事件相关电位技术在偏头痛、丛集性头痛发病机制研究中的应用

发布时间：2018-02-27 00:04

本文关键词： 偏头痛丛集性头痛发病机制认知功能事件相关电位（ERP）技术　出处：《中国人民解放军医学院》2014年博士论文　论文类型：学位论文

【摘要】：背景：偏头痛和丛集性头痛是原发性头痛中较有特点的两种类型，以往的研究认为两者同属于与血管关系较为密切的血管源性头痛。两者在发病机制上有一定的相似之处，但各种研究也发现两者也有不同的特点，目前并没有统一定论。临床观察发现偏头痛和丛集性头痛在发病过程中伴随有多种精神行为和认知活动的改变。认知领域的相关研究发现认知功能的异常改变是基于大脑皮层的结构和功能异常的，，那么，使用客观有效的方法证实偏头痛和丛集性头痛的认知功能异常情况，进而评估两者相关的皮层功能/结构异常的存在，将为两者发病机制中的中枢机制理论提供有力证据。脑电图事件相关电位（event related potentials，ERP）技术通过对大脑高级神经心理活动作出客观评价，从而反映大脑皮层功能。故我们将ERP这一研究手段应用于偏头痛和丛集性头痛患者的认知功能研究，将临床上观察到异常认知活动进行客观量化，以期对两者的皮层状态和功能进行评估。方法：使用E-prime软件编辑Oddball范式刺激程序为无先兆偏头痛患者28位，有先兆偏头痛患者20位，丛集性头痛患者19位和健康对照志愿者28位，进行A、V、VA、V50A、A50V、V100A及A100V共7种类型的刺激并记录同期64导联脑电图。一方面对E-prime软件自动记录的行为学数据：反应时（Response time，RTs）和正确率（accuracy），进行统计分析。另一方面采用Scan4.5软件对原始脑电数据进行离线分析，分段处理并去除伪迹后对反应正确的EEG进行分类叠加，得到各种刺激条件下标准刺激和靶刺激产生的ERP数据并进行相应的统计分析。结果：偏头痛相关研究发现：1）偏头痛患者存在一定程度对信息早期加工的障碍，正常对照组被试诱发的N1波幅最高，无先兆偏头痛组居中，有先兆偏头痛组N1波幅最低。2）听觉刺激条件下，无先兆偏头痛组N2/N2d波幅最低，有先兆偏头痛组居中，正常组被试N2/N2d波幅最高。3）视觉刺激条件下，有先兆偏头痛组N2/N2d波幅最低，无先兆偏头痛组居中，正常组被试N2/N2d波幅最高。4）视听觉间隔出现时，随着刺激间隔时间的增加，有先兆偏头痛患者的P3波幅（400-500ms）增加较大，无先兆偏头痛患者居中，正常对照组被试的波幅基本无变化。5）有先兆偏头痛组VA条件下诱发出较V+A更大的N2/N2d，无先兆偏头痛组和正常人均无此现象。丛集性头痛相关研究发现：1）正常组被试在视觉刺激条件下右侧额区N1波幅优势明显，丛集性头痛患者无此现象。2）在视觉刺激条件下，丛集性头痛患者诱发的P3/P3d波幅显著低于正常对照组。3）刺激间隔对丛集性头痛患者视听觉整合效果的影响与正常人之间无差别。男性头痛患者相关研究发现：1）视觉刺激条件下，男性偏头痛组被试的N2潜伏期较丛集性头痛组和正常对照组显著缩短，P3波幅较丛集性头痛组和正常对照组显著降低。2）在视听觉同时呈现时，正常对照组男性被试主要表现为P3波幅升高，男性丛集性头痛病人和正常人无此现象。结论：1).偏头痛患者对刺激信息的早期识别和监管能力下降，但对视听觉整合的能力较正常人增强，且有先兆偏头痛患者和无先兆偏头痛患者之间亦存在明显差异。2).丛集性头痛患者在早期的视觉加工阶段与正常人即存在差异。3).男性偏头痛患者存在头痛相关皮层的敏化和功能增强的现象。4).在视觉信息传递上，男性丛集性头痛患者与男性偏头痛患者之间存在差异，故虽然两者同属于在发病上以中枢机制占优势的原发性头痛，但还是存在一定的差别。
[Abstract]:Background : Migraine and cluster headache are two types of primary headache . Previous studies have found that both are closely related to vascular headache . There are some similarities between them in the pathogenesis of headache and cluster headache . In this study , it is found that migraine and cluster headache are accompanied by a variety of mental behaviors and cognitive activities . Methods : Using the E - prime software to edit the Oddball paradigm , there were 28 patients with aura - free migraine , 20 patients with aura migraine , 19 in cluster headache and 28 healthy control volunteers . On the other hand , the behavioral data recorded automatically by E - prime software were analyzed . On the other hand , the EEG data recorded by E - prime software were analyzed offline . On the other hand , the correct EEG was classified by Scan4.5 software , and the ERP data generated by standard stimulation and target stimulation were obtained under various stimulation conditions and the corresponding statistical analysis was carried out . Results : 1 ) Patients with migraine had the lowest amplitude of N2 / N2d , no aura migraine group and no aura migraine group . Cluster - induced headache - related study found : 1 ) There was a significant difference in N1 amplitude of right frontal area in normal group . The P3 / P3d wave amplitude induced by cluster headache was significantly lower than that in normal control group under visual stimulation . The results showed that : 1 ) Under the condition of visual stimulus , the N2 latency of the male migraine group was significantly shorter than that in the normal control group , the P3 amplitude was lower than that of the cluster headache group and the normal control group . Conclusion : 1 ) . In migraine patients , the early identification and supervisory ability of stimulation information decreased , but the ability to integrate visual auditory integration was higher than that of normal subjects , and there was also a significant difference between patients with aura migraine and without aura migraine . There was a difference in the early visual processing stage between the patients with cluster headache ( 3 ) . Male migraine sufferers are sensitized and functionally enhanced in the headache - related cortex . There is a difference between the male migraine sufferers and the male migraine sufferers on visual information transmission , so there is a certain difference between the two and the primary headache which is dominated by the central mechanism in the pathogenesis .

【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R741

【相似文献】