發(fā)布時間：2018-05-04 16:12

  本文選題：廣泛性焦慮障礙 + 腦血流自動調節(jié)　； 參考：《吉林大學》2017年碩士論文

【摘要】：目的廣泛性焦慮障礙(generalized anxiety disorder,GAD)一直被認為是功能性病變,患者時常感到緊張、不安、過分擔心、甚至感到驚恐,頭暈、心悸、睡眠障礙,易激惹、警覺性增高等也是常見癥狀,嚴重影響患者的生活質量。近年來大量研究表明GAD與軀體疾病相關,特別是心腦血管疾病,有學者認為GAD患者的器質性改變可能與自主神經功能異常、內分泌功能改變、神經內分泌異常之間存在關聯。近年來GAD的腦血流動力學逐漸受到重視,有研究表明焦慮組患者維持腦血流量(cerebral blood flow,CBF)可發(fā)生改變,也有研究者認為CBF的改變與焦慮程度相關,焦慮患者CBF對二氧化碳分壓變化的敏感性下降,進而造成腦血流自動調節(jié)的受損。我們此前進行的臥立位腦血流的研究發(fā)現焦慮癥患者由臥位轉立位后腦血流速度下降、心率增快,提示腦血流自動調節(jié)功能以及自主神經功能受損。目前對于廣泛性焦慮障礙患者動態(tài)腦血流自動調節(jié)的研究鮮有報道,通過進一步研究廣泛性焦慮障礙與動態(tài)腦血流自動調節(jié)的關系,有望尋找到治療廣泛性焦慮障礙的新靶點。方法本研究共納入112名廣泛性焦慮障礙患者,均為2016年3月至2016年3月期間于吉林大學第一醫(yī)院神經門診就診患者,我們對患者行漢密爾頓焦慮量表(Hamilton Rating Scale for Anxiety,HAMA)及漢密爾頓抑郁評定量表(Hamilton Depression Rating Scale,HAMD)評分,并行經顱多普勒超聲(transcranial Doppler ultrasound,TCD)檢查,同時聯合使用指尖血壓檢測法,得到腦血流速度(cerebral blood flow velocity,CBFV)及動脈血壓,然后通過傳遞函數分析(transfer function analysis,TFA)得到腦血流自動調節(jié)自動調節(jié)參數:相位差、增益、相關性。同時收集患者基本信息,通過統(tǒng)計學分析得到廣泛性焦慮障礙與動態(tài)腦血流自動調節(jié)的關系。結果廣泛性焦慮障礙患者雙側大腦半球相位差明顯低于健康對照組,差異有統(tǒng)計學意義,而雙側大腦半球的增益與健康對照組無統(tǒng)計學差異;輕度、中度、重度廣泛性焦慮障礙各組間相位差及增益的差異沒有統(tǒng)計學意義,HAMA評分與廣泛性焦慮患者雙側大腦半球相位差及增益無明顯相關性;焦慮伴抑郁組的患者與單純焦慮組患者相位差及增益無顯著性差異,HAMD評分與腦血流自動調節(jié)參數無明顯相關性。結論廣泛性焦慮障礙患者動態(tài)腦血流自動調節(jié)功能受損;本研究為發(fā)現廣泛性焦慮障礙患者動態(tài)腦血流自動調節(jié)與焦慮程度相關;廣泛性焦慮障礙是否伴有抑郁對動態(tài)腦血流自動調無明顯影響。
[Abstract]:Objective Generalized anxiety disorder has always been considered as a functional disorder. Patients often feel nervous, restless, overworried, or even panic, dizziness, palpitations, sleep disorders, irritability, increased alertness, etc. Seriously affect the quality of life of patients. In recent years, a large number of studies have shown that GAD is related to somatic diseases, especially cardiovascular and cerebrovascular diseases. Some scholars believe that the organic changes of GAD patients may be related to the abnormality of autonomic nervous function, endocrine function and neuroendocrine abnormality. In recent years, the cerebral hemodynamics of GAD has been paid more and more attention. Some studies have shown that cerebral blood flow can be changed in patients with anxiety, and some researchers believe that the change of CBF is related to the degree of anxiety. The sensitivity of CBF to the change of carbon dioxide partial pressure is decreased, and the cerebral blood flow automatic regulation is impaired. Our previous study of cerebral blood flow in patients with anxiety disorder in supine position showed that the velocity of cerebral blood flow decreased and the heart rate increased in patients with anxiety disorder, suggesting that the automatic regulation of cerebral blood flow and autonomic nervous function were impaired. At present, there are few reports on automatic regulation of dynamic cerebral blood flow in patients with generalized anxiety disorder. By further studying the relationship between generalized anxiety disorder and automatic regulation of dynamic cerebral blood flow, we hope to find a new target for the treatment of generalized anxiety disorder. Methods A total of 112 patients with generalized anxiety disorder were enrolled in this study. All of them were admitted to the first Hospital of Jilin University from March 2016 to March 2016. The patients were evaluated with Hamilton Rating Scale for anxiety scale (Hamilton Rating Scale for scale) and Hamilton Depression Rating scale (Hamma). The patients were examined by transcranial Doppler ultrasound (transcranial Doppler ultrasound) and combined with fingertip blood pressure test. Cerebral blood flow velocity1 (CBFV) and arterial blood pressure (ABP) were obtained, and then the parameters of automatic regulation of CBFV, gain and correlation were obtained by means of transfer function analysis (TFAA). At the same time, the basic information of patients was collected, and the relationship between generalized anxiety disorder and automatic regulation of dynamic cerebral blood flow was obtained by statistical analysis. Results the phase difference of bilateral cerebral hemispheres in patients with generalized anxiety disorder was significantly lower than that in healthy controls (P < 0.05), but the gain of bilateral hemispheres was not significantly different from that of healthy controls. There was no significant difference in phase difference and gain between severe generalized anxiety disorder groups and there was no significant correlation between Hama score and bilateral cerebral hemispheric phase difference and gain in patients with generalized anxiety. There was no significant difference in phase difference and gain between anxiety and depression group and simple anxiety group. There was no significant correlation between Hamd score and cerebral blood flow automatic regulation parameters. Conclusion the automatic regulation of dynamic cerebral blood flow in patients with generalized anxiety disorder is impaired, and it is found that the automatic regulation of dynamic cerebral blood flow in patients with generalized anxiety disorder is related to the degree of anxiety. Whether generalized anxiety disorder is accompanied by depression has no significant effect on automatic cerebral blood flow regulation.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.72

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