本文選題：原發(fā)性失眠 + 腦功能成像　； 參考：《鄭州大學(xué)》2014年博士論文

【摘要】：第一部分原發(fā)性失眠患者靜息態(tài)腦默認(rèn)網(wǎng)絡(luò)fMRI研究目的：本實(shí)驗(yàn)利用磁共振腦功能成像技術(shù),通過功能連接相關(guān)分析方法,選取雙側(cè)后扣帶回(BA23/31)為種子點(diǎn),研究原發(fā)性失眠患者靜息態(tài)默認(rèn)網(wǎng)絡(luò)相關(guān)腦區(qū)神經(jīng)網(wǎng)絡(luò),從神經(jīng)影像學(xué)的角度分析原發(fā)性失眠患者默認(rèn)網(wǎng)絡(luò)腦功能連接是否存在特異性改變及其發(fā)生神經(jīng)機(jī)制,為原發(fā)性失眠臨床認(rèn)知功能障礙診療提供可能的客觀依據(jù)；以期用功能影像學(xué)方法為原發(fā)性失眠患者認(rèn)知障礙神經(jīng)生理學(xué)發(fā)病機(jī)制提供一定的科學(xué)依據(jù)。方法：根據(jù)美國(guó)美國(guó)精神疾病診斷與統(tǒng)計(jì)手冊(cè)第四版(DSM-IV) (Diagnostic and Statistical Manual of Mental Disorders.4th ed DSM-Ⅳ)和國(guó)際睡眠障礙分類(International classification of sleep disorders, ICSD)關(guān)于原發(fā)性失眠(Primary Insomnia, PI)診斷標(biāo)準(zhǔn),符合原發(fā)性失眠入組標(biāo)準(zhǔn)30例,符合正常健康對(duì)照(Healthy control, HC)入組標(biāo)準(zhǔn)30例,HC組性別、年齡與PI組一致。在磁共振掃描前,所有被試者均進(jìn)行臨床量表測(cè)定,包括：匹茲堡睡眠質(zhì)量指數(shù)(Pittsburgh Sleep Quality Index, PSQI)、漢密爾頓抑郁量表(Hamilton Depression Scale, HAMD)、漢密爾頓焦慮量表(Hamilton Anxiety Scale, HAMA)及空間工作記憶量表。磁共振掃描序列包括：磁共振常規(guī)掃描、磁共振靜息態(tài)腦功能成像掃描,采用雙樣本t檢驗(yàn)對(duì)PI、HC組臨床量表進(jìn)行統(tǒng)計(jì)學(xué)分析。以雙側(cè)PCC(BA23/31)為種子點(diǎn),采用SPM8和Rest軟件對(duì)磁共振腦功能數(shù)據(jù)進(jìn)行預(yù)處理,比較PI組、HC組靜息態(tài)腦默認(rèn)網(wǎng)絡(luò)及其差異。結(jié)果：1 PI、HC組臨床資料分析結(jié)果1.1 PI組與HC組對(duì)比,PSQI、HAMD、HAMA、空間工作記憶量表有顯著統(tǒng)計(jì)學(xué)差異。1.2 PI組伴輕度抑郁組與PI伴中度抑郁組對(duì)比,PSQI旨數(shù)、HAMA無明顯統(tǒng)計(jì)學(xué)差異。2 PI、HC組靜息態(tài)腦默認(rèn)網(wǎng)絡(luò)MRI結(jié)果2.1 PI、HC組靜息態(tài)腦默認(rèn)網(wǎng)絡(luò),兩組與PCC功能連接腦區(qū)主要包括：扣帶回、前額葉、雙側(cè)頂葉皮層、海馬旁回及取側(cè)顳葉、枕葉皮層。2.2 PI、HC組對(duì)比,PI組與PCC功能連接增強(qiáng)腦區(qū)包括：雙側(cè)額上回、雙側(cè)中問扣帶回；PI組與PCC功能連接減弱腦區(qū)包括：左側(cè)枕葉、左側(cè)海馬旁回、右側(cè)顳葉。2.3 PI中度抑郁組與輕度抑郁組對(duì)比,PI中度抑郁組與PCC功能連接增強(qiáng)腦區(qū)包括：中問扣帶回、右側(cè)額中回；PI中度抑郁組與PCC功能連接減弱腦區(qū)包括；左側(cè)海馬旁回。3、結(jié)論1、原發(fā)性失眠組具有睡眠障礙及認(rèn)知功能障礙基本臨床特征；焦慮、抑郁是原發(fā)性失眠患者主要的伴隨情感障礙；原發(fā)性失眠伴有抑郁程度與焦慮程度無明顯相關(guān)性；2、原發(fā)性失眠組與健康對(duì)照組存在腦默認(rèn)網(wǎng)絡(luò)；原發(fā)性失眠組存在腦默認(rèn)網(wǎng)絡(luò)異常,揭示了原發(fā)性失眠組存在明顯的記憶力下降認(rèn)知功能障礙及情緒調(diào)節(jié)失常神經(jīng)機(jī)制,與臨床量表存在空問工作記憶認(rèn)知功能下降及伴有抑郁、焦慮情緒異常相一致。3、中間扣帶回是抑郁相關(guān)腦區(qū)標(biāo)志,與抑郁程度相關(guān)。海馬的損害程度與失眠程度相關(guān)。第二部分 原發(fā)性失眠患者與空間工作記憶相關(guān)神經(jīng)網(wǎng)絡(luò)fMIRI研究目的：本實(shí)驗(yàn)利用磁共振腦功能成像技術(shù),通過靜息態(tài)腦功能連接和空問工作記憶任務(wù)態(tài)腦功能成像相關(guān)分析方法,研究原發(fā)性失眠患者與空間工作記憶相關(guān)神經(jīng)網(wǎng)絡(luò)環(huán)路異常及其發(fā)生神經(jīng)機(jī)制,探討右側(cè)頂上小葉(BA7/5)在空問工作記憶中的作用,以期用功能影像學(xué)方法為原發(fā)性失眠患者認(rèn)知功能障礙神經(jīng)生理學(xué)發(fā)病機(jī)制提供一定的科學(xué)依據(jù)。方法：實(shí)驗(yàn)入組標(biāo)準(zhǔn),實(shí)驗(yàn)入組人數(shù)、臨床量表測(cè)定均同第一部分,第二部分實(shí)驗(yàn)在第一部分的基礎(chǔ)上進(jìn)行,磁共振空間工任務(wù)態(tài)fMRI數(shù)據(jù)掃描在第一部分磁共振常規(guī)掃描、磁共振靜息態(tài)腦功能成像結(jié)束后馬上進(jìn)行,腦功能數(shù)據(jù)預(yù)處理過程同第一部分,首先以右側(cè)頂上小葉為種子點(diǎn),比較PI組、HC組靜息態(tài)與其相關(guān)神經(jīng)網(wǎng)絡(luò)及差異,再分析探討空間工作任務(wù)態(tài)下,兩組腦神經(jīng)網(wǎng)絡(luò)及其差異分析,為臨床原發(fā)性失眠認(rèn)知功能障礙提供影像學(xué)科學(xué)依據(jù)。結(jié)果：1 以右側(cè)頂上小葉(BA7/5)為種子點(diǎn),靜息態(tài)與空間工作記憶功能相關(guān)神經(jīng)網(wǎng)絡(luò)研究1.1 HC組靜息態(tài)與右側(cè)頂上小葉(BA7/5)功能連接相關(guān)主要腦區(qū)包括：雙側(cè)頂葉皮層、雙側(cè)額葉皮層、雙側(cè)顳葉皮層、雙側(cè)枕葉皮層、右側(cè)小腦半球、右側(cè)海馬旁回；右側(cè)半球連接強(qiáng)度及范圍高于左側(cè)半球。1.2 PI組與靜息態(tài)與右側(cè)頂上小葉(BA7/5)功能連接相關(guān)主要腦區(qū)包括：積側(cè)頂葉皮層、雙側(cè)額葉皮層、雙側(cè)顳葉皮層、雙側(cè)枕葉皮層、雙側(cè)小腦半球,左側(cè)楔前葉/左側(cè)后扣帶回；右側(cè)半球連接強(qiáng)度及范圍高于左側(cè)半球。1.3 PI.HC組對(duì)比,PI組與右側(cè)頂上小葉(BA7/5)功能連接增強(qiáng)腦區(qū)主要包括：雙側(cè)額葉、雙側(cè)中央后回、左側(cè)楔前葉：功能連接減弱腦區(qū)包括：右側(cè)小腦半球、左側(cè)豆?fàn)詈�、右�?cè)海馬旁回、右側(cè)枕葉皮層。2 PI、HC組空間工作記憶任務(wù)態(tài)fMRI成像結(jié)果2.1 HC組空問工作任務(wù)態(tài)激活腦區(qū)主要包括：雙側(cè)頂葉、雙側(cè)額葉、雙側(cè)顳葉、雙側(cè)枕葉、橋腦、中腦、小腦半球、雙側(cè)丘腦,雙側(cè)島葉。2.2 PI組空間工作任務(wù)態(tài)激活腦區(qū)主要包括：雙側(cè)頂葉皮層、雙側(cè)額葉皮層、雙側(cè)顳葉皮層、雙側(cè)枕葉皮層、雙側(cè)島葉、雙側(cè)小腦半球、左側(cè)海馬旁回、左側(cè)丘腦、右側(cè)橋腦。2.3 PI、HC組對(duì)比,PI組空問工作任務(wù)態(tài)激活增強(qiáng)主要腦區(qū)包括：左顳葉、左側(cè)枕葉、右側(cè)額葉； PI組與空問工作記憶任務(wù)態(tài)激活減弱腦區(qū)包括：左側(cè)海馬旁回、右側(cè)海馬旁回、雙側(cè)颥葉皮層、取側(cè)額葉皮層、雙側(cè)頂上小葉。結(jié)論：1、空問工作記憶任務(wù)是多個(gè)腦區(qū)相互協(xié)作完成,具有特定神經(jīng)網(wǎng)絡(luò),主要包括：雙側(cè)頂葉皮層、雙側(cè)額葉皮層、雙側(cè)顳葉皮層、雙側(cè)枕葉皮層、雙側(cè)島葉、小腦半球、橋腦、丘腦等腦區(qū)；雙側(cè)頂葉為空問工作記憶主要功能腦區(qū)；空問工作記憶任務(wù)具有右半球優(yōu)勢(shì)；2、以右側(cè)頂上小葉(BA7/5)為種子點(diǎn)功能連接靜息態(tài)神經(jīng)網(wǎng)絡(luò),與空間工作任務(wù)態(tài)澈活腦區(qū)主要神經(jīng)網(wǎng)絡(luò)一致,證史右側(cè)頂上小葉(BA7/5)是空問工作記憶網(wǎng)絡(luò)的核心組成部分,可以作為為空間工作記憶的種子點(diǎn)。3、原發(fā)性失眠患者存在空問工作記憶相關(guān)神經(jīng)網(wǎng)絡(luò)異常,揭示原發(fā)性失眠患者臨床空間工作記憶下降、記憶力下降認(rèn)知功能障礙及情感障礙發(fā)生的神經(jīng)網(wǎng)絡(luò)機(jī)制。
[Abstract]:The first part of the study of the resting state brain default network fMRI study in primary insomnia patients: this experiment uses magnetic resonance brain functional imaging technology to select the bilateral posterior cingulate gyrus (BA23/31) as the seed point through functional connection correlation analysis, and studies the neural network of the resting state network related brain area of the patients with primary insomnia, from neuroimaging To analyze the specific changes in the default network brain function connection and its neural mechanism in the patients with primary insomnia, and provide the possible objective basis for the diagnosis and treatment of clinical cognitive impairment in primary insomnia. Scientific basis. Methods: according to the United States American psychiatric diagnosis and statistics manual Fourth Edition (DSM-IV) (Diagnostic and Statistical Manual of Mental Disorders.4th ed DSM- IV) and the international classification of sleep disorders (International classification) on the diagnostic criteria for primary insomnia. According to the standard 30 cases of primary insomnia, 30 cases were in the standard of normal health control (Healthy control, HC), and the sex of group HC was the same as that in the PI group. Before the MRI scan, all the subjects were measured by the clinical scale, including the Pittsburgh sleep mass index (Pittsburgh Sleep Quality Index, PSQI), and the Hamilton Depression Scale (Hamilton Depression Scale, HAMD), the Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA) and the spatial working memory scale. The magnetic resonance scanning sequence included magnetic resonance conventional scan, magnetic resonance resting state brain functional imaging scan, and dual sample t test for PI, HC group clinical scale. Seed points, using SPM8 and Rest software to pretreat magnetic resonance brain function data, compare PI, HC group, resting state brain default network and their differences. Results: 1 PI, HC group clinical data analysis results of group 1.1 PI and HC group, PSQI, HAMD, HAMA, spatial working memory scale Compared with the depressive group, there was no significant difference in PSQI tenor, HAMA,.2 PI, the resting state brain default network MRI results in HC group 2.1 PI, HC group resting state brain default network, two groups and PCC functional connection brain areas mainly including cingulate gyrus, prefrontal lobe, bilateral parietal cortex, parahippocampal gyrus and lateral temporal lobe,.2.2 PI in occipital cortex, HC group contrast The ability to connect the enhanced brain area included bilateral upper frontal gyrus and bilateral cingulate gyrus; PI group and PCC functional connection weakened brain area including left occipital lobe, left parahippocampal gyrus, right temporal lobe.2.3 PI moderate depression group compared with mild depression group, PI moderate depression group and PCC functional connection enhanced brain area including middle cingulate gyrus, right frontal gyrus, PI. In the moderate depression group, the functional connection with PCC weakened the brain area, including the left parahippocampal.3. Conclusion 1, the primary insomnia group had the basic clinical characteristics of sleep disorders and cognitive dysfunction; anxiety and depression were the main associated affective disorders in the patients with primary insomnia; there was no significant correlation between the degree of primary insomnia with depression and the degree of anxiety; 2, The primary insomnia group had the brain default network, the primary insomnia group had the brain default network abnormality, which revealed that the primary insomnia group had obvious memory decline cognitive impairment and emotional regulation dysfunction, and the clinical scale had empty work memory cognitive decline, depression and anxiety. The abnormal phase of the mood was.3, and the middle cingulate gyrus was a sign of depression related brain area, related to the degree of depression. The damage degree of the hippocampus was related to the degree of insomnia. The second part of the primary insomnia patients and the spatial working memory related neural network fMIRI research purposes: this experiment uses magnetic resonance brain power imaging technique and the resting state brain function connection. In order to study the function of the right apical lobule (BA7/5) in the empty working memory, the function of the right apical lobule (BA7/5) in the empty work memory is studied. A certain scientific basis is provided for the pathogenesis of neurophysiology. Methods: the experimental group standard, the number of the experimental group and the clinical scale are the same as the first part. The second part of the experiment is carried out on the basis of the first part. The magnetic resonance spatial task state fMRI data scanning is in the first part of the conventional magnetic resonance scanning, the magnetic resonance resting state brain. After functional imaging, the process of brain function data preprocessing is the same as the first part. First, the right apical lobule is the seed point, and the resting state of group PI and HC is compared with its related neural networks and differences, and then the two groups of neural networks and their difference analysis are analyzed and analyzed in the space work task state, which is the cognitive impairment of clinical primary insomnia. Results: 1: 1 on the right top superior lobule (BA7/5) as the seed point, resting state and spatial working memory function neural network study of the 1.1 HC group resting state and the right parietal lobule (BA7/5) functional connection related main brain areas including: bilateral parietal cortex, bilateral frontal cortex, bilateral temporal cortex, bilateral occipital lobe The cortex, right cerebellar hemisphere, right parahippocampal gyrus, the strength and scope of the right hemispherical connection are higher than that of the left hemisphere.1.2 PI group and the resting state and the right superior lobule (BA7/5) functional connection, including the lateral parietal cortex, bilateral frontal cortex, bilateral temporal cortex, bilateral occipital cortex, bilateral cerebellar hemisphere, left anterior lobe / left anterior lobe. The left posterior cingulate gyrus; the strength and scope of the right hemispherical connection were higher than that in the left hemisphere.1.3 PI.HC group. The functional connection between the PI group and the right upper parietal lobule (BA7/5) enhanced brain region mainly included bilateral frontal lobes, bilateral central posterior gyrus, and left anterior wedge lobe: the functional connection weakened the brain area including the right cerebellar hemisphere, left bean nucleus and right parahippocampal. Gyrus, right occipital lobe cortex.2 PI, HC group space working memory task state fMRI imaging results 2.1 HC group vacant task activation brain area mainly include: bilateral parietal lobe, bilateral frontal lobe, bilateral temporal lobe, bilateral occipital lobe, bridge brain, midbrain, cerebellar hemisphere, bilateral thalamus, bilateral insula lobe.2.2 PI group space working task activation brain area mainly include: Double The lateral parietal cortex, bilateral frontal cortex, bilateral temporal cortex, bilateral occipital cortex, bilateral insula, bilateral cerebellar hemisphere, left parahippocampal gyrus, left thalamus, left thalamus, right bridge brain.2.3 PI, HC group were compared. The activation of task state in the PI group enhanced the main brain areas including left temporal lobe, left occipital lobe, right frontal lobe, and PI group and task memory task. The activation of the brain consists of the left parahippocampal gyrus, the right parahippocampal gyrus, bilateral cortex of the lobe, the lateral frontal cortex, and the upper lobule on the bilateral top. Conclusion: 1, the task of working memory is completed by several brain regions, with a specific neural network, including bilateral parietal cortex, bilateral frontal cortex, bilateral temporal cortex, bilateral cortex, bilateral temporal cortex. Occipital cortex, bilateral Island leaves, cerebellar hemispheres, bridge brain, thalamus and other brain regions; bilateral parietal lobe is the main functional brain area for working memory; empty task memory task has the right hemisphere superiority. 2, the right parietal lobule (BA7/5) is the seed point function connection resting state neural network, and the main neural network in the clear brain area of space work task. The right parietal lobule (BA7/5) is the core component of the empty work memory network, and it can be used as the seed point for spatial working memory. It can be used as the seed point for spatial working memory.3. The patients with primary insomnia have the abnormal working memory related neural network, which reveals the decline in the clinical spatial working memory of the patients with primary insomnia, the cognitive impairment and the memory decline. The neural network mechanism of the occurrence of sensory disturbance.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R740

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