首发未服药抑郁症静息态功能磁共振效应连接研究

发布时间：2019-02-17 09:59

【摘要】：目的：相关研究证实抑郁症患者前额叶皮层-边缘系统存在结构上和功能上的异常,Granger预测分析(GCA)方法能有效地应用于静息态功能磁共振(fMRI)效应连接研究,我们运用该技术来研究首发未服药抑郁症患者前额叶皮层-边缘系统静息态下效应连接的改变,并探讨异常效应连接与患者疾病严重程度和认知功能的关系。方法： 23例符合重性抑郁发作(MDD)的患者(年龄31.1±1.5岁,全为右利手)参与本研究,对照组采用20例性别和年龄匹配的正常志愿者,分别使用汉密尔顿抑郁量表(HAMD)、Montgomery-Asberg抑郁量表(MADRS)和汉密尔顿焦虑量表(HAMA)进行病情评定,然后用Stroop色词测验(SCWT)和连线测验(TMT)进行认知功能测试。在完成神经心理测验后进行静息态功能磁共振扫描,数据预处理后,使用REST-GCA软件包,以MDD的Meta分析中前扣带回(ACC)结果做为种子点坐标进行基于系数的GCA分析,双样本t检验分析两组之间的效应连接的差异,最后提取MDD中有显著统计学差异的异常效应连接改变脑区的GCA值与临床量表和认知功能成绩做相关分析。结果：两组被试的认知功能测验并没有显示出显著的统计学差异,在静息态fMRI分析结果中,相比正常对照,MDD患者的全脑到ACC的效应连接增加的区域主要有右侧岛叶皮层(rAI)、右壳核,而效应连接降低的脑区主要有双侧背外侧额叶皮层,内侧前额叶皮层,左侧眶额皮层(P0.05,Alphasim校正)。ACC到全脑的效应连接没有发现显著的统计学差异。在后验性临床认知相关分析中,MDD患者左、右DLPFC到ACC效应连接与TMT-A完成时间呈负相关(r=-0.59,P0.01；r=-0.77,P0.01),MPFC到ACC效应连接的GCA值也与TMT-A完成时间呈负相关(r=-0.70,P0.01),右DLPFC的效应连接也和TMT-B完成时间呈弱负相关(r=-0.42,P0.05)。结论：双侧背外侧额叶皮层的效应连接的改变验证了MDD存在自上而下认知控制功能减低,揭示出MDD患者潜在的执行功能和注意功能障碍。rAI到ACC效应连接的异常提示静息态下SN切换已出现问题,加上纹状体到ACC效应连接改变,更进一步验证了边缘系统-皮质-纹状体-苍白球-丘脑神经环路失调,这些特异的异常连接进一步补充了MDD患者PLN动态的活动过程,反映了其非任务状态下神经活动基线的异常改变,这些发现能够帮助我们区分和理解MDD的病理机制。
[Abstract]:Objective: to confirm the structural and functional abnormalities of the prefrontal cortex-marginal system in patients with depression. The Granger predictive analysis (GCA) method can be used effectively in the study of resting functional magnetic resonance (fMRI) effect junctions. We used this technique to study the changes of effect junctions in the prefrontal cortex-marginal system in patients with first-episode depression, and to explore the relationship between abnormal effect connections and the severity of disease and cognitive function in patients with first-episode depression. Methods: Twenty-three patients (31.1 卤1.5 years old, all right-handedness) who were consistent with (MDD) were enrolled in this study. The control group consisted of 20 normal volunteers who matched their sex and age. Hamilton Depression scale (HAMD), Montgomery-Asberg), Depression scale (MADRS) and Hamilton anxiety scale (HAMA) were used to evaluate the patients' condition, and then the cognitive function was tested by Stroop color-word test (SCWT) and wired test (TMT). The rest functional magnetic resonance imaging (fMRI) was performed after the completion of the neuropsychological test. After data preprocessing, the coefficent GCA analysis was carried out using the (ACC) result of the anterior cingulate in the Meta analysis of MDD as the seed point coordinate. Two-sample t-test was used to analyze the difference of effect connection between the two groups. Finally, the significant difference of abnormal effect junction in MDD was extracted to analyze the GCA value of the brain region and the clinical scale and cognitive function scores. Results: there was no significant difference in cognitive function test between the two groups. In resting fMRI analysis, there was no significant difference between the two groups. In patients with MDD, the increase of effectual junctions from the whole brain to ACC was mainly in the right isobaric cortex (rAI), right putamen nucleus, while the decrease of the effect junction mainly included bilateral dorsolateral frontal cortex, medial prefrontal cortex, left orbital frontal cortex (P0.05), and the bilateral dorsolateral frontal cortex, medial prefrontal cortex, left orbital frontal cortex (P0.05). No significant statistical difference was found between Alphasim and the effect junctions of). ACC to the whole brain. In posterior clinical cognitive correlation analysis, there was a negative correlation between left and right DLPFC to ACC effect junctions and TMT-A completion time in MDD patients (r = 0.59, P 0.01). The GCA value of r-0.77), MPFC to ACC effect connection was also negatively correlated with the completion time of TMT-A (r-0.70 P0.01), and the effect connection of right DLPFC was negatively correlated with the completion time of TMT-B (r-0.42). P0.05). Conclusion: the changes of the effect junctions in bilateral dorsolateral frontal cortex confirm that there is a decrease in top-down cognitive control function in MDD. The abnormal connection between rAI and ACC effect suggests that there is a problem with SN switching in resting state, coupled with changes in striatum to ACC effect junctions. It is further demonstrated that the marginal system-cortex-striatum, globus pallidus and colliculus neurologic disorders, these specific abnormal junctions further supplement the dynamic process of PLN activity in patients with MDD. These findings can help us to distinguish and understand the pathological mechanism of MDD.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.4;R445.2

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