【作者】 王景；

【导师】 高国栋；

【作者基本信息】 第四军医大学 ， 外科学， 2013， 博士

【摘要】 神经性厌食症是有意节制饮食，导致体重明显低于正常标准的一种进食障碍。神经性厌食症的特征是拒绝将体重维持在高于或等于最低正常体重的水平（即根据年龄和身高所得到的预期体重的85％，或体重指数为17.5kg／m2），或者在生长发育阶段没有出现预期的体重增加。主要患病群体为青少年女性，女性神经性厌食症的平均发病率是19/100,000/year(约为男性发病率的10倍)。精神科治疗(包括药物及心理-行为治疗)配合营养治疗是目前最为普及的治疗方案。然而仍有约20%的患者为难治性神经性厌食症，对上述治疗方案无任何效果，而这也是造成该疾病高病死率的主要原因之一。伏隔核大脑边缘系统的重要组成部分，是奖赏环路的重要结构。基于以往我们对毁损伏隔核在治疗毒品依赖和酒精依赖方面的前期工作，以及毁损伏隔核在治疗强迫症方面的疗效。本研究拟通过立体定向手术干预伏隔核以治疗AN。纳入的12名女性神经性厌食症患者，随机分为两组，分别为单靶点毁损组（伏隔核）和多靶点毁损组（伏隔核、内囊前肢、扣带回），每组6名患者。通过立体定向射频毁损术分别对两组患者进行毁损。术后两组患者术后BMI指数、HAMD、HAMA、Y-BOCS及SF-36得分均立即下降（P<0.05）。单靶点毁损组与多靶点毁损组的患者术后BMI指数、HAMD、HAMA、Y-BOCS及SF-36之间比较均无明显差异（P＞0.05）。单靶点毁损伏隔核与多靶点毁损伏隔核、内囊前肢及扣带回的手术疗效无明显差异。对纳入的5名接受伏隔核脑深部电极植入术的患者行手术治疗。术后HAMD、HAMA、Y-BOCS、SF-36的改变均显示逐步的改善效果（P<0.05）。NAc-DBS组与单靶点毁损组、多靶点毁损组的患者术后BMI指数、HAMD、HAMA、Y-BOCS及SF-36之间比较均无明显差异（P＞0.05）。NAc-DBS治疗AN是有效的。通过本研究发现，立体定向手术干预伏隔核单靶点治疗神经性厌食症是有效的。射频毁损术与脑深部电刺激术间疗效无明显差异。可通过患者实际病情选择手术方式。更多还原

【Abstract】 AN is one kind of eating disorders. AN patients intentionally control their diet andhence have significantly lower weight than the normal standard. The characteristics of ANis refusal to maintain a body weight which is greater than or equal to the lowest level ofnormal body weight (i.e.,85%of the expected body weight according age and height, orBMI of17.5kg/m2), or lack of expected weight gain in certain growth and developmentstages. Majority of the patients are young women; the average rate of AN incidence inwomen is19/100,000/year, which is about10times of that in men.Psychiatric treatment (including drugs and psycho-behavioral therapy) accompaniedby nutritional therapy is the most popular treatment for AN so far. However, about20%ofthe AN patients are refractory to above treatments, and this is one of the main reasonscausing high mortality of AN.NAc is an important part of the limbic system of brain and a critical structure of brain’s reward loop. Based on the results from our previous works of treating drug abuseand alcoholism by NAc ablation and the adverse therapeutic effect of NAc ablation onobsessive-compulsive disorders, the present study aims to investigate the effect ofstereotactic surgical intervention of NAc on the treatment of AN.The purpose of this experiment was to effectively treat AN through stereotacticsurgery and implantation of deep brain stimulation.12female patients were randomlyassigned into two groups.6patients underwent bilateral ablation of NAc.6patientsunderwent bilateral ablation of NAc, anterior limb of internal capsule and cingulate gyrus.The BMI、HAMD、HAMA、Y-BOCS and SF-36scoles of patients who received bilateralablation of NAc have shown immediate improvements（P<0.05）. And the such scolesshowed no significant difference （P＞0.05）between two groups. Other5patients whoreceived deep brain stimulation also shown immediate improvements in the BMI、HAMD、HAMA、Y-BOCS and SF-36scoles（P<0.05）. And the such scoles also showedno significant difference （P＞0.05）between patients who received stereotactic surgeryand implantation of deep brain stimulation. Taking together, the study indicates that NAcis an effective target for AN treatment. Stereotactic surgical intervention of NAc caneffectively improve the symptoms in AN patients.更多还原