多维评价岛叶胶质瘤对共情能力的影响

发布时间：2018-09-02 07:14

【摘要】：背景：共情(empathy)是一个多维的心理学概念,包括情感共情(affective empathy,AE)与认知共情(cognitive empathy, CE),前者是体验、分享他人的情绪：后者则是理解和推测他人的情感状态。共情对个体情感体验和社会活动至关重要。岛叶位于大脑外侧裂的深部,被额叶、颢叶、顶叶形成的岛盖所覆盖,与周围众多结构连接,这种高度复杂的联系使得其解剖结构和功能也较为复杂。目前对岛叶参与高级认知功能研究甚少,尤其对岛叶参与共情过程的研究。目的：利用人际反应指数量表及共情行为学范式,对局限于岛叶胶质瘤患者的共情能力进行评价,探索岛叶胶质瘤患者是否存在情感共情和认知共情能力缺陷以及初步探究左右侧岛叶在共情作用方面是否存在差异。并希望运用认知神经科学的相关理论及方法,为临床开展脑高级功能监测提供参考,进一步为提高脑胶质瘤的研究和治疗水平提供前瞻性的指导。方法：募集2014年3月-2015年12月就诊于安徽医科大学附属省立医院神经外科的15例岛叶肿瘤患者,18例非岛叶胶质瘤及24例健康成人。收集一般资料(性别、年龄、教育程度等信息)。所有被试者均行常规MRI扫描,并进行基本认知功能、基本智力、情感交流及表达、人格特征和负面情绪几个主要方面评估,包括：蒙特利尔认知评估量表(MoCA,中文版)、瑞文标准推理测验(SPM)、多伦多20项述情障碍量表(TAS-20)、五大人格分析(NEO-FFI-60)和抑郁自评量表(SDS)。采用戴维斯人际反应指数量表(IRI-C)、情感识别范式、疼痛共情范式及情感采择范式综合评价被试的共情能力,包括情感共情和认知共情。结果：①背景资料：各组间性别、年龄、受教育年限、SPM、MoCA、 NEO-FFI-60和SDS分均无统计学差异(Ps0.05)。②TAS-20和IRI-C:各组间TAS-20(F=23.360,Ps＜0.001)、PT(F=6.139,Ps=0.004)、EC(F=6.112,Ps=0.004)、AE(F=5.423,Ps=0.007)、CE(F=5.137,Ps=0.009)和共情总分(F=11.677,Ps＜0.001)差异具有统计学意义,且岛叶胶质瘤患者TAS-20、观点采择、共情性关心和共情总分低于其他两组；而各组间PD和FS得分差异无统计学意义(Ps＞0.05)。③共情行为学范式：各组间情绪识别范式、疼痛共情范式及情感采择范式正确率差异均有统计学意义(F=63.190,Ps＜0.001；F=15.035,Ps＜0.001；F=13.301,Ps＜0.001),岛叶胶质瘤患者正确率显著低于其他两组；岛叶胶质瘤组的疼痛共情任务反应时间较健康对照组显著延长,各组间其他共情范式的反应时间差异无统计学差异。④情感共情和认知共情指标：岛叶胶质瘤组中,情感识别行为学任务与IRI-C量表中的AE得分及其EC得分呈正相关(r=0.890,Ps＜0.001；r=0.643,Ps=0.010)；疼痛共情行为学任务与IRI-C量表中的AE得分呈正相关(r=0.646,Ps=0.009)；情感采择行为学任务与IRI-C量表中的CE得分及其PT得分呈正相关(r=0.687,Ps=0.005；r=0.591,Ps=0.020)。与病例对照组和健康对照组相比,岛叶胶质瘤组的AE和CE指标显著低于其他两组,差异具有统计学意义。但是,在本组病例中,左侧岛叶胶质瘤与右侧岛叶胶质瘤患者的AE(Ps=0.89)和CE指标(Ps=0.14)差异无明显统计学意义。结论：各组被试中,岛叶胶质瘤组患者的一般智力、基本认知功能、人格和负面情绪未见明显影响,但存在一定程度的述情障碍,而且情感共情和认知共情能力均明显受损。所以,岛叶胶质瘤对患者的社会情感功能造成了一定的损害。岛叶胶质瘤组中,左、右侧岛叶胶质瘤患者在情感共情和认知共情能力方面未见明显差异。综上可以得出,岛叶不仅在情感共情功能方面发挥重要作用,可能在认知共情功能方面也具有一定的作用；且左、右侧岛叶可能对共情的影响不具有差异性。本试验也证实了利用认知神经科学的方法能够反应颅内相关病变与高级认知功能的关系,具有一定的临床实用价值。
[Abstract]:BACKGROUND: Empathy is a multi-dimensional psychological concept, including affective empathy (AE) and cognitive empathy (CE). The former is experience, sharing others'emotions; the latter is understanding and speculating others' emotional state. Empathy is essential to individual emotional experience and social activities. The insular lobe is located in the brain. The deep part of the lateral fissure, which is covered by the frontal lobe, the hiatus lobe, and the parietal lobe, connects with many structures around it. This highly complex connection makes its anatomical structure and function more complex. Appearance and empathic behavior paradigm were used to evaluate empathy ability of insular glioma patients, to explore whether there are deficiencies in empathy and cognitive empathy in insular glioma patients, and to explore whether there are differences in empathy between left and right insular lobes. Methods: From March 2014 to December 2015, 15 patients with insular tumors, 18 patients with non insular gliomas and 24 healthy adults were enrolled. All subjects were scanned by conventional MRI and assessed in terms of basic cognitive function, basic intelligence, emotional communication and expression, personality characteristics and negative emotions, including: Montreal Cognitive Assessment Scale (MoCA, Chinese version), Raven's Standard Reasoning Test (SPM), Doran's. More than 20 items of Alexithymia Scale (TAS-20), five personality analysis (NEO-FFI-60) and self-rating depression scale (SDS) were used to evaluate the empathy ability of the subjects, including emotional empathy and cognitive empathy. Results: Background data: Each group was assessed by Davis interpersonal response index (IRI-C), emotion recognition paradigm, pain empathy paradigm and emotion selection paradigm. (2) TAS-20 and IRI-C: TAS-20 (F = 23.360, Ps < 0.001), TAS-20 (F = 23.360, Ps < 0.001), PT (F = 6.139, Ps = 0.004), EC (F = 6.112, Ps = 0.004), EC (F = 6.112, Ps = 0.004), AE (F = 5.423, Ps = 0.423, Ps = 0.007, CE (F = 5.137, Ps = 0.137, Ps = 0.Ps = 0.009) and total empathy (F = 0.009) and total empathy (F = 0.009), EC (EC (F = 6.112, P = 6.112, P = 6.112, Ps = 0.Ps 11.677, Ps < 0.001) the difference was statistically significant, and TAS-20 scores of patients with insular glioma were lower than those of the other two groups, but there was no significant difference in PD and FS scores among the three groups (Ps > 0.05). 3 Empathic behavior paradigm: There were significant differences in the correct rates of emotion recognition paradigm, pain empathy paradigm and emotion selection paradigm among the three groups (F = 63.190, Ps < 0.05). The correct rate of insular glioma patients was significantly lower than that of the other two groups; the response time of pain empathy task in insular glioma group was significantly longer than that of the healthy control group, and there was no significant difference in the response time of other empathy paradigms among the groups. In glioma group, emotional recognition behavior task was positively correlated with AE score and EC score of IRI-C scale (r = 0.890, Ps < 0.001; r = 0.643, Ps = 0.010); pain empathy behavior task was positively correlated with AE score of IRI-C scale (r = 0.646, Ps = 0.009); affective choice behavior task was positively correlated with CE score and PT score of IRI-C scale. There was a positive correlation (r = 0.687, Ps = 0.005; r = 0.591, Ps = 0.020). Compared with the case control group and the healthy control group, the AE and CE indexes of insular glioma group were significantly lower than those of the other two groups, and the difference was statistically significant. Conclusion: The general intelligence, basic cognitive function, personality and negative emotions of insular glioma patients were not significantly affected, but there was a certain degree of alexithymia, and emotional empathy and cognitive empathy were significantly impaired. In the insular glioma group, there was no significant difference in the ability of emotional empathy and cognitive empathy between left and right insular glioma patients. Empathy has no difference. This study also confirmed that cognitive neuroscience can reflect the relationship between intracranial lesions and advanced cognitive function. It has a certain clinical value.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R739.41

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