汶川地震后慢性创伤后应激障碍神经通路脑影像研究

发布时间：2018-10-20 13:33

【摘要】：背景：根据条件反射去条件反射以及条件反射泛化理论、认知理论、社会-个人理论三个理论体系,根据这三个理论派生出来的治疗方法,本文探索这些理论和治疗方法的神经通路。提出四条慢性创伤后应激障碍神经通路,一是恐惧通路：丘脑-杏仁核-内侧前额叶-海马通路,包含小脑、中缝核、蓝斑、中脑腹侧被盖区等杏仁核传出脑区。二是犒赏通路：有伏隔核-中脑腹侧被盖区-杏仁核-眶额回组成。三是整合认知情绪注意力、提高自我意识的通路：丘脑-顶叶-顶颞叶交界区-后扣带-楔叶-岛叶-背外侧前额叶通路。四是决策选择、工作记忆的通路：丘脑-背外侧前额叶-眶额叶-内侧前额叶-前扣带喙部-前扣带背部-齿状核-杏仁核。目的：研究创伤后应激障碍神经通路的功能状态,为选择合理治疗方法提供依据。方法：研究对象为创伤后应激障碍患者组和对照组。患者组是经过汶川地震后9-16个月内的无合并诊断未治疗的创伤后应激障碍患者(总样本126例其中青少年28例)。对照组是在同一地区的经受同样灾前灾后创伤经历的终身无任何疾病的幸存者(总样本121例其中青少年24例)。应用SPM8软件做静息态数据的全脑连接、感兴趣区研究,探索脑区之间的相关性。应用FSL软件研究在视觉青少年和成人的创伤性视觉刺激下、成人个体化听觉创伤性刺激下脑BOLD信号增强或者减弱。结果：静息态数据全脑连接方法研究显示,经过一类错误的检验,有7条为比较弱的正连接,2条为比较强的负连接。这7条为减弱的正连接连接分别为左侧内侧前额叶与右侧杏仁核、左侧海马、右侧海马、左侧海马旁回、右侧海马旁回、右侧直回之间的连接。2条为增强的负相关分别为左侧后扣带与左侧岛叶、右侧岛叶之间的连接。以矫正后的P0.05Z2.3为阈值,在负性创伤性视觉刺激下,研究发现青少年和成人分别较静息状态,BOLD信号减少区域在杏仁核以上层面；青少年在视觉任务负性刺激下,组间比较显示创伤后应激障碍组较对照组BOLD信号减少区域在核磁层面在右侧岛叶和右侧颞叶以上,主要以中线结构和右侧脑区为主；正性视觉任务减去负性视觉任务的组间比较,创伤后应激障碍组的青少年比较对照组激活增加区域为右侧的背外侧前额叶激活,减少区域为右侧岛叶皮质、右侧颞叶皮质、右侧扣带皮质和连接这几个脑区之间的大量的白质；成人在负性创伤性听觉任务刺激下,在想象负性听觉故事时,组间比较结果显示创伤后应激障碍组在右侧岛叶皮质、右侧岛叶白质、右侧颞叶皮质、右侧颞叶白质较对照组BOLD信号增强。讨论：在无意注意的静息情况下,研究显示主要为两个通路的异常,以杏仁核-内侧前额叶为中心的恐惧通路,岛叶-后扣带的注意力自我意识通路,建议采取调节注意力的治疗和暴露治疗合并使用。在视觉创伤刺激的情况下,成人和青少年创伤后应激障碍组的四条通路都异常；而右脑通路存在修复功能；研究结果支持四个理论体系,建议采取综合的治疗或干预方式。创伤后应激障碍青少年的右侧背外侧前额叶皮质和右侧颞叶是异常神经通路中的最脆弱的脑区,建议采取针对性的认知治疗。青少年创伤后应激障碍的岛叶和整个扣带白质的功能低下支持自我调节注意力通路理论,建议采取针对调整注意力的治疗方式。负性个体化听觉任务研究为现实想象疗法在慢性成人创伤后应激障碍治疗提供依据,这种治疗方法可通过调节右侧颞叶和右侧
[Abstract]:BACKGROUND: According to the three theoretical systems of the theory, the cognitive theory, the social-personal theory, and the treatment methods derived from these three theories, this paper explores the neural pathways of these theories and methods. Four chronic post-traumatic stress disorder neurological pathways were suggested, one is the fear pathway: the thalamus-pituitary-medial prefrontal lobe-hippocampus pathway, including the cerebellum, the middle seam nucleus, the blue spot, the ventral side of the midbrain, and so on. Two is reward path: there is a V-septal nucleus-ventral belly side is covered by the cover area-occipital-orbital. Three is the whole cognitive emotional attention, the way to improve the self-consciousness: the thalamus-parietal lobe-parietal lobe boundary zone-posterior buckle band-wedge blade-island leaf-back lateral frontal lobe pathway. Four is the choice of decision-making, the path of working memory: the anterior frontal lobe of the thalamus-dorsal frontal lobe, the anterior frontal lobe, and the back-dentate nucleus of the anterior buckle. Objective: To study the functional status of nerve pathway in post-traumatic stress disorder, and to provide a reasonable treatment method. Rationale. Methods: Study subjects are post-traumatic stress disorder patients Group and control group. Patients with post-traumatic stress disorder after Wenchuan earthquake (9-16 months) (126 of total) 28 cases). The control group was survivors of any disease without any disease after undergoing the same disaster in the same area (121 of the total samples) The whole brain connection, interest area research and exploration of resting state data using SPM8 software were studied in 24 cases. Correlation between brain regions. Using FSL software to study the traumatic visual stimuli of visual adolescents and adults, adult human auditory traumatic stimulation of brain BOLD Signal enhancement or attenuation. Results: The study of all-brain-connection method of resting state data shows that 7 is a weak positive connection after a type of error detection. and 2 is a relatively strong negative connection. The positive connection connection of the seven strips is the connection between the medial prefrontal lobe of the left side and the right side of the right side, the left hippocampus, the right hippocampus, the left hippocampus, the side of the right hippocampus and the right straight back, respectively Left rear buckle belt and left island The connection between the leaves and the right island leaves was determined by the corrected PO. 05Z2. 3. Under the negative traumatic visual stimuli, it was found that adolescents and adults were in a resting state, and the BOLD signal reduction area was at the above-mentioned level. Compared with control group, BOLD signal reduction area in the post-traumatic stress disorder group was higher than that of the control group on the right side island leaf and the right side region, mainly in the middle line structure and the right side brain region. In comparison with the group that subtracted negative visual tasks, the adolescents in the post-traumatic stress disorder group activated the increased area to the right side of the dorsal prefrontal lobe in the post-traumatic stress disorder group, with the reduced area being the right-side island leaf cortex, the right lateral cortex, the right buckle belt cortex, and the attachment There are a large number of white matter between these brain regions; in adults with negative traumatic auditory tasks, the group comparisons show that post-traumatic stress disorder groups are located on the right island leaf cortex, the right island leaf white matter, the right lateral cortex, and the right side. BOLD signal enhancement in white matter is higher than that of control group. The study shows that in resting condition, the study shows that the abnormality of the two pathways, the fear pathway centered on the medial prefrontal lobe, the attention self-consciousness pathway of the island leaf-posterior buckle band, and the suggestion are taken. The treatment and exposure treatment of attention was combined. In the case of visual wound stimulation, the four pathways of the post-traumatic stress disorder group were abnormal in adults and adolescents, whereas the right brain pathways had rehabilitation functions; and the results support four theories It is suggested that comprehensive treatment or intervention should be adopted. The right dorsal lateral frontal cortex and right posterior frontal cortex of adolescents with post-traumatic stress disorder are the most brittle in abnormal neural pathways. The weak brain regions suggest targeted cognitive therapy. The island leaves of post-traumatic stress disorder and the low functioning of the whole button support self-regulated attention pathway theory. It is suggested to adopt a treatment mode aiming at adjusting attention. The negative individualized hearing task is based on the realistic imagination therapy in the treatment of post-traumatic stress disorder in adults.
【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R749.5

【共引文献】