创伤后应激障碍患者血清丙二醛及血浆超氧化物歧化酶水平研究

目的：通过测定创伤后应激障碍（PTSD）患者血清丙二醛（MDA）及血浆超氧化物歧化酶（SOD）水平,探讨PTSD患者是否存在显著的脂质过氧化。方法：地震灾后1年,对596例参加抗震救灾的志愿者进行PTSD问卷调查,确诊为PTSD者24例,对其中18例（PTSD组）和32名未参加抗震救灾的健康招募者（对照组）进行血清MDA浓度及血浆总SOD活性检测。结果：两组血清MDA浓度及血浆SOD活性均为非正态分布资料;运用等级资料检验,两组血清MDA浓度及血浆SOD活性水平差异均存在显著的统计学意义（P=0.008,0.007）。结论：PTSD患者存在显著的脂质过氧化。     

创伤后应激障碍患者远期认知功能损害的随访研究

目的探讨创伤后应激障碍（PTSD）患者远期认知功能损害的特点。方法选取2004年1月～2005年12月来河北医科大学第一医院精神科就诊的38例符合DsM—IV—TR诊断标准的PTSD患者（PTSD组）,同期在本院就诊的40例广泛性焦虑症患者（焦虑组）,本院常规体检的37名正常人群（健康对照组）。入组时及9年后随访分别完成汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、威斯康星卡分类测验（WCST）、韦氏记忆测试（wPS—R）的测评。结果3组对象入组时性别、年龄、受教育年限差异均无统计学意义（P〉o．05）。入组时焦虑组患者HAMA、HAMD评分高于PTSD组及健康对照组,PTSD组HAMA、HAMD评分高于健康对照组,差异有统计学意义（P〈0．05）。9年后随访,3组间HAMA和HAMD评分差异无统计学意义（P〉0．05）。入组时和9年后随访PTSD组韦氏记忆测查成绩均低于焦虑组及健康对照组,差异有统计学意义（P〈0．01）。入组时和9年后随访PTSD组患者WCST7项目因子中的总应答数（Ra）、错误应答数（Re）显著高于焦虑组及健康对照组,差异有统计学意义（P〈0．05）,各组完成分类数（cc）、正确应答数（Rc）、持续错误数（Rpe）、非持续性错误数（nRpe）、完成第一个分类所需的应答数（Rf）的差异无统计学意义（P〉0．05）。结论PTSD患者发病时存在认知功能损害,主要表现为记忆功能和执行功能损害,且记忆及执行功能损害较广泛性焦虑症患者严重。PTSD患者9年后随访仍存在认知功能损害,提示PTSD的认知功能损害长期持续存在。     

34例汶川地震灾区籍大学生创伤后应激障碍症状叙事疗法的疗效研究

目的 了解汶川地震2年后灾区籍大学生心理状况,观察叙事疗法对创伤后应激障碍（PTSD）患者症状的疗效.方法 采用方便取样.以四川某学院460例5·12地震灾区学生为研究对象,用创伤后应激障碍（PTSD）症状清单平民版（PTSD Checklist-Cicilian version, PCL-C）（分B、C、D三组症候群）,进行自填式调查.使用抑郁自评量表（SDS）、焦虑自评量表（SAS）对灾区籍大学生进行测评,采用叙事疗法对其中34例重度PTSD患者进行了治疗.结果 地震后2年灾区籍大学生PTSD患病率为7.39%,女性（4.78%）高于男性（2.61%）,叙事治疗前后除SDS总分外,其余各项差异显著（P＜0.05）.结论 叙事疗法对地震后灾区籍大学生PTSD治疗有效,在以后的叙事心理干预中应注意关注PTSD患者的抑郁症状.     

创伤后应激障碍同型半胱氨酸水平

目的:探讨创伤后应激障碍(PTSD)患者早期的同型半胱氨酸水平.方法:汶川地震3个月后,对660例抗震志愿者进行PYSD问卷调查,对于可疑PTSD者给予结构性访谈,确诊53例PTSD.随机选取27例PTSD者(PTSD组),35例参加救灾的无PTSD人员(无PTSD组)及78例未参加抗震救灾的同单位人员(对照组),对其血浆同型半胱氨酸水平进行检测.结果:3组血浆同型半胱氨酸浓度均为非正态分布.运用等级资料检验发现,PTSD组与无PTSD组间以及无PTSD组与对照组间在同型半胱氨酸水平差异无显著性,而PISD组与对照组间存在显著的统计学差异. 结论:虽然目前仍不清楚同型半胱氨酸与PTSD间具体关系,但在PTSD的早期就存在血浆同型半胱氨酸水平的升高.     

军人创伤后应激障碍的P300及其与心身症状相关性的对照研究

目的探讨军人创伤后应激障碍（PTSD）的事件相关电位P300变异特点及其与心身症状的相关性.方法对符合中国精神障碍分类与诊断标准第三版（CCMD-3）中PTSD诊断标准的60例患者（PTSD组）以及56例健康军人（对照组）,使用美国Nicolet Bravo脑电生理仪进行P300检测;应用症状自评量表（SCL-90）和事件影响量表（IES）进行心身症状评定,并分析PTSD组的P300与心身症状的相关性.结果 PTSD组的P300靶潜伏期P3（CZ脑区）与N2（PZ脑区）缩短,靶波幅P3（PZ脑区）升高与非靶波幅P2（CZ脑区）降低,与对照组的差异均有显著性（P＜0.05～0.01）;SCL-90总分及其躯体化、强迫、抑郁、焦虑因子分,IES总分及其回避和闯入因子分均明显高于对照组（P＜0.01=）;PTSD患者的部分心身症状与P300部分潜伏期、波幅显著相关（P＜0.05～0.01）.结论 P300可试作为PTSD辅助诊断的一个脑电生理学标志.     

重型颅脑损伤病人创伤后应激障碍的风险因素分析

目的 探讨重型颅脑损伤病人并发创伤后应激障碍（PTSD）的危险因素。方法 回顾性分析2020年1月至2022年2月收治的110例重型颅脑损伤的临床资料。出院前采用PTSD自评量表（PTSD-SS）评估PTSD情况,总分≥50分表示存在PTSD。结果 110例PTSD-SS评分总分（49.64±7.29）分,其中≥50分52例（47.27%）。多因素logistic回归分析显示,女性、低龄、家庭人均月收入低、非亲属照顾、无经济赔偿、合并颅内感染为重型颅脑损伤并发PTSD的独立影响因素（P<0.05）。根据多因素logistic回归分析结果构建PTSD列线图显示一致性指数为0.886,预测PTSD具有较高的应用价值。结论 重症颅脑损伤病人并发PTSD的风险较高,女性、年轻病人、收入低、非亲属照顾、无经济赔偿、合并颅内感染等因素会增加PTSD发生风险,临床应密切关注,识别PTSD风险因素,并给予有效的防治措施降低PTSD发生率。     

创伤后应激障碍与血同型半胱氨酸、叶酸及维生素 B12的相关性

目的 探讨创伤后应激障碍（PTSD）患者应激症状与血同型半胱氨酸、叶酸、维生素B12 代 谢的相关性。方法 2016 年11 月—2017 年11 月对驻疆某部官兵经历创伤性事件后，按照创伤后应激 障碍筛查量表（PCL-C）评分阳性和美国精神疾病诊断统计手册第五版（DSM-5）的诊断标准，根据是否为 PTSD分为PTSD组（n=27）和在相同暴露条件下的未患PTSD的对照组（n=39）。对两组空腹血浆同型半胱 氨酸、叶酸、维生素B12 及部分其他血液学指标进行分析。结果 PTSD组血同型半胱氨酸水平高于对照 组，叶酸、维生素B12 水平、T3、T4低于对照组，差异均有统计学有意义，而TSH、LDL、HDL-C 组间比较， 差异均无统计学意义。结论 PTSD患者其血同型半胱氨酸较高，叶酸及维生素B12 水平较低。     

循证护理在脑卒中后PTSD患者中的应用

目的 探讨循证护理在脑卒中创伤后应激障碍（PTSD）患者中的应用效果。方法 将261例 脑卒中患者随机分为对照组130 例和观察组131 例，对照组采用常规治疗与护理，观察组在此基础上 采用循证护理，比较两组护理效果。结果 脑卒中后6 个月内出现PTSD症状的患者对照组44 例、观 察组42 例。护理后，观察组抑郁、焦虑症状改善率高于对照组（P ＜ 0.05），睡眠质量改善率高于对照组 （P＜ 0.01），服药依从性优于对照组（P＜ 0.05），脑卒中一年内复发率低于对照组（P＜ 0.05）。结论 循证 护理能够有效改善脑卒中后PTSD 患者的抑郁、焦虑及睡眠障碍症状，提高患者服药依从性，促进脑卒 中二级预防并降低脑卒中复发率。     

创伤后应激障碍与抑郁症患者对小剂量地塞米松抑制试验的反应

目的 通过小剂量的地塞米松抑制试验来比较抑郁症与创伤后应激障碍（PTSD）患者的垂体-肾上腺轴功能.方法 采用酶联免疫吸附法（ELISA）测定30例抑郁症和PTSD 患者的血浆中皮质醇、促肾上腺皮质激素基线水平,并行小剂量地塞米松（0.35 mg）抑制试验后再测定两组血浆的皮质醇、促肾上腺皮质激素水平.结果 抑郁症和PTSD 患者的的血浆皮质醇、促肾上腺皮质激素（ACTH）基线水平的差异无统计学意义（P＞0.05）;PTSD 患者对小剂量地塞米松抑制试验与抑郁症组比较,表现为皮质醇和ACTH的降低,即呈现超敏反应（P〈0.05）.结论 PTSD 患者对小剂量地塞米松抑制试验呈现超敏现象,这恰恰为该类PTSD 患者存在持久亢进的垂体-肾上腺轴功能的假说提供了证据.     

重庆市农村和城市失独人员心身健康状况及生活 质量比较

目的 了解农村、城市失独人员的心身健康及生活质量现状。方法 随机抽取重庆市主 城3个区符合条件的失独人员841人，分为城市失独组（n=377），农村失独组（n=464）。使用一般情况调查表、 90项症状自评量表（SCL-90）、抑郁自评量表（SDS）、社会支持评定量表、世界卫生组织生存质量测定量 表简表，进行一对一问卷评定，评定身心健康状况及生活质量，同时与674名未失独的对照组进行对比。 结果 城市失独组、农村失独组、对照组3组在SCL-90总分及因子分、SDS、社会支持、生活质量得分上 差异有统计学意义（P＜ 0.01）。Logistic回归分析显示， SCL-90是失独者抑郁情绪的风险因素，社会支持 的失独者抑郁情绪的保护因素。结论 失独人员身心健康状况较差，生活质量下降，尤其是农村失独群 体。加大农村失独者的社会帮扶力度，提高医疗和养老保障服务。     

首次发病且未用药的成年早发和晚发抑郁症患者脑功能连接差异研究

目的比较成年早发抑郁症(EOD)和成年晚发抑郁症(LOD)患者默认网络(DMN)内部功能连接的差异,探究不同发病年龄的抑郁症患者是否有不同的发病机制。方法选取在昆明医科大学第一附属医院精神科门诊或住院的EOD患者(n=58)和LOD患者(n=62)为研究对象,同期招募年轻健康对照组(n=60)和年老健康对照组(n=52)。对受试者进行静息态功能磁共振扫描,选择左侧楔前叶为种子点,计算该种子点与全脑的功能连接,并比较各组间该种子点的功能连接差异。结果四组之间功能连接具有差异的脑区涉及双侧额叶、颞叶、基底节、枕叶、顶叶及小脑等脑区。EOD组左侧楔前叶与左侧小脑Crus1区、左侧小脑IX区、左侧颞中回、右侧楔前叶、右侧前扣带回、右侧额中回、右侧角回、右侧脑岛、右侧内侧额上回、右侧颞中回的功能连接均高于年轻健康对照组(Z=3. 752 4～5. 867 8,P均0. 05);而左侧楔前叶与左侧额中回、左侧中央旁小叶、右侧缘上回、右侧额上回、右侧颞下回、右侧中央后回、右侧中央前回、右侧枕上回的功能连接均低于年轻健康对照组(Z=-5. 007 6～-3. 797 7,P均0. 05)。LOD组左侧楔前叶与左侧小脑Crus2区、左侧尾状核、左侧颞下回、左侧小脑Crus1区、左侧角回、左侧额中回、右侧额中回、右侧角回、右侧眶额部额中回的功能连接均高于年老健康对照组(Z=4. 122 8～6. 579 4,P均0. 05);与左侧海马旁回、左侧额上回、右侧枕中回、右侧中央前回、右侧内侧额上回、右侧锯状回、右侧颞下回、右侧中央旁小叶、右侧梭状回、右侧后扣带回的功能连接均低于年老健康对照组(Z=-5. 884 0～-3. 617 2,P均0. 05)。EOD组左侧楔前叶与左侧锯状回、左侧小脑IV-VI区、左侧小脑Crus2区的功能连接比LOD组高(Z=4. 087 7、3. 937 4、3. 672 1,P均0. 05);EOD组左侧楔前叶与右侧额中回、右侧眶额部额下回、右侧额上回的功能连接比LOD组低(Z=-4. 274 8、-3. 956 8、-4. 724 3、-3. 663 2,P均0. 05)。结论 DMN内部功能连接增高及额顶网络功能连接降低可能与EOD的发病机制相关,而DMN前部功能连接增高和后部功能连接降低可能与LOD的发病机制相关,不同发病年龄的成年抑郁症患者可能有不同的发病机制。     

Different spatial patterns of brain atrophy and global functional connectivity impairments in major depressive disorder

Alterations in grey matter structure and functional connectivity (FC) are pathological features of major depressive disorder (MDD). However, the relationship between brain structural and functional impairments in MDD remains uncertain. Thus, the aim of this study was to investigate the relationship between alterations in grey matter volume (GMV) and resting-state global functional connectivity density (rs-gFCD) in MDD. Forty-five patients with MDD and 48 healthy controls underwent structural and resting-state functional magnetic resonance imaging (fMRI). GMV and rs-gFCD maps of each subject were created, and the intergroup differences in these neuroimaging metrics were evaluated. Compared to healthy controls, patients with MDD displayed reduced GMV in the left insula, putamen, amygdala and hippocampus (mainly in the limbic system). In contrast, decreased rs-gFCD was observed in the left postcentral and precentral gyri, right fusiform gyrus and lingual gyrus (mainly in the sensory system). Furthermore, we found no significant correlations between GMV and rs-gFCD in these brain regions. Finally, overlap ratio analysis demonstrated that the spatial distribution patterns of intergroup differences on the GMV and rs-gFCD maps were distinct. Our findings suggest that the presence of distinct spatial distribution patterns of brain atrophy and global FC impairments might be pathological features of MDD.     

The atrophy and laterality of the hippocampal subfields in parents with or without posttraumatic stress disorder who lost their only child in China

Investigating hippocampal subfields may provide new and important insights into the pathophysiology of posttraumatic stress disorder (PTSD). However, no study has examined the hippocampal subfield volume changes in parents with or without PTSD who had lost their only child and could no longer conceive in China. Fifty-seven parents with PTSD (PTSD+), 11 trauma-exposed parents without PTSD (PTSD?), and 39 non-traumatized controls were recruited to examine the hippocampal subfield volumes using magnetic resonance imaging. Correlations of the volumes with the time since trauma and Clinician-Administered PTSD Scale (CAPS) scores were investigated in the PTSD+ group. The volumes of the bilateral cornu ammonis (CA) 2–3, CA4–dentate gyrus (DG), and left subiculum were significantly smaller in the PTSD+ and PTSD? groups than in the controls, but there were no significant differences between the PTSD+ and PTSD? groups. Additionally, the left CA2–3 and CA4–DG volumes reduced more than those on the right side in the PTSD+ and PTSD? groups. The subfield volumes were not related to the time since trauma and the CAPS scores in the PTSD+ group. In conclusion, hippocampal subfield volumes decreased in parents who lost their only child with or without PTSD, and the volumetric reduction may be independent of PTSD and trauma-related. Moreover, the hippocampal volume deficits showed laterality that the left side was affected more than the right, and the hippocampal subfields may show differential vulnerabilities to trauma/PTSD, with the CA2–3 and CA4–DG subfields more sensitive than others.     

Aberrant voxel-based degree centrality and functional connectivity in Parkinson's disease patients with fatigue

Aims

The study aimed to investigate alterations in the inherent connectivity pattern of global functional networks in Parkinson's disease (PD) patients with fatigue.

Methods

Eighteen PD patients with fatigue (PD-F), 20 PD patients without fatigue (PD-NF), and 23 healthy controls (HCs) were recruited and analyzed by the voxel-wise degree centrality (DC) and the seed-based functional connectivity (FC) analysis. Meanwhile, the surface-based morphometry (SBM) analysis was also commanded to explore the structural alternations among groups.

Results

PD-F patients displayed reduced DC values in the left postcentral gyrus relative to PD-NF and HCs groups, while increased DC values in the bilateral precuneus compared to HCs. Simultaneously, altered DC value in the left postcentral gyrus negatively corresponded to the mean fatigue severity scale (FSS) in PD-F patients. Additionally, the receiver operating characteristic (ROC) curves uncovered that the reduced DC value of the left postcentral gyrus could discriminate PD-F from PD-NF and HCs groups. Our FC analysis further revealed that altered FC was located predominantly in the sensorimotor network in the PD-F group. Moreover, we discovered no statistically significant differences between the three groups concerning cortical thickness.

Conclusion

Our findings indicated that the altered functional connectivity in the sensorimotor network centering on the left postcentral gyrus and the bilateral precuneus might be the potential pathogenesis of PD with fatigue.     

Duloxetine effects on striatal resting‐state functional connectivity in patients with major depressive disorder

Reward deficits and associated striatal circuitry disturbances have been implicated in the onset and progression of major depressive disorder (MDD). However, no studies have been conducted to investigate how the striatal circuitry changes during standard antidepressant, which is important for development of novel and targeted treatments for MDD. We examined the seed‐to‐whole‐brain functional connectivity (FC) for six striatal subregions based on resting‐state fMRI data of 23 MDD patients before and after 8‐week duloxetine, a serotonin, and noradrenaline reuptake inhibitor. Twenty‐three healthy controls (HCs) were also scanned twice with an 8‐week interval. After the analysis of covariance, we observed significant group‐by‐time interaction on FC of the dorsal caudate (DC), ventral striatum (VS), and putamen seeds. Post hoc analyses revealed that the FC between several right striatal seeds and left superior frontal gyrus (SFG), between right DC and left precuneus, between right superior VS and left inferior parietal lobe, were significantly higher in MDD patients compared to HCs at baseline and were reduced after treatment. Conversely, the FC between right inferior VS and left cerebellum was lower in MDD patients and was increased after treatment. Patients with larger reduction in right superior VS—left SFG FC exhibited larger alleviation of rumination. These findings suggest that duloxetine modulates the striatal FC with dorsolateral prefrontal cortex, posterior default mode network, and cerebellum, and partly, these changes underlie symptomatic improvement. This study adds to our understanding of antidepressant mechanism and future therapeutic development might benefit from considering these striatal circuitry as potential targets.     

偏头痛与静息态脑功能连接研究

目的本文研究采用静息态功能磁共振成像(rfMRI)技术描述偏头痛患者静息态脑功能连接改变,为探索偏头痛的发病机制提供影像学资料。方法收集16例偏头痛患者与16例健康对照,采集rfMRI成像,计算低频振幅,找出感兴趣区做功能连接进行统计分析。结果偏头痛患者左侧岛叶、左侧额下回低频振幅显著低于对照组,右侧视觉皮质低频振幅显著高于对照组;以左侧额下回、右侧枕中回为感兴趣区,发现左侧额下回与脑干之间的功能连接增强,与双侧枕叶之间的功能连接减弱;右侧枕中回与双侧楔前叶延伸至扣带回中部区域之间的功能连接增强,与双侧中央前回、双侧缘上回、双侧颞上回及双侧额下回之间的功能连接减弱。结论偏头痛患者无头痛发作时神经元活动强度改变,大脑功能连接异常,这导致大脑整合信息过程改变,并与偏头痛发病相关。     

Altered intra- and interregional synchronization in the absence of the corpus callosum: a resting-state fMRI study

Agenesis of the corpus callosum (AgCC) can result in subtle to severe cognitive deficits. Individuals with impaired cognition often show abnormalities on resting-state functional magnetic resonance imaging (rs-fMRI). This study used rs-fMRI to investigate changes in regional homogeneity (ReHo) and functional connectivity (FC) among individuals with AgCC. AgCC individuals (n = 10) and age-, sex-, and education-matched healthy control subjects (n = 19) were included in this study. The ReHo values were calculated to represent spontaneous brain activity. The regions which showed altered ReHo were selected as seeds to compare FC with the whole brain between the AgCC group and the healthy control group. Compared with healthy control subjects, the AgCC individuals had increased ReHo in the left anterior cingulate gyrus, left rolandic operculum, and right precuneus and decreased ReHo in the right calcarine, right cingual gyrus and right cuneus gyrus. The right calcarine and the right lingual gyrus in the AgCC exhibited decreased FC with bilateral cuneus, superior occipital gyrus, Rolandic operculum, superior temporal gyrus, posterior central gyrus, and midcingulate gyrus.The right cuneus gyrus in the AgCC individuals exhibited decreased FC with the bilateral calcarine gyrus, left cuneus, and left superior occipital gyrus. Our study revealed several subareas within the visual cortex exhibited remarkable abnormalities of spontaneous brain activity and decreased FC with the higher-order cognitive cortex.The abnormalities of ReHo and FC in AgCC individuals may provide new insights into the neurological pathophysiology.     

难治性癫痫患者楔前叶功能连接的静息态功能磁共振成像研究

目的应用静息态功能磁共振成像(rs-f MRI)探讨难治性癫痫患者楔前叶与全脑功能连接的改变及其意义。方法对23例难治性癫痫患者(癫痫组)及23名健康人(对照组)进行rs-f MRI检查,采集数据后采用功能连接的方法,分别计算以左侧楔前叶和右侧楔前叶为感兴趣区与全脑的功能连接,运用双样本t检验的统计学方法发现两组的显著性差异并进行分析。结果癫痫组左侧楔前叶与双侧顶下小叶、双侧岛叶、右侧缘上回、右侧额中回和双侧额下回的功能连接较对照组减弱(均P0.05);癫痫组左侧楔前叶与双侧海马旁回、双侧额上回、左侧后扣带回的功能连接较对照组增强(均P0.05)。癫痫组右侧楔前叶与左侧顶下小叶、右侧缘上回、右侧额中回、右侧额下回的功能连接较对照组减弱(均P0.05);癫痫组右侧楔前叶与双侧楔叶、左侧后扣带回的功能连接较对照组增强(均P0.05)。结论难治性癫痫患者静息状态下楔前叶与全脑的功能连接存在异常,"默认网络"功能的抑制可能是癫痫患者意识及认知等功能损害的重要原因。