肝气郁结证患者PET脑功能成像研究及中医神经信息学研究探讨

【作者】 陈锦锋；

【导师】 王玉来； 尹岭；

【作者基本信息】 北京中医药大学 ， 中医内科， 2005， 博士

【摘要】 1 临床实验部分--肝气郁结证PET脑功能成像研究1. 1 目的探讨不同疾病的共同点--肝气郁结证(异病同证),是否在中枢神经系统存在共同的激活区域、激活程度是否相同、是否具有特异性等问题,以期获得肝气郁结证脑功能变化的可视性实验依据,探索肝气郁结证的实质和物质基础,并探索利用脑功能成像新技术研究脏腑证候脑机制的新方法和新途径。1. 2 方法选用德国siemens公司的Ecat Exact HR+PET扫描仪器,采用异病同证的方法,按照公认的肝气郁结证计量诊断标准,制定纳入、排除、剔除和脱落标准,采用配对的方法,以18FDG(氟18脱氧葡萄糖)为示踪剂,进行无认知任务的PET脑功能成像。图像分析和统计均采用脑功能研究显像领域的金标准--SPM软件。1. 3 结果与正常人比较,肝气郁结证相关脑区多呈现葡萄糖代谢减低,葡萄糖代谢减低脑区有(P<0. 01) :左侧额下回(Brodmann area 47) 、扣带回前部、扣带回后部、颞中回(Brodmann area 21) 、额中回(Brodmann area 6) ;双侧颞上回(Brodmann area 37,38) 、中央前回(Brodmann area 4,6) 等。葡萄糖代谢增高的脑区域有(P<0. 01) :脑干中脑、延桥交界、右侧楔叶(Brodmannarea 18) 、左侧小脑。1. 4 结论1. 4. 1 肝气郁结证PET脑功能成像结论:① 不同疾病肝气郁结证(异病同证)患者在相关脑区存在葡萄糖代谢异常,其葡萄糖代谢异常与大脑各叶的功能密切相关。② 肝气郁结证与抑郁症之间存在的共性--情绪异常,是相关脑区葡萄中文摘要糖代谢减低的真正结果,提示肝气郁结证的实质是与脑功能异常有关的情绪失常,即情志致病。.42肝与中医脑的关系研究探讨结论:肝与脑密切相关,是进行肝气郁结证脑功能成像的基础。1 .4.3肝气郁结证量化标准研究探讨结论:肝气郁结证的诊断标准必备2项症状:情绪低落症状和肝经循行部位症状,同时具备这2项,才能诊断为肝气郁结证,其余症状为非必需的、非特异的,单独存在时难以判断是肝气郁结证,但若同时与必备症状存在,则有助于肝气郁结证的诊断。肝气郁结证的核心症状是情绪低落,对应的是抑郁状态,而不一定是抑郁症。.5小结 肝气郁结证的主要表现是情志失常,而情志(情绪)异常的现代研究认为是与大脑机能失常有关,提示肝气郁结证的实质是与脑功能异常有关的情绪异常,即情志致病。2理论研究部分—中医神经信息学的探讨2.1目的探讨中医神经信息学建立的可行性,并阐明中医神经信息学的内涵和外探寻中医神经信息学的发展框架,开拓中医现代化研究的新思路。方法:别,自Z戈,‘ 通过对脑科学发展趋势、以及人类脑计划、神经信息学等研究的分析,探讨中医神经信息学产生的背景、开展中医神经信息学研究的必要性,阐述中医神经信息学的概念、目的、发展框架、研究方向以及研究内容等。2.3结论 中医神经信息学是传统中医和神经信息学的有机结合,是借鉴脑功能成像等神经信息学的研究方法来研究探讨中医内容的交叉科学。既是一门新兴的学科,又是神经信息学的一部分,也是中医现代化研究的有机内容。中医神经信息学是传统中医和现代脑研究的桥梁,是对中医体系的拓展和补充。同时中医神经信息学又是中国利用自身优势参与国际人类脑计划和神经信息更多还原

【Abstract】 1 Clinical research part-the study on the stagnation of Liver-Qi syndrome using brain functional imaging techniques with PET1.1 Objectiveto explore the possible changes in the brain functional imaging of the stagnation of Liver-Qi syndrome involved in multi-diseases and try to find the rules of these changes1.2 MethodsWe chose the subjects according the authorized diagnosis criteria of the stagnation of Liver-Qi syndrome and then paired them with control group which in the similar condition but without the stagnation of Liver-Qi syndrome. All the subjects including the control group were scanned under PET (Ecat Exact HR , Siemens production) after the injection of FDG without any cognition task. The results of brain imaging were analyzed and the statistics of data was performed with the special software SPM v99.1.3 ResultsFor the subjects of the stagnation of Liver-Qi syndrome compared with the control group, the metabolism of glucose decreases in the following brain sections (PO.01): Brodmann area 47, Cingulated cortex, Brodmann area 21, Brodmann area 6, Brodmann area 37 and 38 of both sides, Brodmann area 4 and 6. While the metabolism of glucose increases in the area of mesocephalon, the area of the borderline of medulla oblongata, Brodmann 18 area and the left cerebellum.1.4 Conclusions1.4.1 the conclusions in the brain functional imaging of the stagnation of Liver-Qi syndrome using PET:For the subjects of the stagnation of Liver-Qi syndrome involved in multi-diseases, the metabolism of glucose is abnormal in some brain sections (P<0.01). This abnormity reflects the maladjustment of the brain lobs.The common symptom -the disorder of emotion, both in the stagnation of Liver-Qi syndrome and the depression, is caused by the dysfunction of themetabolism of glucose in the correlative brain sections.1.4.2 The close relation between the Liver and the brain makes up the theoretic foundation of studying the stagnation of Liver-Qi syndrome by brain functional imaging using PET.1.4.3 The diagnosis criteria of the stagnation of Liver-Qi syndrome should include two parts-the disorder of emotion and the symptoms occurring along the Liver Channel. Other symptoms are dispensable and not special for the diagnosis criteria. But they can help to diagnose. Furthermore, the kernel symptom of the stagnation of Liver-Qi syndrome is the disorder of emotion, which consists with the depressive status.1.5 SummaryThe main symptom of the stagnation of Liver-Qi syndrome is the disorder of emotion, which is proved that it is correlated with the disfunction of the brain. These indicate that the substance of the stagnation of Liver-Qi syndrome is the disorder of emotion caused by the dysfunction of the brain.2 Theoretic research part-the discuss of Neuroinformatics of TCM2.1 Objectto discuss the feasibility of establishing the new subject of neuroscience -Neuroinformatics of TCM, and to describe the conception of it2.2 MethodsBy studying the recent development of the neuroscience, the Human Brain Project and the Neuroinformatics, we discussed the background of establishing Neuroinformatics of TCM and the necessity of studying it, described its conception, its aims, its developing plans, its research directions, its varied content and so on.2.3 ConlutionsNeuroinformatics of TCM is a new subject of neuroscience given birth by the close combination of TCM and Neuroinformatics. It is a part of neuroscience that studies TCM with the methods of neuroinformatics, such as brain imaging techniques. It is not only a part of Neuroinformatics, but also a part of the research of TCM. It is the breakthrough or cut-in for China to engage in the research of Human Brain Project and Neuroinformatics.2.4 SummaryIn brief, Neuroinformatics of TCM is a new subject of neuroscience with two research aims, three development plans, four research directions and varied research content.更多还原