下接受6分钟功能磁共振扫描,以Reho法对影像学数据进行局部一致性分析,比较产后抑郁组与产后对照组脑局部一致性的差异。(2)11名产后抑郁症患者与11名产后对照组被试接受正、负性音乐刺激下脑功能磁共振扫描,以SAM量表评价收听音乐时的主观愉悦度,比较两组主观愉悦度和脑功能差异。(3)10名产后抑郁症患者与10名产后对照组被试接受三个水平的心算应激下的脑功能磁共振扫描,以应激量表评价主观应激水平,以酶联免疫法测定唾液皮质醇水平,比较两组主观应激评价、应激前后皮质醇水平和脑功能差异。 研究数据采用方差分析、t检验、卡方检验、相关分析等统计方法,经过分析讨论,本研究得出以下主要结论： (1)产后抑郁症患者存在静息态下局部一致性异常的脑区,主要表现在左右后扣带回、右前扣带回、右前额叶、右侧顶叶局部等脑区一致性增高；右颞上回、右颞中回、右颞下回、左、右岛叶等脑区局部一致性降低。这些异常脑区多处于默认网络中,提示产后抑郁症患者默认网络存在异常。 (2)产后抑郁症患者存在负性情绪偏向。与产后对照组相比,在正性音乐刺激下激活增强的脑区为右侧尾状核、右侧顶下小叶、左侧颞下回等,表现出正性情绪减弱。在负性音乐刺激下,激活增强的脑区为双侧海马、右侧岛叶、右侧尾状核、壳核、左侧顶下小叶和左侧颞下回等,表现出负性情绪增强,并且,负性音乐下,产后抑郁症患者的右侧海马的异常激活与主观愉悦度评价呈负相关。这些脑区的异常激活,可能是其负性情绪偏向的脑病理基础。 (3)产后抑郁组对低水平的心算应激的主观应激评价与产后对照组没有差异；而对中等水平和高水平心算应激的主观应激评价均高于对照组；产后抑郁组基线皮质醇水平高于产后对照组,应激任务下,皮质醇升高水平低于产后对照组。产后抑郁组与产后对照组相比较,应激任务下激活增强的脑区为左、右侧壳核、左侧额叶(BA44、45)、左侧海马等,并且,应激下产后抑郁症患者的左侧壳核的激活与主观应激体验呈现正相关。产后抑郁症这种应激下的心理、内分泌和脑功能的异常,可能是应激在其疾病中发挥作用的病理基础。 (4)产后抑郁症静息态和任务态下脑激活和情绪反应存在的异常,并且与普通(非产后)抑郁症不完全相同,提示产后抑郁症患者具有自身独特的脑功能变化特征。
[Abstract]:Postpartum depression is a common perinatal mental disease occurring in the puerperium, mainly with depressive mood. At present, the study of the disease remains at the level of psychosocial factors and hormones. The pathogenesis, especially the brain mechanism, is still unclear. The rapid development of brain science and functional imaging technology in the past decade has made us study The basis of brain neuropathology is possible.
The purpose of this study was to study the brain activation and emotional response characteristics of postpartum depression patients in resting state and task state (positive, negative stimulation and stress task) by brain functional magnetic resonance (fMRI), scale and endocrine assay. The study was divided into 3 parts: (1) the difference between postpartum depression group and postpartum control group at resting state brain functional magnetic resonance (fMRI) Study. (2) the study of negative emotional bias and its brain mechanism of postpartum depression. (3) the study of subjective stress assessment, cortisol level and brain functional MRI in postpartum depression group and postpartum control group. The study on the changes of brain function under the resting state and task state of postpartum depression was studied for postpartum. The study of brain pathology mechanism of depression provides further experimental evidence.
Experimental methods: (1) 12 postpartum depression patients and 11 postpartum control groups were subjected to 6 minute functional magnetic resonance imaging (fMRI) at resting state. The Reho method was used to analyze the local conformance of the imaging data. (2) 11 postpartum depression patients and 11 postpartum control groups were compared. The subjects received positive, negative music stimuli, and the SAM scale was used to evaluate the subjective pleasure of listening to music. Two groups of subjective pleasures and brain function differences were compared. (3) 10 postpartum depression patients and 10 postpartum controls received three levels of brain functional MRI scan under the stress of three levels, with a stress scale The level of subjective stress was assessed. The level of cortisol in saliva was measured by ELISA. The subjective stress assessment, cortisol level and brain function before and after stress were compared between the two groups.
The data were analyzed by ANOVA, t test, chi square test and correlation analysis. After analysis and discussion, the following conclusions were drawn:
(1) the patients with postpartum depression had the brain region with local conformance in resting state, mainly in the posterior cingulate gyrus, right anterior cingulate gyrus, right prefrontal lobe and right parietal lobe, and other brain regions increased, right temporal gyrus, right temporal gyrus, right temporal gyrus, left, right Island lobe and other brain regions decreased. Most of these abnormal brain regions were in default. The network indicates that the default network of patients with postnatal depression is abnormal.
(2) there was negative emotional bias in postpartum depression. Compared with the postpartum control group, the enhanced brain area activated by positive music stimulation was the right caudate nucleus, the right apical lobule, the left temporal gyrus, and the positive mood weakened. Under negative music stimulation, the activation of the brain was bilateral hippocampus, right Island leaf, right caudate nucleus, and shell. The nucleus, left parietal lobule and left temporal gyrus showed negative emotional enhancement, and the abnormal activation of the right hippocampus in the patients with postpartum depression was negatively correlated with the subjective pleasure evaluation under negative music. The abnormal activation of these brain regions may be the pathological basis of the negative emotional bias.
(3) the subjective stress evaluation of postpartum depression group had no difference with the postpartum control group, but the subjective stress evaluation was higher than that of the control group. The baseline cortisol level of postpartum depression group was higher than that of the postpartum control group. The level of cortisol increased under stress task was lower than that of the postpartum control group. The postpartum depression group was compared with the postpartum control group. The activation of the brain area under the stress task was left, right putamen, left frontal lobe (BA44,45), left hippocampus, etc., and the activation of the left putamen in postpartum depression was positively correlated with the subjective stress experience. Abnormality may be the pathological basis for stress to play a role in its disease.
(4) the abnormality of the brain activation and emotional response in the resting state and the task state of postpartum depression, and not exactly the same as that of the general (non postpartum) depression, suggests that the patients with postpartum depression have their own unique brain function changes.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R749.4
本文编号：2145226
[Abstract]:Postpartum depression is a common perinatal mental disease occurring in the puerperium, mainly with depressive mood. At present, the study of the disease remains at the level of psychosocial factors and hormones. The pathogenesis, especially the brain mechanism, is still unclear. The rapid development of brain science and functional imaging technology in the past decade has made us study The basis of brain neuropathology is possible.
The purpose of this study was to study the brain activation and emotional response characteristics of postpartum depression patients in resting state and task state (positive, negative stimulation and stress task) by brain functional magnetic resonance (fMRI), scale and endocrine assay. The study was divided into 3 parts: (1) the difference between postpartum depression group and postpartum control group at resting state brain functional magnetic resonance (fMRI) Study. (2) the study of negative emotional bias and its brain mechanism of postpartum depression. (3) the study of subjective stress assessment, cortisol level and brain functional MRI in postpartum depression group and postpartum control group. The study on the changes of brain function under the resting state and task state of postpartum depression was studied for postpartum. The study of brain pathology mechanism of depression provides further experimental evidence.
Experimental methods: (1) 12 postpartum depression patients and 11 postpartum control groups were subjected to 6 minute functional magnetic resonance imaging (fMRI) at resting state. The Reho method was used to analyze the local conformance of the imaging data. (2) 11 postpartum depression patients and 11 postpartum control groups were compared. The subjects received positive, negative music stimuli, and the SAM scale was used to evaluate the subjective pleasure of listening to music. Two groups of subjective pleasures and brain function differences were compared. (3) 10 postpartum depression patients and 10 postpartum controls received three levels of brain functional MRI scan under the stress of three levels, with a stress scale The level of subjective stress was assessed. The level of cortisol in saliva was measured by ELISA. The subjective stress assessment, cortisol level and brain function before and after stress were compared between the two groups.
The data were analyzed by ANOVA, t test, chi square test and correlation analysis. After analysis and discussion, the following conclusions were drawn:
(1) the patients with postpartum depression had the brain region with local conformance in resting state, mainly in the posterior cingulate gyrus, right anterior cingulate gyrus, right prefrontal lobe and right parietal lobe, and other brain regions increased, right temporal gyrus, right temporal gyrus, right temporal gyrus, left, right Island lobe and other brain regions decreased. Most of these abnormal brain regions were in default. The network indicates that the default network of patients with postnatal depression is abnormal.
(2) there was negative emotional bias in postpartum depression. Compared with the postpartum control group, the enhanced brain area activated by positive music stimulation was the right caudate nucleus, the right apical lobule, the left temporal gyrus, and the positive mood weakened. Under negative music stimulation, the activation of the brain was bilateral hippocampus, right Island leaf, right caudate nucleus, and shell. The nucleus, left parietal lobule and left temporal gyrus showed negative emotional enhancement, and the abnormal activation of the right hippocampus in the patients with postpartum depression was negatively correlated with the subjective pleasure evaluation under negative music. The abnormal activation of these brain regions may be the pathological basis of the negative emotional bias.
(3) the subjective stress evaluation of postpartum depression group had no difference with the postpartum control group, but the subjective stress evaluation was higher than that of the control group. The baseline cortisol level of postpartum depression group was higher than that of the postpartum control group. The level of cortisol increased under stress task was lower than that of the postpartum control group. The postpartum depression group was compared with the postpartum control group. The activation of the brain area under the stress task was left, right putamen, left frontal lobe (BA44,45), left hippocampus, etc., and the activation of the left putamen in postpartum depression was positively correlated with the subjective stress experience. Abnormality may be the pathological basis for stress to play a role in its disease.
(4) the abnormality of the brain activation and emotional response in the resting state and the task state of postpartum depression, and not exactly the same as that of the general (non postpartum) depression, suggests that the patients with postpartum depression have their own unique brain function changes.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R749.4
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