失独父母脑白质微结构扩散张量成像纵向改变及其与创伤后应激障碍症状的关系分析  

A study on longitudinal changes in white matter microstructure of parents who have lost their only child based on diffusion tensor imaging and its relationship with symptoms of posttraumatic stress disorder

作　　者：兰青悦 曹志宏 戚荣丰 罗一烽 张丽[3] 葛继元 戴欢欢 刘波 陈峰[4] 李凌江[3] 卢光明 Lan Qingyue;Cao Zhihong;Qi Rongfeng;Luo Yifeng;Zhang Li;Ge Jiyuan;Dai Huanhuan;Liu Bo;Chen Feng;Li Lingjiang;Lu Guangming(Department of Radiology,the Affifiliated Yixing Hospital of Jiangsu University,Wuxi 214200,China;Department of Radiological Diagnosis,Jinling Hospital,Nanjing University School of Medicine/General Hospital of Eastern Theater Command,Nanjing 210002,China;Mental Health Institute,the Second Xiangya Hospital,National Technology Institute of Psychiatry,Key Laboratory of Psychiatry and Mental Health of Hunan Province,Central South University,Changsha 410011,China;Department of Radiology,Hainan Provincial People′s Hospital,Haikou 570311,China)

机构地区：[1]江苏大学附属宜兴医院放射科,无锡214200 [2]南京大学医学院附属金陵医院东部战区总医院放射诊断科,南京210002 [3]中南大学湘雅二医院精神科国家精神心理疾病临床医学研究中心,长沙410011 [4]海南省人民医院放射科,海口570311

出　　处：《中华医学杂志》2022年第23期1760-1765,共6页National Medical Journal of China

基　　金：国家自然科学基金(81801678,81301209,82171518,81971602);全军医学科技“十二五”科研重点基金(BWSllJ063);江苏省自然科学基金青年项目(BK20170223);湖南省自然科学基金青年项目(2020JJ5844);无锡市卫健委重大项目(Z201908);无锡市中青年拔尖人才项目(BJ2020109);无锡市卫健委转化专项(ZH202108)。

摘　　要：目的探讨失独不伴精神疾病的父母脑白质微结构扩散张量成像的纵向改变及其与创伤后应激障碍(PTSD)症状的关系。方法收集2016年9月至2017年3月江苏省失独且不伴任何精神疾病的父母作为研究对象(TENP组,32名),在基线期和5年随访结束时接受MRI扫描,同时采用临床用PTSD诊断量表(CAPS)评估相关症状的严重程度。另外招募与基线期TENP组性别、年龄及受教育程度匹配的无精神疾病的健康者作为对照(对照组,27名),并接受同样的MRI扫描方案。采用基于纤维束示踪的空间统计方法横向分析基线期TENP组和对照组各向异性分数(FA)值差异,并进一步将横向差异脑区作为感兴趣区,对TENP组进行纵向随访。同时采用偏相关分析纵向差异脑区FA值变化与CAPS评分变化之间的关系。结果与对照组相比,基线期TENP组右侧扣带回、钩束、上纵束、皮质脊髓束、下额枕束、下纵束和大钳FA值下降(0.613±0.032比0.631±0.034,0.539±0.048比0.563±0.045,0.534±0.033比0.558±0.039,0.560±0.038比0.580±0.030,0.519±0.023比0.549±0.024,0.489±0.038比0.518±0.027,0.499±0.027比0.533±0.032;均P<0.05)。由基线期到随访结束,TENP组的创伤再体验症状及回避/麻木症状得分降低[(5.2±2.8)比(8.1±4.9)分,(4.0±3.2)比(6.6±5.4)分;均P<0.05];右侧皮质脊髓束、下额枕束、下纵束和大钳FA值下降(0.523±0.049比0.537±0.049,0.568±0.052比0.590±0.050,0.540±0.063比0.559±0.059,0.520±0.059比0.547±0.059;均P<0.05);右侧下额枕束、右侧下纵束FA值的减低与回避/麻木症状得分的减低呈负相关(r=-0.458、-0.374,均P<0.05)。结论失独创伤可导致失独者脑白质微结构完整性损伤。随着失独时间的推移,失独父母在不发展为PTSD等精神疾病且临床症状有所缓解的情况下,其脑白质微结构损伤仍在持续性进展。Objective To investigate the longitudinal changes of white matter microstructural based on diffusion tensor imaging in parents who lost their only child without psychiatric disorders and its relationship with symptoms of posttraumatic stress disorder(PTSD).Methods Parents who had who lost their only child and without psychiatric disorders in Jiangsu Province,from September 2016 to March 2017,were retrospectively collected(TENP group,32).MRI scans were performed at baseline and at the end of 5-year follow-up,and the Clinician Administered PTSD Scales(CAPS)were used for assessing the severity of symptoms.Additionally,sex,age and education level matched healthy subjects were recruited as healthy controls(control group,27)and underwent MRI scanning using the same protocol.The differences of fractional anisotropy(FA)values between TENP group and control group at baseline were analyzed by using Tract-based spatial statistics method,and the brain areas of lateral differences were used as the regions of interest for longitudinal follow-up analysis of TENP group.Partial correlation analysis was used to evaluate the relationship between FA values changes in longitudinal differences in brain regions and CAPS scores.Results Compared with the control group,FA values of the right cingulate gyrus,Uncinate fasciculus,superior longitudinal fasciculus,corticospinal tract,Inferior fronto-occipital fasciculus,Inferior longitudinal fasciculus and forceps major in TENP group were decreased at baseline((0.613±0.032)vs(0.631±0.034),(0.539±0.048)vs(0.563±0.045),(0.534±0.033)vs(0.558±0.039),(0.560±0.038)vs(0.580±0.030),(0.519±0.023)vs(0.549±0.024),(0.489±0.038)vs(0.518±0.027),(0.499±0.027)vs(0.533±0.032);all P<0.05).From baseline to follow-up,scores of trauma reexperience symptoms and avoidance/numbness symptoms were decreased((5.2±2.8)vs(8.1±4.9),(4.0±3.2)vs(6.6±5.4);all P<0.05);FA values of the right corticospinal tract,Inferior fronto-occipital fasciculus,Inferior longitudinal fasciculus and forceps major were decreas

关 键 词：体层摄影术 X线计算机 失独 扩散张量成像 基于纤维束示踪的空间统计 白质 创伤后应激症状 随访研究 

分 类 号：R749.5[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]