【作者】 丁军；

【导师】 苏林雁；

【作者基本信息】 中南大学 ， 精神病与精神卫生学， 2010， 博士

【摘要】 目的：探讨首发药物未治疗青少年重性抑郁障碍患者与正常对照组青少年之间脑三维结构磁共振影像灰质体积形态学异常变化,以探讨青少年重性抑郁障碍的脑结构病理生理学机制。方法：依据美国精神疾病诊断与统计手册第四版DSM-Ⅳ及发育与健康评定DAWBA临床访谈手册进行诊断性筛查,并采用儿童焦虑相关情绪障碍筛查表SCARED和简易情绪筛查量表SMFQ进行抑郁相关症状严重程度评估后,对18例(男10人,女8人,平均年龄15.77±1.18岁)首发未药物治疗青少年重性抑郁障碍患者和年龄性别匹配的18例(平均年龄16.18±0.94岁)青少年健康对照组进行脑三维结构扫描,应用基于体素的形态测量学分析方法,VBM)对脑灰质体积异常变化进行分析比较。结果：本研究的抑郁组相比于对照组灰质形态学体积增加的部位主要在左脑颞上回及双侧颞叶颞中回,(BA22,19)；体积减少部位主要位于左脑额叶(BA11,47)、右脑顶叶(BA7,40)和左脑顶叶(BA5),右脑岛叶(BA13)及右脑颞叶(BA 13)。结论：本例对首发、未药物治疗青少年重性抑郁障碍的病例对照研究显示,抑郁组相比对照组的灰质体积变化呈现双向性,灰质体积增大的部位,主要为左脑颞上回及双侧颞叶颞中回。灰质体积下降的部位主要在左脑额叶,尤其是(BA11区)及右脑顶叶、左脑顶叶、右脑岛叶和右脑颞叶。部分成人抑郁障碍研究报告较多的海马、杏仁核及前扣带回ACC的灰质体积变化在本例研究中抑郁组和对照组相比无显著性差异。目的：了解国际情绪图片系统(IAPS)在中国10-12岁组儿童中应用的数据特征,并与IAPS提供的国外测试数据进行比较。方法：采用便利抽样调查方法对长沙市某小学10-12岁组70名儿童进行图片测评,选择IAPS中126张图片进行愉悦度、唤醒度和优势度的三维自评的九点评分法进行评定。结果：(1)本研究获得的对图片的三个维度评价数据与IAPS提供的国外测试数据之间具有较好的相关性,但在愉悦度存在统计学显著性差异。(2)本研究显示的三个维度评价存在男女两性差异的图片中主要以正性图片为主。结论：IAPS具有良好的国际通用性,且适用于儿童,但也需要进行本土化基础数据研究支持以供选择。目的：通过功能磁共振研究首发未药物治疗青少年重性抑郁障碍患者及健康青少年对照组在情绪图片刺激任务状态下的脑功能活动特征的异同,以探讨青少年重性抑郁障碍的脑功能病理生理学机制。方法：对18例(男10人,女8人,平均年龄15.77±1.18岁)首发未药物治疗青少年重性抑郁障碍患者和年龄性别匹配的18例(平均年龄16.18±0.94岁)青少年健康对照组应用国际情绪图片系统IAPS(正性、中性、负性)进行时长为5分40秒的功能磁共振扫描(fMRI)。对影像数据以SPM软件进行双样本t检验分析来获取病例组与对照组之间不同脑激活部位的异同。结果：抑郁组相比对照组在正性刺激时以左脑顶叶后中央回(BA7)、左脑颞叶梭状回(BA20)的激活减弱为主；在中性刺激时激活增强与减弱的程度类似,分别主要为左脑枕叶梭状回(BA19)和左脑额叶额下回(BA46)在负性刺激时以激活增强为主,主要为右脑额叶额中回(BA8)及左脑颞叶颞上回(BA38)等。结论：抑郁组相比对照组在正性图片刺激时以激活减弱为主,在中性图片刺激时激活增强与减弱类似,在负性图片刺激时激活以增强为主。本研究提示BA10在抑郁障碍的正性情绪图片刺激时可能起到对情绪信息多中心的协调及注意的分配和再分配功能。部分成人抑郁研究报道的杏仁核、海马激活异常在本研究未能显示出抑郁组和对照组之间的差异。目的：通过静息态功能磁共振研究首发未药物治疗青少年重性抑郁障碍患者及健康青少年对照组的基础状态下脑同步神经元自发活动特征,以探讨青少年重性抑郁障碍脑基础功能病理生理学机制。方法：对18例(男10人,女8人,平均年龄15.7±1.18岁)首发药物未治疗青少年重性抑郁障碍患者和年龄性别匹配的18例(平均年龄16.18±0.94岁)青少年健康对照组在静息状态下进行时长为7分38秒的功能磁共振扫描(resting-state fMRI)。对影像数据以Rest软件进行静息态数据分析,采用ALFF算法来获取抑郁组与对照组有显著性差异的脑区部位。结果：抑郁组相比对照组在静息态ALFF值显著性增大的部位有左脑边缘叶海马回(BA30)、右脑顶叶后中央回(BA2)、右脑岛叶(BA13)、左脑额叶额下回(BA6)、左脑顶叶楔前叶(BA7)、右脑枕叶楔叶(BA18)、左脑枕叶枕中回(BA19)、右脑额叶额中回(BA8)等部位。抑郁组相比对照组静息态ALFF值减小的部位主要在左侧丘脑,左脑颞叶颞中回(BA21)、左脑尾状核、左脑额上回(BA6)等部位。结论：本研究应用ALFF方法探索性地对首发未药物治疗青少年抑郁障碍的静息态脑功能与对照组进行对比,呈现局部增高及局部降低的双向性变化,增高的部位以左脑海马回(BA30)、右脑顶叶中央后回(BA2)、右脑岛叶(BA13)等为主,推测抑郁组这些部位可能存在静息态脑同步自发神经元活动的增强；降低的部位以左脑为主,以左侧丘脑、左脑颞中回(BA21)、左脑尾状核等为主,推测抑郁组这些部位可能存在静息态脑同步自发性神经元活动的减弱。上述部位部分与默认网络DMN有关,并推测可能存在抑郁障碍的丘脑的神经元自发活动下降,导致日后代偿性神经元数量的增加。更多还原

【Abstract】 Objective:To investigate the gray matter volume abnormalities on brain three dimension structure of first-episode medication-naive adolescents with major depressive disorder compared with healthy control group,so as to explore the probable pathophysiological mechanism of adolescent major depression.Methods:Firstly according to American Diagnostic and Statistical Manual on Mental Health 4th edition(DSM-IV) criteria and Development and Wellbeing Assessment(DAWBA) clinically interviewing,18 first-episode medication-naive adolescents (male 10,female 8,mean age 15.77±1.18) with major depressive disorder and 18 age and sex-matched healthy adolescents (mean age 16.18±0.94) were chosen to fill the forms of Chinese version of The Screen for child anxiety related emotional disorders(SCARED) and short Mood and Feelings Questionnaire(sMFQ),to appraise the severity of their symptoms. Then both groups were scanned using 3T magnetic resonance imaging,and voxel based morphometry approach on Statistical Parametrical Mapping was used to analyse the data. The VBM gray matter volume of both groups were compared using two sample t-test.Results:Compared with the control group, in depressive group gray matter volume increased in left superior temporal gyrus and bilateral middle temporal gyrus,especially in BA 22 and BA19;,whereas gray matter volume decreased in left frontal lobe (BA11,47),right parietal lobe(BA 7,40),left parietal lobe (BA 5),right insular(BA 13)and right temporal lobe (BA 13).Conclusion:This first-episode medication naive adolescent major depressive disorder research manifested that gray matter volume in MDD group mainly decreased in left frontal lobe(BA11,47),right parietal lobe(BA 7,40),left parietal lobe (BA 5),right insular(BA 13)and right temporal lobe (BA 13).Though gray matter volume also manifested increase in left superior temporal gyrus and bilateral middle temporal gyrus especially in BA 22 and BA19.This research did not show significant abnormalities in amygdala, hippocampus and anterior cingulate cortex which were reported in some adult major depressive disorder related researches.Objective:To explore basic characteristics among Chinese 10-12 ys children using International Affective Picture System, and compare the acquired data base with the data supplied by IAPS.Methods:70 children were sampled in a local school, using the selected 126 pictures from IAPS,each one rated valence,arousal and dominance by self assessment.Results:(1) The scores of present study of three-dimension assessment were highly correlated with the children’s assessment data base provided by IAPS,whereas still existed significant difference in valence scores. (2) In some positive pictures it manifested sex difference.Conclusion:IAPS is highly generalized and suitable for children internationally, though needs localized tests database in Chinese children for further application.Objective:To investigate the functional abnormalities using emotional picture stimuli on first-episode medication-naive adolescents with major depressive disorder compared with normal control group,so as to explore the pathophysiological mechanism of adolescent depression.Methods:Firstly according to American Diagnostic and Statistical Manual on Mental Health 4th edition(DSM-IV) criteria and Development and Wellbeing Assessment(DAWBA) clinically interviewing,18 first episode medication naive adolescents(male 10,female 8,mean age 15.77±1.18) with major depressive disorder and 18 age and sex-matched healthy adolescents (mean age 16.18±0.94) were chosen to fill the forms of Chinese version of The Screen for child anxiety related emotional disorders(SCARED) and short Mood and Feelings Questionnaire(sMFQ)to appraise the severity of their symptoms. Then both groups were scanned using 3T fuctional magnetic resonance imaging watching positive,neutral or negative pictures selected from International Affective Picture System (IAPS),then Statistical Parametrical Mapping software was used to analyze the data. The different activation or deactivation of both groups were compared using two sample t-test.Results:Compared with the control group, in depressive group decreased activation were mainly found in left parietal lobe (postcentral gyrus BA7),left temporal (fusiform gyrus BA 20)when watching positive pictures; when watching neutral pictures increased activation mainly in left occipital lobe (fusiform gyrus BA 19) and decreased activation mainly in left frontal lobe (inferior frontal gyrus BA 46);when watching negative pictures mainly manifested increased activation in right medial frontal gyrus (BA 8)and left superior temporal gyrus(BA 38).Conclusion:This first-episode medication-naive adolescent major depressive disorder functional magnetic resonance imaging research using IAPS manifested that functional activation differences between MDD group and control group were mainly found decreased when watching positive pictures; when watching neutral pictures some regions activation increased and some regions decreased;when watching negative pictures mainly manifested increased activation. There was a clue that BA 10 in depressive group may function as coordinator and attention allocator with multi emotion information centers.This research did not show significant abnormalities in amygdala and hippocampus which were mostly reported in adult major depressive disorder related researches.Objective:To investigate the resting-state functional abnormalities using amplitude of low frequency fluctuation algorithm on first-episode medication-naive adolescents with major depressive disorder compared with healthy control group,so as to explore the probable brain pathophysiological spontaneous activities of adolescent depression.Methods:Firstly according to American Diagnostic and Statistical Manual on Mental Health 4th edition(DSM-IV) criteria and Development and Wellbeing Assessment(DAWBA) clinically interviewing,18 first episode medication naive adolescents (male 10,female 8,mean age15.77±1.18) with major depressive disorder and 18 age and sex-matched healthy adolescents (mean age 16.18±0.94) were chosen to fill the forms of The Screen for child anxiety related emotional disorders(SCARED) and short Mood and Feelings Questionnaire (sMFQ) to appraise the severity of their symptoms. Then both groups were scanned using 3T fuctional magnetic resonance imaging,and amplitude of low frequency fluctuation ALFF algorithm of Rest software based on Statistical Parametrical Mapping software was used to analyse the data. The different ALFF change in whole brain regions of both groups were compared using two sample t-test.Results:Compared with the control group,in depressive group significant increased ALFF change manifested in left hippocampal gyrus (BA 30),right parietal postcentral gyrus (BA 2),right insular (BA 13),left inferior frontal gyrus (BA 6),left parietal precuneus (BA 7),right occipital cuneus(BA 18),left occipital lobe (middle occipital gyrus BA 19),right middle frontal gyrus(BA8),etc. Significant decreased ALFF change manifested in left middle temporal gyrus(BA 21),left caudate, left superior frontal gyrus (BA 6),etc.Conclusion:This research using amplitude of low frequency fluctuation (ALFF) algorithm explored the brain resting state abnormalities of first-episode medication-naive adolescent with major depressive disorder compared with healthy control group. It manifested regional increased ALFF change and decreased ALFF change at the same time. The increased ALFF regions include left hippocampal gyrus (BA 30), right parietal postcentral gyrus(BA 2),right insular,etc.;whereas decreased ALFF regions include left thalamus, left middle temporal gyrus (BA 21),left caudate etc. Some regions mentioned may associated with default mode network, and there was a clue that thalamus may exist decreased spontaneous neuron activities in depressive subjects,thus may lead to compensated increased neuron quantity later.更多还原