运用VBM法研究创伤后应激障碍患者在脑结构上的动态变化

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摘要目的探讨经历车祸以及目睹车祸创伤性事件后出现创伤后应激障碍（PTSD）患者脑内结构形态学的动态改变。方法选取2019年1—12月在新疆维吾尔自治区石河子市公路上经历车祸交通事故就诊于石河子大学医学院第一附属医院及新疆维吾尔自治区石河子市人民医院患者40例。其中经历车祸所致PTSD患者17例作为PTSD组和经历车祸但未发生PTSD患者23例作为非PTSD组。采用基于体素的形态学测量方法（VBM）对两组脑图像进行后处理，比较PTSD组与非PTSD组在创伤事件1周、2个月时在脑结构上的变化，比较PTSD组、非PTSD组第1次功能性磁共振成像（fMRI）与第2次fMRI在脑结构上的变化。结果在车祸创伤事件1周时PTSD组与非PTSD组的fMRI检查中脑结构未见异常，在创伤事件后2个月时PTSD组较非PTSD组右侧前额叶体积变小（P ＜ 0.01，GRF校正）。非PTSD组在创伤事件后2个月较1周时的fMRI检查中脑结构检查未见异常；PTSD组在创伤事件后2个月较第1周左侧中央沟盖及前扣带回体积缩小（P ＜ 0.01，GRF校正）。结论 PTSD患者右侧前额叶、前扣带回及中央沟盖等结构发生改变，可能是导致PTSD发病的重要因素，同时根据上述脑结构是否改变有助于PTSD的早期诊断。

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	李浩浩薛瑾艳胡敏梁霞张桂青

关键词 ：创伤后应激障碍, 功能性磁共振, 脑结构, 动态变化

Abstract：Objective To investigate the dynamic changes in brain structure morphology of patients with post-traumatic stress disorder (PTSD) after experiencing or witnessing a traumatic accident such as car accident. Methods From January to December 2019, a total of 40 patients who experienced traffic accidents such as car accident on roads in Shihezi, Xinjiang Uygur Autonomous Region were selected and admitted to the First Affiliated Hospital, School of Medicine, Shihezi University and the Municipal People′s Hospital of Shihezi, Xinjiang Uygur Autonomous Region. Among them, 17 cases of the patients who experienced a car accident developed PTSD were treated as PTSD group and 23 cases of the patients who experienced a car accident but did not develop PTSD were treated as non-PTSD group. Voxel-based morphological measurement method (VBM) was used to post-process the brain images of the two groups. The brain structure changes in the PTSD group and the non-PTSD group at one week and two months of the traumatic event were compared. The brain structure changes of the first functional magnetic resonance imaging (fMRI) and the second fMRI were compared between the PTSD group and the non-PTSD group. Results No abnormalities were found in brain structure during fMRI examinations of the PTSD group and non-PTSD group at one week of the traumatic event. At two months after the traumatic event, the PTSD group had a smaller volume of the right prefrontal lobe than the non-PTSD group (P ＜ 0.01, GRF adjusted). No abnormalities were found in the brain structure of the non-PTSD group during fMRI examinations at two months after the traumatic event compared with one week. In the PTSD group, the volume of left central sulcus and anterior cingulate gyrus decreased at two months after the traumatic event compared with that at one week. (P ＜ 0.01, GRF adjusted). Conclusion Structural changes in the right frontal lobe, anterior cingulate gyrus, and central sulcus of PTSD patients may be important factors leading to the pathogenesis of PTSD. At the same time, based on whether these changes in brain structure as above may help in the early diagnosis of PTSD.

Key words： Post-traumatic stress disorder Functional magnetic resonance Brain structure Dynamic change

基金资助:国家自然科学基金资助项目（31860279）。

通讯作者: 张桂青（1965.4-），女，博士，教授，主任医师，博士生导师；研究方向：心理康复。

作者简介: 李浩浩（1992.1-），男，硕士；研究方向：心理康复。

引用本文:

李浩浩薛瑾艳胡敏梁霞张桂青. 运用VBM法研究创伤后应激障碍患者在脑结构上的动态变化[J]. 中国医药导报, 2020, 17(29): 13-16.
LI Haohao XUE Jinyan HU Min LINAG Xia ZHANG Guiqing. Dynamic changes in brain structure of patients with post-traumatic stress disorder using VBM method. 中国医药导报, 2020, 17(29): 13-16.

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