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目的:利用事件相关设计的功能磁共振成像技术探讨汉族女性抑郁症患者明确和不明确识别动态面部表情的神经基础。方法:以15例女性重性抑郁症患者为病例组(抑郁组),与之相匹配的健康者为对照组,利用配对t检验比较两组在明确和不明确识别动态面部表情时激活脑区的差异,设对比有差异(P<0.001,未校正)的体素范围(K值)≥10为具有显著性差异。结果:(1)与对照组相比,抑郁组在明确识别动态喜悦表情时右枕中回、右顶下小叶、左中央后回、右中央前回、右楔前叶活动增高,而右顶上小叶、左顶上小叶等区域活动降低;抑郁组在不明确识别动态喜悦表情时右顶下小叶活动增高,而右楔叶、右中央后回、左顶上小叶等区域活动降低。(2)与对照组相比,抑郁组在明确识别动态悲伤表情时右枕中回、左中央后回、左楔前叶活动增高,而左额中回活动降低;抑郁组在不明确识别动态悲伤表情时左梭状回、右中央前回、右楔前叶、左颞上回、左缘上回、边缘叶(两侧海马旁回、左后扣带回)、皮质下区以及中脑等区域活动增高,而右中央后回、颞叶等区域活动降低。结论:抑郁症患者和正常对照在识别喜悦情绪时,与情绪产生的相关脑区活动无明显差异,脑区激活的主要差异表现为明确状态下感知面部运动能力降低,而在不明确状态时却增强;而患者在识别悲伤表情时都表现为情绪产生相关脑区活动增强,而情绪调节相关脑区活动减弱,这种异常在无意识状态下(不明确条件下)更为明显。
OBJECTIVE: To explore the neural basis for the explicit and unambiguous identification of dynamic facial expressions in Han female depression patients using event-related design of functional magnetic resonance imaging. Methods: Fifteen female patients with major depressive disorder were selected as the case group (depression group) and the matched healthy subjects as the control group. Paired t-test was used to compare the two groups in activating the brain area when the facial expression was clearly and indefinitely identified (P <0.001, uncorrected) voxel range (K value) ≥ 10 for the difference was significant. Results: (1) Compared with the control group, in the depression group, the right middle occipital gyrus, the right apical lobule, the left middle back, the right middle anterior gyrus and the right wedge anteriorly increased when they clearly identified the dynamic facial expressions. In the depression group, the activity of right parietal lobule increased, while the activities of right wedge, right posterior central gyrus, left parietal lobule and other regions decreased. (2) Compared with the control group, in the depression group, when the dynamic expression of sadness was clearly identified, the right middle occipital gyrus, the left posterior central gyrus, the left anterior lobe increased, while the left frontal gyrus decreased. In the depression group, Sad face left fusiform back, right central anterior back, right wedge anterior lobe, left temporal superior, left margin of the upper back, edge of the leaves (both sides of the parahippocampal gyrus, left posterior cingulate), subcortical area and the brain Regional activities increased, while the right central back, temporal lobe and other regional activities decreased. Conclusions: There is no significant difference between cognitive impairment and normal controls when compared with emotion-related brain activity. The major difference in brain activation is the decrease of cognitive ability of facial motility under definite state, while in the absence of definite state . However, when patients identify sad facial expressions, they show more activity in brain areas related to emotion production and less brain activity in areas related to emotion regulation. Such abnormalities are more obvious under unconscious conditions (under ambiguous conditions).