早发与成人精神分裂症的静息态功能比率低频振幅及功能连接研究

发布时间：2018-08-06 15:08

【摘要】：目的:通过静息态功能磁共振成像(functional magnetic resonance imaging,fMRI)中比率低频振幅(fractional amplitude of low-frequency fluctuations,fALFF)与功能连接(functional connectivity,FC)的分析方法探讨早发精神分裂症与成人精神分裂症发病的共性与特异性,并探索精神分裂症(Schziphrenia,SZ)两种时间段下的神经影像学标记以及病理生理学机制。方法:收集首次发作未经治疗的早发精神分裂症(early onset schizophrenia,EOS)与成人精神分裂症(adult onset schizophrenia,AOS)患者各32例,符合美国精神障碍诊断与统计手册第4版的诊断标准(Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition,DSM-Ⅳ),同时在学校和社区张贴志愿者招募书收集健康被试,健康受试者要求一般人口学信息与病例组相匹配。健康受试者入组前经由专业心理测评人员对其心理情况进行评估并进行90项症状自查清单量表(Symptom checklist 90,SCL-90)评测,以排除近期重大事件影响导致脑影像学的差异改变,经入排标准排除不合格健康被试后,健康受试者成人与小孩组各37例。病例组受试者均由两名精神卫生科副主任及以上级别医师确认诊断,同时采用阳性与阴性症状量表(Positive and Negative Symptom Scale,PANSS)评估精神病性症状的严重程度并记录存档。通过筛选后的患者与健康受试者分别通过静息态fMRI检测,图像后处理采取DPABI软件进行预处理,排除头动三维平移2mm的被试,采用REST软件进行fALFF、基于体素的FC统计分析,结果采用AlphaSim校正,校正后p0.05为差异有统计学意义(单个体素p0.005、集群的大小67voxel、体积1809mm3、18个体素边缘连接),结果通过DPABI_VIEW计算出自由度值,并根据脑区t值对照t值表查找出相应的p值,图像结果通过BrianNet Viewer进行显示。结果:1.早发精神分裂症患者组与其匹配的健康被试的fALFF、FC值差异:两样本t检验结果显示患者组在左侧角回、左侧背外侧额上回、右侧岛叶、右侧舌回、右侧楔前叶、左侧颞上回处与健康被试存在差异。提取上述的差异脑区的时间序列作为感兴趣区域(Region of interest,ROI)进行全脑体素的FC分析,结果发现左侧角回与左侧眼眶部额下回FC增高;左侧背外侧额上回与右侧岛叶、左侧岛盖部额下回、右侧额中回FC增高;右侧岛叶与右侧背外侧额上回FC增高;右侧舌回与右侧额中回、两侧苍白球、右侧岛盖部额下回、右侧内侧额上回FC增高;右侧楔前叶与左侧颞中回FC增高;左侧颞上回未发现差异的FC值。2.成人精神分裂症患者组与其匹配的健康被试的fALFF、FC值差异:两样本t检验结果显示患者组在右侧楔前叶处与健康被试存在差异。以右侧楔前叶为ROI采取FC分析发现其与左侧内侧眶部额上回、右侧三角部额下回的FC增高。结论:(1)经fALFF分析发现EOS与AOS患者均存在右侧楔前叶功能紊乱,提示右侧楔前叶脑区可能是导致精神分裂症发病的核心区域之一,同时该区域可能是精神分裂症诊断的神经影像学标记之一。(2)经fALFF分析发现早发精神分裂症感觉运动网络(包括言语和听觉区域)存在神经活性增加,同时发现视觉皮层存在神经活性紊乱。(3)通过功能连接分析方法发现早发精神分裂症的视觉—前额叶皮层神经环路异常激活,成人精神分裂症的右侧楔前叶与背外侧前额叶皮层存异常的功能连接。
[Abstract]:Objective: To explore the generality and specificity of early onset schizophrenia and adult schizophrenia through the analysis of the low frequency amplitude (fractional amplitude of low-frequency fluctuations, fALFF) and functional connectivity in functional magnetic resonance imaging (fMRI). Sex, and explore the neuroimaging markers and pathophysiology mechanisms under two time periods of Schziphrenia (SZ). Methods: 32 cases of early onset schizophrenia (EOS) and adult schizophrenia (adult onset schizophrenia, AOS) were collected for the first time, and they were conformed to American mental disability. The diagnostic criteria for the fourth edition of the diagnostic and Statistical Manual (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM- IV), and volunteers recruited in schools and communities to collect healthy subjects, and healthy subjects to require general demographic information to match the case group. The assessment staff assessed their psychological conditions and evaluated the 90 symptom checklist (Symptom Checklist 90, SCL-90) to exclude the changes in brain imaging results from the impact of recent major events. After the exclusion criteria were excluded from unqualified health subjects, 37 healthy subjects and 37 children. All the cases were two. Positive and Negative Symptom Scale (PANSS) was used to assess the severity and record of psychiatric symptoms by the deputy director of the Department of mental health and the above level physician, and the patient was examined by the resting state fMRI by the selected patients and the healthy subjects, and the post-processing of the image took DPABI. The software is pretreated, the subjects that remove the three dimensional shift 2mm of the head move, using the REST software for fALFF, based on the FC statistical analysis of voxel, the results are corrected by AlphaSim, and the corrected P0.05 is statistically significant (single individual P0.005, cluster size 67voxel, volume 1809mm3,18 individual element edge connection), and the results are calculated by DPABI_VIEW. The values of the degree of freedom were found and the corresponding P values were found according to the T value of the brain area of the brain. The image results were displayed by BrianNet Viewer. Results: 1. the group of early onset schizophrenia patients was different from those of the matched healthy subjects, fALFF, FC. The two sample t test showed the left lateral angle, the left lateral dorsal frontal gyrus, the right Island leaf, the right side, and the right side. Lingual gyrus, right anterior lobe, left superior temporal gyrus and healthy subjects were different from those of the healthy subjects. The time series of the different brain regions were extracted as the region of interest (Region of interest, ROI) for FC analysis of all brain voxels. The results showed that the left angular gyrus and the left orbital part of the lower frontal gyrus FC increased; the left lateral dorsal lateral frontal gyrus and the right Island leaf, the left Island cover were found. In the lower frontal gyrus, the FC of the right middle frontal gyrus increased, the right Island lobe and the right dorsal lateral frontal gyrus increased FC, the right lingual gyrus and the right frontal gyrus, the two sides of the pallidus, the right medial frontal gyrus, the upper right medial frontal gyrus FC increased, the right anterior lobe and the left middle temporal gyrus FC increased, and the left temporal upper gyrus did not find the difference FC value of.2. adult schizophrenic patients. The fALFF, FC value difference between the group and the matched healthy subjects: the two sample t test showed that the patient group was different from the healthy subjects at the right anterior wedge. With the right anterior wedge of ROI, the FC analysis was used to detect the upper frontal gyrus in the left medial orbit and the FC in the right trigonometric lower frontal gyrus. Conclusion: (1) the fALFF analysis showed that both EOS and AOS patients were found. There is a dysfunction of the right anterior lobe, suggesting that the right anterior lobe of the wedge may be one of the core regions that lead to schizophrenia, and this area may be one of the neuroimaging markers for the diagnosis of schizophrenia. (2) fALFF analysis shows that the neural network of early onset schizophrenia (including speech and auditory regions) has nerves. The activity increased and there was a neuroactivity disorder in the visual cortex. (3) the visual prefrontal cortex of early schizophrenia was abnormal activation by functional connection analysis, and the functional connection between the right anterior lobe of the adult schizophrenia and the dorsolateral prefrontal cortex was found in adult schizophrenia.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.3

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