PET_CT对肝气郁型经前期综合征患者郁怒症脑功能成像研究_王德敬_郭晓艳_林乐

辽宁中医杂志 2014 年第 41 卷第 2 期
·233·
brain region，and measured radioactive asymmetric index（ AI） ． No obvious regular difference was found in normal premenstrual women． But depression － anger － symptom patients were of difference． Glucose metabolism in the right middle frontal gyrus was obviously lower than that in the left middle frontal gyrus，which suggested that left forehead cortex was related to the positive emotion and right forehead cortex was related to the negative emotion． Conclusion： （ 1） ． It is concluded from PET － CT brain imaging of the premenstrual women that brain glucose metabolism dose not have obviously regular difference． （ 2） ． The conclusions of PET － CT brain imaging of depression － anger － symptom patients with premenstrual syndrome（ PMS） are as follows： 2． 1． There exists glucose metabolic abnormalities in related brain area． The abnormity is closely related to the function of the brain lobs． 2． 2． The common symptoms of both depression － anger － symptom patients and the depression patients are emotion disorder，which are caused by the reduction of the metabolism of glucose in the correlative brain sections． It is concluded that the essence of depression － anger － symptom sufferers is emotion disorder，related to the disorder of brain function － － emotional disease． （ 3） ． The close relation between liver and brain makes up the theoretic foundation of studying brain functional imaging of those who suffer from depression and anger． （ 4） ． Ｒight forehead cortex is related to the negative emotion of depression － anger － symptom suffering with premenstrual syndrome（ PMS） and stagnation of liver － Qi syndrome． It controls the left side of the body． This is consistent with the liver － gallbladder － qi to the left side of the body in traditional Chinese medicine． （ 5） ． Through the discussion of brain positioning of depression and anger，we try to provide a scientific basis for the effective treatment by drugs and psychological therapy，so as to work out a series of best treatment．
收稿日期： 2013 － 08 － 24 基金项目： 中国博士后科学基金（ 20090461263） 作者简介： 王德敬（ 1966 － ） ，女，山东烟台人，教授、主任医师，博士后，研究方向： 中西医结合康复治疗脑血管病。 通讯作者： 郭晓艳（ 1987 － ） ，山东烟台人，住院医师，硕士，研究方向： 针炙治疗脑血管病。
（ 1． 山东中医药高等专科学校，山东 烟台 265200； 2． 山东中医药大学，山东 济南 250355； 3． 烟台毓璜顶医院，山东 烟台 264000； 4． 天津中医药大学，天津 300193）
摘 要： 目的： 揭示经前期妇女、肝气郁型 PMS（ 经前期综合征） 郁怒症者脑发病机制，为两者脑功能变化的提供可 视性实验依据，为情绪的脑定位提供科学依据。方法： 运用无创性 PET － CT，采用成组 t 检验的统计方法与测定双侧脑 区视觉分析放射性分布不对称指数（ AI） ，研究经前期妇女、肝气郁型 PMS 的郁怒者，观察到脑组织中哪些区域与经前 期、PMS 患者郁怒症有关。结果： （ 1） 与正常妇女经前期比较，经前期综合征肝气郁结郁怒者组相关脑区多呈现葡萄糖 代谢减低，葡萄糖代谢减低脑区 P ＜ 0. 01 有： 右侧额中回，有非常显著性差异； P ＜ 0. 05 有： 中脑、左侧额下回、右侧额下 回等有显著性差异。（ 2） 正常妇女经前期与 PMS 肝气郁结郁怒者组相关脑区不对称指数（ AI） 双侧脑区视觉分析异常区 勾画感兴趣区（ ＲOI） ，测定放射性分布不对称指数（ AI） 。正常妇女经前期未见明显有规律性差异。PMS 肝气郁结郁怒 组有差别的： 葡萄糖代谢明显有规律性差异的是右侧额中回代谢明显低于左侧额中回，提示右前额皮层与消极感情有 关，左前额皮层与积极感情有关。结论： （ 1） 经前期妇女脑葡萄糖代谢未见明显有规律性差异。（ 2） 肝气郁型 PMS 郁怒 者的实质是与脑功能异常有关的情绪失常，即情志致病。（ 3） 肝与脑密切相关，是进行肝气郁型 PMS 郁怒者脑功能成像 的基础。（ 4） 右前额皮层与肝气郁型 PMS 郁怒症患者的消极感情有关，右前额皮层支配身体的左侧，这与中医的肝胆之 气行于身体的左侧是一致的。（ 5） 探讨郁怒的脑定位，为有效的药物和心理疗法进行干预提供科学依据，据此制订系列 的治疗方案。
关键词： 经前期； 经前期综合征（ PMS） ； 肝气郁结型； 郁怒者症； PET 脑功能成像 中图分类号： Ｒ271． 115 文献标志码： B 文章编号： 1000-1719（ 2014） 02-0232-05
Study on Brain Functional Image of Depression and Anger Symptom for PMS Patients with Liver － qi Obstacle by PET － CT
·232·
辽宁中医杂志 2014 年第 41 卷第 2 期 DOI∶10． 13192 / j． issn． 1000-1719． 2CT 对肝气郁型经前期综合征患者
郁怒症脑功能成像研究
王德敬1，2 ，郭晓艳4 ，林乐军3 ，李善春3 ，指导： 乔明琦2 ，张慧云2
Ji'nan 250355，Shandong，China； 3． Yuhuangding Hospital in Yantai，Yantai 264000，Shandong，China； 4． Tianjin University of TCM，Tianjin 300193，China）
Abstract： Objective： This paper aims to explore the pathogenesis in the brain functional imaging of normal premenstrual woman and depression － anger － symptom patients with premenstrual syndrome（ PMS） and stagnation of liver － Qi syndrome，so as to provide the experimental basis for the visibility of brain functional changes and to provide a scientific basis for emotional brain positioning． Methods： The research is done by sense of vision induction such as images or video，in accordance with the recognized diagnostic criteria for depression and anger symptom for PMS patients with liver － Qi obstacle，and by using non － invasive PET － CT to set the standard for integration，elimination，rejection and falling off． The results of brain imaging were analyzed and the statistics of data was performed according to the standardization value（ SUV） of relevant region，and the asymmetric index（ AI） was determined of radioactive distribution in bilateral brain regions visual analysis by using statistical methods of group t test． This was different from the previous research． The patients＇ brain was scanned by PET － CT to observe the brain areas relatived to the depression － anger － symptom of premenstrual woman and PMS patients． Ｒesults： （ 1） The relative brain region of the subjects presented more glucose metabolism，compared with that of normal premenstrual woman． There were some brain areas in which glucose metabolism reduced，P ＜ 0. 01． The area was middle frontal gyrus，which was of significant difference． The area included midbrain， left inferior frontal gyrus，right inferior frontal gyrus，left middle frontal gyrus，left superior temporal gyrus，right superior temporal gyrus，left middle temporal gyrus，right middle temporal gyrus，left precentral gyrus，left hippocampus，right hippocampus，right cerebellum，right Sphenophyllum，left amygdala and right amygdala，which were of significant difference as well，P ＜ 0. 05． 2． The index（ AI） of related brain regions was asymmetric between the normal premenstrual woman and depression － anger － symptom patients with Premenstrual syndrome（ PMS） ． We outlined region of interest（ ＲOI） by visual analyzing abnormality of the bilateral