药物过度使用性头痛的注意力损伤：神经生理与行为学证据

发布时间：2018-02-24 06:16

本文关键词： 被动前注意力偏侧忽略神经心理机制视空间注意力失匹配负波药物过度使用性头痛　出处：《浙江大学》2015年博士论文　论文类型：学位论文

【摘要】：背景药物过度使用性头痛(Medication Overuse Headache, MOH)是一种临床上常见的慢性继发性头痛,其发病机制至今尚不明确。既往研究已经从分子遗传、生物化学、功能影像学、心理等多个角度对MOH的发病机制进行了探讨,而与疼痛感知、药物过度使用紧密相关的注意力并未得到重视。此外,既往针对原发性头痛的研究大多显示患者存在主动注意力损伤,针对物质使用障碍的研究显示患者存在视空间注意力的损伤,提示MOH可能亦存在注意力的受损。但是,这些研究很少关注被动注意力,多集中于主动注意力的某个种类或局部,而缺少局部结合整体的研究。而且大多数研究既未排除头痛本身对研究结果的影响,也很少控制焦虑、抑郁等共病因素。因此,本研究通过评价MOH的被动注意力和视空间注意力,希望从局部和整体、时间和空间上,多层次、多角度地探明MOH是否存在特征性注意力损伤。目的 1.明确MOH患者是否存在被动前注意力的损伤； 2.探明MOH患者是否存在视空间注意力的损伤； 3.将MOH患者注意力损伤的结果与慢性紧张型头痛(Chronic Tension-type Headache, CTTH)患者进行比较,并评估与焦虑、抑郁的相关性,对MOH的发病机制进行初步探讨。方法 1.在41名健康被试、22名CTTH患者和26名MOH患者中进行事件相关电位(Event-related Potentials, ERPs)的失匹配负波(Mismatch Negativity, MMN)测试。对MMN测试中三组被试所测得的N1及MMN的波幅和潜伏期进行Two-way ANOVA统计分析。当检测出主效应时,运用LSD检验法进行事后检验,评估相关参数在每两组间的差异； 2.在22名健康被试、26名CTTH患者和21名MOH患者中进行线段中分试验,对三组被试所测得的线等分误差指数(the Index of the Line Bisection Error, Index)和线等分误差净值(the Net of Line Bisection Errors, Net)进行One-way ANOVA统计分析。当检测出主效应时,运用LSD检验法进行事后检验,评估二者在每两组之间的差异； 3.运用Self-rating Anxiety Scale (SAS)和Self-rating Depression Scale (SDS)测量所有被试的焦虑和抑郁水平,运用One-way ANOVA进行统计分析,当检测出主效应时,运用LSD检验法进行事后检验,评估二者在每两组之间的差异。运用Spearman等级相关分析MMN潜伏期/波幅、Index/Net与被试的年龄、教育水平、焦虑水平、抑郁水平和头痛持续时间之间可能的相关关系。结果 1.MMN测试中所有被试在接受标准刺激和新奇刺激时均能在三个中线电极位点(Fz, Cz, Pz)得到清晰的N1成分和MMN成分；不论是标准刺激还是新奇刺激,其引发的N1潜伏期和波幅在三个组之间的差异没有统计学意义；而MOH组的MMN潜伏期与健康对照组和CTTH组比较均显著地缩短,MMN波幅与健康对照组和CTTH组比较均显著地降低； 2.在线段中分试验中,MOH组Index和Net均向左偏,而健康对照组和CTTH组轻度向右偏； 3.MOH组的焦虑和抑郁水平均显著高于健康对照组,但不论是MMN的潜伏期和波幅,还是Index和Net均与被试的焦虑、抑郁水平无相关性。结论 1.我们在MOH患者中发现了显著缩短的MMN潜伏期和显著降低的MMN波幅,说明MOH患者被动前注意力转移的敏感性增高,但转移过程中所分配到的认知资源减少； 2.在线段中分试验中我们发现MOH患者主观中点呈现了显著的左侧偏移,说明MOH患者存在对右侧空间的偏侧忽略,提示MOH患者右侧大脑半球功能优势或左侧大脑半球功能低下或者二者兼而有之； 3.MOH患者的焦虑水平、抑郁水平显著升高,但MMN潜伏期/波幅的变化、线段中分试验主观中点的偏移结果与患者的焦虑和抑郁水平、头痛本身及头痛持续时间长短无关,提示结果具有疾病的特异性,间接提示MOH可能与物质使用障碍存在共同的神经心理机制。
[Abstract]:background
Medication overuse headache (Medication Overuse, Headache, MOH) is a common clinical chronic secondary headache, its pathogenesis is still not clear. It is from molecular genetics, biochemistry, functional imaging, multi angle psychology on MOH pathogenesis are discussed, and the pain drug overuse is closely related to perception, attention is not taken seriously. In addition, the previous research on primary headache patients showed mostly active attention on injury, substance use disorders that exist in patients with visual spatial attention injury, suggesting that MOH may also have attention damage. However, these studies rarely focus on passive attention. A kind of multi focus on active attention or local, and the lack of overall Research on local combination. And most of the research did not exclude headache itself to the node Few factors such as anxiety, depression and other co morbidities are also controlled. Therefore, this study is to evaluate the passive attention and spatial attention of MOH. We hope to explore whether MOH has characteristic attention deficit from different angles and angles.
objective
1. it was clear whether there was a passive pre attention injury in MOH patients.
2. to find out whether MOH patients had visual impairment of attention.
3., we compared the results of MOH patients' attention deficit with those of Chronic Tension-type Headache (CTTH) patients, and evaluated the correlation with anxiety and depression, and discussed the pathogenesis of MOH.
Method
1. in 41 healthy subjects, the event-related potentials of 22 CTTH patients and 26 MOH patients (Event-related, Potentials, ERPs) mismatch negativity (Mismatch Negativity, MMN N1 and MMN) test. The test of MMN test in three subjects the amplitude and latency were analyzed by Two-way ANOVA statistics. When detecting the main effect, we use LSD test post test to assess differences of related parameters in each of the two groups;
2. in 22 healthy subjects, 26 CTTH patients and 21 MOH patients were divided into test line, the three groups of subjects were measured by the line bisection error index (the Index of the Line Bisection Error, Index) and line bisection error (the Net of Line Bisection net Errors, Net) were One-way ANOVA statistical analysis. When detecting the main effect, we use LSD test to post test differences in assessment of the two in each of the two groups;
3. using Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) measurement of all subjects in levels of anxiety and depression, the use of One-way ANOVA for statistical analysis, when detecting the main effect, we use LSD test to post test differences in assessment of the two in each of the two groups using Spearman MMN rank correlation analysis. The latency of Index/Net / amplitude, and subjects of age, educational level, anxiety level, possible correlation between depression level and duration of headache.
Result
The 1.MMN test in all subjects received standard stimulation and novel stimuli were in three loci (Fz, midline electrodes Cz, Pz) N1 and MMN components clearly; whether the standard stimulus or novelty, the latency and amplitude of N1 between the three groups the difference was not statistically significant MOH; group MMN group and CTTH group compared with control latency was significantly shortened, MMN group and CTTH group were compared with control were significantly reduced;
2. in the segment test, the Index and Net in group MOH were left to the left, while the healthy control group and the CTTH group were slightly to the right.
The level of anxiety and depression in group 3.MOH was significantly higher than that in healthy control group, but no matter the latency and amplitude of MMN, or Index and Net, there was no correlation with anxiety and depression level of subjects.
conclusion
1., we found significantly shortened MMN latency and significantly reduced MMN amplitude in MOH patients, indicating that the sensitivity of MOH to passive attention is higher, but the cognitive resources allocated during transfer are reduced.
2. in the line segment trials, we found that the subjective midpoint of MOH patients showed a significant left lateral deviation, indicating that MOH patients had a partial neglect of the right side space, suggesting that the right hemisphere function advantage or left hemisphere function of MOH patients is low or the two have both.
3.MOH patients' anxiety level and depression levels were significantly increased, but the latency of MMN / amplitude changes, offset results test and subjective midpoint line with the level of anxiety and depression, headache and headache duration has showed with disease specificity, suggesting that MOH may be indirect and substance use disorders are neuropsychological a common mechanism.

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R741

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