PMS肝郁气滞证患者悲伤情绪的表现特点与内在机制研究

【作者】 王雪；

【导师】 赵燕；

【作者基本信息】 北京中医药大学 ， 中医诊断学， 2019， 硕士

【摘要】 目的:经前期综合征(Premenstrual Syndrome,PMS)是指反复发作于月经周期黄体期的身体和精神两方面的症候群,包括烦躁、抑郁、疲劳,伴有腹部及四肢水肿、乳房胀痛、头痛等症状[1]。中医学的相关文献中虽然没有经前期综合征这一病名,但有很多相似的症状描写。中医妇科学教材将其统称为“月经前后诸证”[2]。PMS的症状表现与肝疏泄失常的病机变化存在着本质联系,临床上以肝郁气滞证最为常见[3]。目前关于PMS躯体症状的研究已相对丰富,但对于精神方面的研究还很少,应用心理学技术对于PMS这一疾病的研究相对不足,中医学也缺乏对于PMS情志方面的研究,限制了中医情志研究的深入。本研究应用心理学情绪诱发实验技术,对PMS肝郁气滞证患者从心理学与生理学两方面进行研究,通过分析PMS肝郁气滞证患者的各项量表得分,评定其各阶段的主观情绪感受,记录并分析相关生理指标与脑电波数据,总结PMS肝郁气滞证患者的临床表现特点及其对悲伤情绪的感受特点,探讨PMS肝郁气滞证患者的生物学机制和脑电变化,为PMS肝郁气滞证患者心理学层面的研究提供数据支持,为中医情志理论的研究及临床心身疾病的防治提供参考。方法:1.问卷调查的方法本研究以本校女大学生为研究对象,在校发放调查问卷。根据PMS及肝郁气滞证的诊断标准和世界卫生组织对于健康的定义,对被试者进行分组,共纳入PMS组被试者33人,健康组被试者24人。应用BAI[量表,BDI量表、EPQ-RSC问卷、ASLEC问卷,以及健康状况调查问卷对PMS肝郁气滞证患者的临床表现特点进行分析。2.情绪视频诱发实验的方法本研究从北京师范大学认知神经科学与学习国家重点实验室周仁来教授团队的情绪视频库中,选取具有中性、悲伤两种情绪刺激程度5分的视频作为被试者的观看素材,每段视频约3分钟。实验于被试者月经前11～7天(黄体期)进行,共分为静息、中性视频、悲伤视频三个阶段。并于各阶段记录被试者的主观情绪评分,分析PMS肝郁气滞证患者悲伤情绪的主观反应特点。3.生物学机制研究的方法本研究在静息阶段、中性视频、悲伤视频后采集被试者的血压、唾液,并应用美国Biopac公司的MP150生理多导记录仪采集各阶段的皮电、心率及心率变异性数据。其中唾液样本委托北京华大蛋白质研发中心有限公司应用ELISA法进行检测,检测指标为皮质醇、P物质与α-淀粉酶的含量。生理多导数据由北京飞宇星电子科技有限公司对数据进行标准化处理,将返回的数据进行分析,探讨PMS肝郁气滞证患者悲伤情绪的生物学机制。4.脑电研究的方法本研究在静息阶段、中性视频、悲伤视频阶段,应用美国Neuroscan公司开发的40导脑电记录系统,采集PMS肝郁气滞证患者的脑电波数据,脑电指标包括delta波(0.15～4Hz)、theta波(4～8Hz)、alpha波(8～13Hz)、beta波(13～25Hz)、gamma波(25～100Hz)的功率,并委托北京飞宇星电子科技有限公司对数据进行标准化处理,将返回的数据进行分析,探讨PMS肝郁气滞证患者悲伤情绪的脑电变化特点。结果:1.临床表现特点PMS组在BAI、BDI、EPQ-RSC、ASLEC及健康状况调查问卷的总分及人际压力因子、健康适应因子、躯体化-情感因子、认知因子、神经质、掩饰性的得分上均高于健康组,且在急躁易怒、善太息、胁肋胀满、疲乏无力、头晕、心悸、气短、恶心、胃脘不适、腰腹不适、腿部不适等条目的得分中均高于健康组。中度PMS患者在BAI、健康状况调查问卷的总分上高于轻度PMS患者,且在急躁易怒、胸闷、气短、恶心、胃脘不适、畏寒、头晕、目涩、瞌睡条目的得分中高于轻度PMS患者。2.悲伤情绪诱发的主观反应特点在情绪总体维度方面,PMS组与健康组在观看悲伤视频后,唤醒度均显著增高。情绪总体维度的变化趋于一致。在情绪具体维度方面,PMS组与健康组在观看观看悲伤视频后,平静得分均明显降低,悲伤得分均明显升高,且各阶段的悲伤得分变化趋于一致。PMS组在静息及悲伤视频阶段的悲伤得分均略高于健康组。3.生物学机制①血压:PMS组观看悲伤视频后,与静息阶段相比,舒张压明显升高。在各视频阶段,PMS组的收缩压与舒张压均略高于健康组。②皮质醇:PMS组在观看中性视频后皮质醇含量下降明显,观看悲伤视频后下降不显著。PMS组皮质醇的含量波动较小。③P物质:PMS组与健康组相比,P物质含量变化较小,悲伤视频阶段PMS组的P物质含量低于健康组。④α-淀粉酶:PMS组在静息、中性视频、悲伤视频阶段的α-淀粉酶含量均低于健康组。⑤心率及心率变异性:观看悲伤视频后,PMS组的皮电明显升高,HRV指标以下降趋势为主,VLF、TP明显升高,RR均值、SDNN、RMSSD、NN50、PNN50、LF、LF/HF明显降低。PMS组与健康组相比,观看悲伤视频阶段,PMS组的皮电、RR均值VLF、TP高于健康组,其余均低于健康组。4.脑电变化观看悲伤视频后,两组被试者各波段电极功率均以下降为主,并引起了较多相似脑区的激活,主要为枕叶、顶叶和额叶脑电波功率下降,具体表现为delta波的枕叶,theta波的枕叶、双侧顶颞、左额部,alpha波的全脑,beta波的顶叶和gamma波的顶叶与额叶脑电波功率下降。另外,PMS 组还引起了delta波的右额颞,beta波与ga mma波的前额部脑电波功率增高。观看中性视频后PMS组脑电波功率变化明显,各波段均存在下降脑区,无功率上升脑区。主要激活脑区为右额、顶叶、枕叶,具体表现为delta波的右心额颞、theta波的右额、alpha波的顶叶与额叶、beta波的顶叶与枕叶功率下降。结论:PMS肝郁气滞证患者的临床表现特点为:焦虑症状明显,有抑郁倾向,同时这部分人群存在急躁易怒、抑郁悲伤,以及胃肠与消化道等躯体不适的症状表现。本研究补充了既往研究对于PMS患者在心理学方面的认识,本研究发现PMS肝郁气滞证患者为高神经质人群,具有掩饰性人格的特点,容易隐藏自己的情绪,较易受更多生活事件的影响。同时本研究还发现,随着PMS程度的加重,被试者的焦虑程度加重,抑郁程度无明显变化。PMS肝郁气滞证患者的主观反应特点为:在悲伤情绪刺激下,实验成功唤起并诱发了PMS肝郁气滞证患者的悲伤情绪,并且这部分人群的悲伤感受更高。PMS肝郁气滞证患者的生物学机制为:在悲伤情绪刺激下,PMS肝郁气滞证患者的应激反应较弱,基线应激水平较低,在面对应激刺激时不能对机体产生很好的调控作用。悲伤情绪刺激使PMS肝郁气滞证患者自主神经系统总的张力降低,且以副交感神经系统活动程度降低最为明显。PMS肝郁气滞证患者的脑电变化特点为:在情绪刺激下PMS肝郁气滞证患者的脑区活动更强,脑电变化都以下降为主。观看悲伤视频后,主要引起了额叶、枕叶、顶叶的脑区活动。观看中性视频时,PMS组产生了更多脑区的活动,并且脑电变化均以下降为主,主要活动脑区为右额部、顶叶和枕叶。PMS组观看中性视频与悲伤视频相比,脑电波下降区域较为相似,可能是由于PMS患者在接受情绪刺激时把中性情绪误认为是负性情绪视频而引起了与悲伤情绪刺激相类似的脑电波活动。有所不同的是,观看悲伤视频时,出现顶叶和颞叶脑电波的上升,而中性视频时无上升波段出现,这可能与悲伤视频更强烈地刺激了PMS肝郁气滞证患者的情绪感受相关。综上所述,本研究丰富了对于PMS疾病的认识,补充了既往研究对于PMS肝郁气滞证患者在心理学方面的认识,初步探索了PMS肝郁气滞证患者悲伤情绪的内在机制,丰富了中医肝-脑理论,为PMS疾病的研究及中医情志学的研究提供了一定的数据支持。更多还原

【Abstract】 Objective:Premenstrual Syndrome(PMS)refers to both physical and mental symptoms of recurrent seizures in the luteal phase,including irritability,depression,fatigue,abdominal and limb edema,breast tenderness,headache,etc.[1].Although there is no premenstrual syndrome in the relevant literature of traditional Chinese medicine,there are many similar symptoms.TCM gynecology textbooks are collectively referred to as "the syndrome before and after menstruation"[2].The symptomatic manifestations of PMS are closely related to the pathogenesis of hepatic spasm disorder.Clinically,liver qi stagnation syndrome is the most common[3].At present,the research on the physical symptoms of PMS is relatively abundant,but there are few studies on the mental aspects.The application of psychology technology is relatively insufficient for the research of PMS.Chinese medicine also lacks research on the emotional status of PMS,which limits Chinese medicine.The depth of emotional research.This study applied psychological emotion-induced experimental technique to study PMS patients with liver qi stagnation syndrome from two aspects of psychology and physiology.By analyzing the scores of patients with PMS liver qi stagnation syndrome,the subjective evaluation of each stage was evaluated.Emotional feelings,record and analyze relevant physiological indicators and brainwave data,summarize the clinical manifestations of PMS liver qi stagnation syndrome patients and their feelings of sad ness,and explore the biological mechanism and brain electricity of patients with PMS liver qi stagnation syndrome The changes provide data support for the psychological research of patients with PMS liver qi stagnation syndrome,and provide reference for the study of TCM emotional theory and the prevention and treatment of clinical psychosomatic diseases.Methods:1.Questionnaire methodThis study used the female college students as the research object to issue questio nnaires at school.According to the diagnostic criteria of PMS and liver qi stagnation syndrome and the definition of health in the World Health Org anization,the subjects were grouped into 33 subjects in the PMS group and 24 in the health group.The clinical manifestations of patients with PMS liver qi stagnation syndrome were analyzed using BAI scale,BDI scale,EPQ-RSC questionnaire,ASLEC questionnaire,and health questionnaire.2.Emotional video evoked experimentIn this study,from the emotional video library of the team of Professor Zhou Renlai from the National Key Laboratory of Cognitive Neuroscience and Learning,Beijing Normal University,the video with 5 points of neutral and sad emotions was selected as the material of the subject.The video is about 3 minutes.The experiment was conducted in 1 to 7 days before the menstruation(the luteal phase),and was divided into three stages:resting,neutral video,and sad video.The subjects’ subjective emotional scores were recorded at each stage,and the subjective response characteristics of sadness in patients with PMS liver qi stagnation syndrome were analyzed.3.Method of biological mechanism researchIn this study,the blood pressure and saliva of the subjects were collected after resting stage,neutral video and sad video,and the data of skin electrical,heart rate and heart rate variability were collected at various stages using Biopac’s MP150 physiological multi-channel recorder.The saliva samples were entrusted to Beijing Huada Protein Re search and Development Center Co.5 Ltd.for detection by ELISA.The detection indexes were cortisol,substance P and a-amylase.The physiological multi-channel data was standardized by Beijing Feiyuxing Electronic Technology Co.,Ltd.,and the returned data were analyzed to explore the peripheral biological mechanism of sadness in patients with PMS liver qi stagnation syndrome.4.Method of brain electricity researchIn the resting stage,neutral video,sad video stage,the 40-lead EEG recording system developed by Ne uro scan Co mpany of the United States was used to collect brainwave data o f patients with PMS liver qi stagnation syndrome,and the EEG indicators included delta wave(0.15～4Hz),theta wave(4～8Hz),alpha wave(8～13Hz),beta wave(13～25Hz),gamma wave(25～100Hz)power,and commissioned Beijing Feiyuxing Electronic Technology Co.,Ltd.Standardized processing was carried out,and the returned data was analyzed to explore the central mechanism of sadness in patients with PMS liver qi stagnation syndrome.Results:1.Clinical manifestationsIn the PMS group,the scores of BAI,BDI,EPQ-RSC,ASLEC,and health status questionnaires were higher than those of interpersonal stress factors,health adaptation factors,somatization-emotional factors,cognitive factors,neuroticism,and disguise.Groups,and in the irritable,irritability,flank,fullness,fatigue,dizziness,palpitations,shortness of breath,nausea,stomach discomfort,waist discomfort,leg discomfort and other items were higher than the healthy group.Patients with moderate PMS had higher scores in BAI and health questionnaire than those with mild PMS,and scored in irritable,chest tightness,shortness of breath,nausea,stomach discomfort,chills,dizziness,dizziness,and drowsiness.Medium is higher than mild PMS patients.2.Characteristics of subjective response induced by sadnessIn terms of the overall dimensions of emotions,the PMS group and the health group showed a significant increase in arousal after watching the sad video.The changes in the overall dimensions of emotions tend to be consistent.In terms of the specific dimensions of emotions,after the PMS group and the health group watched the sad video,the calm scores were significantly reduced,the sadness scores were significantly increased,and the sadness scores at each stage tend to be consistent.The scores of sadness in the PMS group during the resting and sad video stages were slightly higher than those in the healthy group.3.Biological mechani’sm①Blood pressure:After watching the sad video in the PMS group,the diastolic blood pressure was significantly higher than that in the resting phase.At each video stage,the systolic and diastolic blood pressures of the PMS group were slightly higher than those of the healthy group.② Cortisol:The co rtisol content of the PMS group decreased significantly after watching the neutral video,and the decrease was not significant after watching the sad video.The content of cortisol in the PMS group fluctuated less.③P substance:Compared with the healthy group,the P substance content in the PMS group was less changed,and the P substance content in the PMS group in the sad video stage was lower than that in the healthy group.④α-amylase:The content of a-amylase in the PMS group was lower than that in the healthy group at rest,neutral video and sad video.⑤Heart rate and heart rate variability:After watching the sad video,the skin power of the PMS group was significantly increased,the HRV index was mainly decreased,and the VLF and TP were significantly increased.The RR mean,SDNN,RMSSD,NN50,PNN50,LF,LF/HF is significantly reduced.Compared with the healthy group,the PMS group watched the sad video stage.The skin power,RR mean VLF,and TP of the PMS group were higher than those of the healthy group,and the others were lower than the healthy group.4.EEG changesAfter watching the sad video,the power of each band of the two groups was mainly decreased,and caused the activation of more similar brain regions,mainly the power loss of the occipital,parietal and frontal cerebral brain waves,which was expressed as delta.The occipital lobe of the wave,the occipital lobe of theta wave,the bilateral apical ridge,the left frontal part,the whole brain of the alpha wave,the parietal lobe of the beta wave,and the parietal and frontal lobe brain wave power of the gamma wave decrease.In addition,the PMS group also caused the right frontal ridge of the delta wave,and the power of the forehead brain wave of the beta wave and the gamma wave increased.After watching the neutral video,the brain power wave power of the PMS group changed significantly,and there were declining brain regions in each band,and there was no power to increase the brain region.The main activation brain regions are right frontal,parietal,and occipital lobe,which are expressed as the right frontal ridge of the delta wave,the right frontal of theta wave,the parietal and frontal lobe of the alpha wave,and the parietal and occipital power o f the beta wave.Conclusion:The clinical manifestations of patients with PMS liver qi stagnation syndrome are:anxiety symptoms are obvious,there is a tendency to depressio n,and this group of people has irritable irritability,depression,and symptoms of physical discomfort such as gastrointestinal and digestive tract This study supplements the psychological understanding of PMS patients in previous studies.This study found that patients with PMS liver qi stagnation syndrome are highly neurotic,have the characteristics of concealed personality,are easy to hide their emotions,and are more susceptible to more life.The impact of the event.At the same time,this study also found that with the increase of the degree of PMS,the anxiety of the subjects increased,and the degree of depression did not change significantly.The subjective response characteristics of patients with PMS liver qi stagnation syndrome were:under the sorrowful emotional stimulation,the experiment successfully aroused and induced the sadness of patients with PMS liver qi stagnation syndrome,and the grief feeling of this part of the population was higher.The biological mechanism of PMS patients with liver qi stagnation syndrome is:under the sorrowful emotional stimulation,the PMS liver qi stagnation syndrome patients have weak stress response,low baseline stress level,and can not be on the body in the face of stress stimuli.Produces good regulation.Sad emotional stimulation reduced the total tension of the autonomic nervous system in patients with PMS liver qi stagnation syndrome,and the degree of activity of the parasympathetic nervous system was most significantly reduced.The characteristics of EEG changes in patients with PMS liver qi stagnation syndrome were:under the emotional stimulation,the brain activity of PMS liver qi stagnation syndrome was stronger,and the changes of EEG were mainly decreased.After watching the sad video,it mainly caused brain activity in the frontal lobe,occipital lobe,and parietal lobe.When watching the neutral video,the PMS group produced more brain activity,and the changes in EEG were mainly decreased.The main active brain regions were the right frontal,parietal and occipital Compared with the sad video,the PMS group observed that the areas of brain wave decline were similar,which may be due to the fact that PMS patients mistakenly think that neutral emotions are negative emotion videos when they receive emotional stimulation,which is similar to sad emotion stimulation.Brain wave activity.The difference is that when watching the sad video,the rise of the parietal and temporal lobe brainwaves occurs,while the neutral video has no rising band,which may stimulate the PMS liver qi stagnation syndrome more strongly with the sad video.Emotional feelings are related.In summary,this study enriches the understanding of PMS disease,supplements the previous research on the psychological aspects of patients with PMS liver qi stagnation syndrome,and initially explores the internal mechanism of sadness in patients with PMS liver qi stagnatio n syndrome.It enric hes the liver-brain theory of traditional Chinese medicine,and provides some data support for the research of PMS disease and the research of TCM emotions.更多还原