躯体化障碍情绪相关脑区的功能网络及脑代谢特征研究

Somatization disorder (SD) is termed as complainings of physical symptoms that have no medical basis. It brings heavy economical burdens to the society. Our prior study shows that the experience and suppression of negative emotions contribute to the development and maintenance of SD. However, the biological mechanisms by which negative emotions might be linked to SD are poorly understood. Previous research has found that dysfunctions and abnormal levels of some neurotransmitters in emotion-related brain regions were associated with both negative emotion experience and suppression, and SD. Thus, the current study tests the hypothesis that dysfunctions and abnormal levels of some neurotransmitters in certain emotion-related brain regions play important roles in the link from negative emotions to SD. SD patients would be recruited. Patients with Diabetic Peripheral Neuropathy and health control people would be selected as comparisons. Both in resting and visual emotion-arousal states, brain regions functions and neurotransmitter metabolic levels would be evaluated respectively with fMRI and MRS. Brain functional network analysis would be conducted to explore the functional connectivities between different brain regions of SD patients. Furthermore, experiences and suppression of negative emotions in SD patients would be assessed using psychosocial measurements. The potential mediating and moderating roles of dysfunctional brain networks and neurotransmitter metabolic patterns would be tested. Moreover, differences in the functions and neurotransmitter metabolic patterns of brain regions would be explored after SD patients are treated with cognitive-behavioural therapy(CBT). The results of current study could help find out the biological mechanisms through which negative emotions might have fostered SD, and have the potential to inform the design of better treatment strategies for individuals with SD.

躯体化障碍（SD）表现为与客观医学证据不符的躯体不适，给国家带来沉重经济及社会负担。我们的前期研究发现人类负性情绪体验及其压抑可诱发SD，但其生物学机制不明。既往研究发现情绪相关脑区功能及神经递质代谢异常与负性情绪、SD均相关，提示前者在负性情绪诱发SD的过程中可能发挥重要作用。为验证该假设，本研究选取SD患者为对象，以糖尿病周围神经病变和健康人群为对照，应用功能核磁共振及质子磁共振波普成像技术，测量被试在静息态和情绪图片刺激时脑区功能信号及神经递质水平，采用脑功能网络分析探讨SD患者各脑区在时间及空间上的功能网络连接特征，并结合负性情绪的心理学测量，探索情绪相关脑区功能及代谢改变在负性情绪引发SD过程中发挥的作用。并进一步通过观察认知行为治疗（CBT）后SD患者脑区功能及代谢的变化，探讨CBT起效的生物学机制。本研究可为阐明SD发病的部分生物学机制提供初步线索，为其防治提供一定理论参考。

躯体症状障碍（SSD）表现为与客观医学证据不符的躯体不适，给国家带来沉重经济及社会负担，探讨其社会心理学和神经生物学发病机制，并探索两者相互作用的机制，有针对性的尝试心干预方法，有重要社会及经济意义。本研究选取大学生被试，探讨了躯体化症状与个体负性情绪、家庭环境因素、个体自尊、情绪管理方式等因素的相关性。选取了SSD 患者为对象，以糖尿病周围神经病变和健康人群为对照，应用功能核磁共振成像技术，测量被试在静息态和情绪图片刺激时脑区功能信号，并结合负性情绪的心理学测量，探索了情绪相关脑区功能改变在正性、中性和负性情绪引发SSD 过程中发挥的作用。并结合上述研究结果，为患者提供进一步的认知行为家庭治疗，探讨针对SSD的有效干预方法。本研究发现SSD症状与家庭环境、负性情绪体验及表达方式相关，并且家庭环境在愤怒引发症状的路径中发挥调节作用。SSD患者在情绪刺激时，在右侧颞上回、内侧前额叶、右侧背外侧前额叶等脑区的激活存在不同程度的异常。关注家庭互动和认知行为的家庭治疗干预方法可以较有效的减轻患者躯体化症状。本研究为阐明SSD发病的社会心理学及神经生物学机制做出了贡献，为未来制定有针对的心理干预方法提供了神经生物学和心理社会学层面的理论和发病机制参考。