- 學位論文
自殺企圖與意念之憂鬱症患者大腦功能聯結體分析
Connectome analysis of brain functional network alterations in depressed patients with suicide attempt and ideation
摘要
目的：在學術上已有許多研究利用靜息態功能性磁振造影(resting-state functional resonance imaging, rs-fMRI)來探討憂鬱症患者的大腦，針對憂鬱症患者自殺企圖的研究相對較少，因此我們的研究是利用rs-fMRI去探討有無自殺企圖和自殺意念之憂鬱症患者與正常人的大腦是否有功能性連接以及網路上的差異。 材料與方法：總共招募了144名受測者，44名健康受測者 (Healthy Controls, HC)、32名無自殺意念無自殺企圖憂鬱症患者(Depressive patients without suicide attempt and suicide ideation, NS)、35名有自殺意念無自殺企圖憂鬱症患者(Depressive patients with suicide ideation, SI)以及33名有自殺企圖憂鬱症患者(Depressive patients with suicide attempt, SA)，在3 Tesla 的MRI(Verio, SIEMENS, Germany)下使用echo planar image (EPI)的序列進行掃描，取得靜息態功能性磁振造影(rs-fMRI)的影像，並進行以下的分析，包括：功能性連接(functional connectivity, FC)、部分低頻震盪現象(fractional amplitude of low-frequency fluctuations, fALFF)、區域同質性(regional homogeneity, ReHo)、圖論分析(graph theoretical analysis, GTA)和基於網路分析方法(network-based statistics analysis, NBS)，來調查有自我傷害行為或想法憂鬱症患者。 結果：在FC的結果顯示，SA組與SI組在海馬迴、視丘以及運動皮質區域其功能性連接都有異於NS組以及HC組的情形。在基於體素分析方法(voxel-based analysis ,VBA)分析中，我們發現SA組在視丘、顳中回、顳上回、頂上回、角回、殼核和眶部額下回其mfALFF值或mReHo值異於NS組與HC組，SI組在視丘、顳級顳上回、楔葉、顳級顳中回和顳中回其mfALFF值或mReHo值異於NS組與HC組，NS組在中央前回以及輔助運動皮質區其mfALFF值或mReHo值異於HC組。在量表相關性分析中，我們發現SA組與漢氏憂鬱量表相關性分析中，其mfALFF值或mReHo值在三角部額下回、中央前回、額中回、角回、顳中回、輔助運動皮質區、顳上回等腦區有相關性，與焦慮總分相關性分析中，其mfALFF值或mReHo值在三角部額下回、前扣帶皮質、顳下回、額中回等腦區有相關性，與憂鬱總分相關性分析中，其mfALFF值或mReHo值在顳下回、梭狀回、楔葉等腦區有相關性。在SI組與漢氏憂鬱量表相關性分析中，其mfALFF值或mReHo值在楔葉、海馬迴、顳級顳上回、海馬旁回等腦區有相關性，與焦慮總分相關性分析中，其mfALFF值或mReHo值在中央後回、額下回、額中回、舌回等腦區有相關性，與憂鬱總分相關性分析中，其mfALFF值或mReHo值在中央後回和楔葉等腦區有相關性。在GTA與NBS的分析中，在自殺企圖實驗中發現憂鬱症患者SA相較於HC的大腦有略佳的整合能力，在自殺企圖和自殺意念實驗還發現HC相較於SA和SI的大腦有略佳分工能力。 結論：在FC和VBA的分析中，我們的結果顯示，SA組在視丘和顳中回的部分有異常活化的情形，SI組在視丘以及楔葉的部分有異常活化的情形，我們可以推測視丘的異常可能與罹患憂鬱症有關，而顳中回異常可能與自殺企圖有關，以及楔葉的異常與自殺意念有關。在量表相關性分析中，我們發現SA組在額中回、角回和顳上回的部分與憂鬱量表有相關性，我們推測這些腦區的異常可能與SA組的憂鬱症嚴重程度、焦慮程度有關，SI組的部分我們發現楔葉和海馬迴與憂鬱量表有相關性，因此我們推測這些腦區的異常可能與SI組的憂鬱症嚴重程度、焦慮程度有關。在GTA與NBS的分析中，我們發現SA相較於HC的大腦有略佳的整合能力，還發現HC相較於SA和SI的大腦有略佳分工能力，因此我們推測當憂鬱症患者有自殺企圖或是自殺意念，大腦的功能性連接有異於正常人的情形，但是這樣的異常不能表示是自殺企圖或自殺意念所造成的或是因為大腦本身的異常而導致憂鬱症患者出現自殺企圖或自殺意念的現象，未來需要更多縱向研究來釐清兩者之間的關係，也可以繼續針對上述的腦區進行探討。
並列摘要
Purpose: Our aim was to use resting-state fMRI (rs-fMRI) to investigate the functional differences between depression patients which included depressive patients with suicide attempt (SA), depressive patients with suicide ideation (SI), depressive patients without suicide attempt and suicide ideation (NS) and healthy controls (HC). Methods and Materials: Our study recruited four groups of 144 participants: 33 depressive patients with suicide attempt (SA), 35 depressive patients with suicide ideation (SI), 32 depressive patients without suicidal attempt and suicide ideation (NS), and 44 healthy controls (HC). All participants were scanned using a 3T MRI (Verio, SIEMENS, Germany) imaging system with an echo planar image (EPI) sequence to obtain resting-state functional images. Results: In FC analysis, we found that hippocampus, thalamus, and motor cortex had different FC in the SA and SI compared with the NS and HC. In voxel-based analysis (VBA) analysis, we found that thalamus, middle temporal gyrus, superior temporal gyrus, superior parietal gyrus, angular gyrus, putamen, and inferior orbitofrontal gyrus had different mean fractional amplitude of low-frequency fluctuations (mfALFF)/ mean regional homogeneity (mReHo) in the SA compared with the NS and HC. And we found that thalamus, superior temporal pole gyrus, cuneus, middle temporal pole gyrus, and middle temporal gyrus had different mfALFF/ mReHo in the SI compared with the NS and HC. We also found that precentral gyrus and supplementary motor area had different mfALFF/ mReHo in the NS compared with the HC. In multiple regression analysis, we found that inferior triangular frontal gyrus, precentral gyrus, middle frontal gyrus, angular gyrus, middle temporal gyrus, supplementary motor area, and superior temporal gyrus in the SA had correlation between mfALFF/ mReHo and HAM-D. We found that inferior triangular frontal gyrus, anterior cingulate cortex, inferior temporal gyrus, and middle frontal gyrus in the SA had correlation between mfALFF/ mReHo and anxiety score. We also found that inferior temporal gyrus, fusiform gyrus, and cuneus gyrus in the SA had correlation between mfALFF/ mReHo and depression score. We found that cuneus gyrus, hippocampus, superior temporal pole gyrus, and parahippocampal gyrus in the SI had correlation between mfALFF/ mReHo and HAM-D. We found that postcentral gyrus, inferior frontal gyrus, middle frontal gyrus, and lingual gyrus in the SI had correlation between mfALFF/ mReHo and anxiety score. We also found that postcentral gyrus and cuneus gyrus in the SI had correlation between mfALFF/ mReHo and depression score. In the GTA among the three groups, i.e. SA, NS and HC, we found a significant tendency in the characteristic path length, normalized characteristic path length (λ), global efficiency, assortativity and transitivity. In NBS analysis, we compared the edges of the brain networks between the SA and the HC. In the GTA among the three groups, i.e. SI, NS and HC, we found a significant tendency in the global efficiency. In NBS analysis, we compared the edges of the brain networks between the SI and the HC, and also between the SI and the NS. Conclusions: In functional connectivity analysis, voxel-based analysis, multiple regression analysis, GTA, and NBS, we found differences in SI/SA compared with NS and HC. We concluded that the brain function of major depressive disorders with and without suicide attempt or suicide ideation changed compared with healthy participants. Although our results are not all similar to other researches, but still had some same brain area such as thalamus. We also concluded that cuneus was related to suicidal ideation. We suggested that depressed patients with or without suicide attempt/ suicidal ideation may affect their brain functional connectivity.
參考文獻
延伸閱讀
- 周幸玲（2008）。重鬱症個案自殺企圖與生活型態防衛機轉相關性之探討〔碩士論文，臺北醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0007-2307200814214200
- 鐘明勳、杜家與、蔣欣欣、張達人（2015）。幻想式的人際糾結－自殺企圖憂鬱症患者的人際模式。醫學與健康期刊，4(1)，35-44。https://www.airitilibrary.com/Article/Detail?DocID=23046856-201503-201503230024-201503230024-35-44
- 陳雅卉（2009）。大學生自尊、憂鬱程度、社會支持與自殺意念之相關研究-以某大學為例〔碩士論文，國立臺灣師範大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0021-1610201315154784
- Liu, Y. W., Yuan, T. I., Hsien, Y. Y., Huang, T. C., & Tai, Y. M. (2016). 不同性別之生命態度，憂鬱及自殺意念相關差異研究初探. 臺灣精神醫學, 30(4), 250-258. https://www.airitilibrary.com/Article/Detail?DocID=10283684-201612-201701030021-201701030021-250-258
- Fan, L. Y. (2018). Cortical atrophy and functional connectivity change in individuals with subjective cognitive decline [master's thesis, National Taiwan University]. Airiti Library. https://doi.org/10.6342/NTU201800896