惊恐障碍患者静息态下海马不同亚区功能异常的fMRI研究

【作者】 张鑫；

【导师】 张宁；

【作者基本信息】 南京师范大学 ， 应用心理学， 2018， 硕士

【摘要】 惊恐障碍(Panic Disorder,PD)是焦虑障碍中的一种典型的亚型。是一种以反复发作的、难以预料的惊恐发作为主要特征的精神障碍。目前对于精神疾病的诊断仍依赖症状学标准,缺乏有效的生物学指标等因素。影像学技术尤其是静息态功能磁共振技术由于其众多优点而逐渐应用于焦虑障碍等精神疾病的研究中。海马一直以来是被认为与惊恐障碍的病理生理机制密切相关,但机制尚不清楚。本文主要探讨惊恐障碍(Panic Disorder,PD)患者海马不同亚区是否存在功能异常,从而探讨海马不同亚区在惊恐障碍患者神经环路中的作用。由精神科医生基于《精神障碍诊断与统计手册》第五版(Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition,DSM-5)的标准以及《简明国际神经精神访读中文版》(the MINI-International Neuropsychiatric Interview,M.I.N.I.)对PD患者进行诊断、研究者对年龄在20-50岁、排除其他躯体疾病和精神疾病的PD患患者,进行人口学资料、症状学资料(主要是汉密尔顿焦虑量表)以及影像学资料的采集。本文共纳入了 28名PD患者,18名健康人进行数据分析。采用功能核磁共振方法,主要探讨静息态下,PD患者相比于健康人,海马和全脑的功能连接状况。研究首先比较了PD患者和健康人的左侧,右侧海马分别与全脑的功能连接情况,在发现存在异常后,又基于前人研究,对海马分割后的亚区与全脑功能连接的结果的进行了比较。统计分析结果(两样本t检验)均经由FDR校正,p均小于0.05。结果表明,静息态下,PD患者相比于健康人而言(FDR<0.05):(1)左侧梭状回与左侧海马的功能连接增强(t=5.460);左侧梭状回与右侧海马的功能连接增强(t=4.182),右侧梭状回与右侧海马的功能连接增强(t=4.62)。(2)右侧中央前回与左侧海马前部功能连接减弱(t=-4.752),左侧角回与左侧海马前部功能连接增强(t=4.226);左侧眶额下回与左侧海马中部功能连接减弱(t=-4.272);右侧尾状核与与左侧海马后部功能连接增强(t=4.758);左侧梭状回与回与右侧海马前部功能连接增强(t=4.018),右侧梭状回与右侧海马前部的功能连接增强(t=4.752)。静息态下,惊恐障碍患者与健康人相比,海马的不同的亚区存在着一定的功能连接异常。海马前部可能参与了惊恐障碍的情绪过程。更多还原

【Abstract】 Panic Disorder(PD)is a typical subtype of anxiety disorder.PD is characterized by recurrent and unexpected panic attacks.At present,the diagnosis of mental illness still depends on the criteria of symptomatology because of lack of effective biological indicators.Imaging technology,especially resting state functional magnetic resonance imaging,has been applied to the research of mental disorders such as anxiety disorders.The hippocampus has been thought to be closely related to the pathophysiological mechanism of panic disorder,but the mechanism is unclear.The aim of this article is to explore if different hippocampus subdivisions play different roles in panic disorder,and to identify if they belong to different panic circuity.Participants were screened for being right-handed and 20-50 years old who didn’t taking any psychoactive medications or psychotherapy for three months before scanning fMRI.And patients were being diagnosed with PD based on DSM-5 and the MINI-International Neuropsychiatric Interview,M.I.N.I.Forty-six participants were enrolled in this study:28 patients with panic disorder,and 18 subjects with health control.Patients were recruited from Nanjing Brain Hospital,China.We collected participants’ demographic data and Hamilton Anxiety Scale data.All participants were given written informed consent before starting the experiment.And we studied the functional connectivity between different hippocampus subdivisions and the whole brain by resting-state fMRI.All two sample t-test were corrected by FDR,and p values were below 0.05.In resting-state fMRI,Compared with HCs(FDR<0.05):(1)PD patients showed increased functional connectivity between left hippocampus and left fusiform(t=5.460),between right hippocampus and left fusiform(t=4.182),between right hippocampus and right fusiform(t=4.62).(2)PD patients showed decreased functional connectivity between left anterior hippocampus and left precentral gyrus(t=-4.752),between left middle hippocampus and left inferior orbital frontal gyrus(t=-4.272);the patients also showed increased functional connectivity between left anterior hippocampus and left angular gyrus(t=4.226),between left posterior hippocampus and right caudate(t=4.758),between right anterior hippocampus and left fusiform(t=4.018),between right anterior hippocampus and right fusiform(t=4.752).Compared with HCs,PD patients’ hippocampus subdivisions play different role in resting-state.The left anterior hippocampus may be one part of the emotional regulation circuit.更多还原