经前情感障碍肝气逆、郁两证相关脑区功能定位与脑功能连接特征

Our reserch and related study have showed: key link closely of PMDD associated with brain disease ,but which brain functional region chaged will not define. The research will regard catharsis liver disorders leading to typical disease syndrome premesnstrual dysphoric disorder liver-qi sthenia symptom and liver-qi depressed symptom as entry point, will adopt technology of BLOD-fMRI and rest fMRI (rfMRI),to expore positioning related brain regions and positioning of the prefrontal cortex, to analyze functional connectivity of the prefrontal cortex and differences in brain areas with premesnstrual dysphoric disorder liver-qi sthenia symptom and liver-qi depressed symptom,to compare distinctive in the positioning cortexs and functional connectivity both liver-qi sthenia symptom and liver-qi depressed symptom. We shall put forward hypothesis of "PMDD key link in the central specific brain regions, to the prefrontal cortex is key brain regions and connected to the differences in brain interval function abnormality is its characteristic; PMDD with liver-qi sthenia symptom and liver-qi depressed symptom, there are differences between the two brain regions is both overlap and the regulation ", this will reveal deep liver pathogenesis is central mechanisms, expounds the scientific connotation of TCM theory, liver overthe innovation theory.

我们及美洲精神病学杂志2013年社论研究表明：PMDD发病关键环节与脑中枢关系密切，但涉及哪些主要脑区功能改变及差异脑区间的功能连接特征尚不清楚。 以肝疏泄失常典型病证经前情感障碍肝气逆、肝气逆郁两证为切入点，在前期研究基础上，拟采用BLOD-功能磁共振成像(BLOD-fMRI)和静息状态功能磁共振成像技术， 探寻与该病征发病密切相关的主要脑区功能定位及差异脑区间的功能连接特征，同时比较上述指标有何异同，由此提出"PMDD发病关键环节在中枢特定脑区，以前额叶皮质为发病关键脑区且与差异脑区间功能连接异常是其特征；PMDD肝气逆、郁两证调控脑区既有重叠又有差异"科学假说。深层次揭示肝疏泄失常发病中枢机制，阐明中医理论的科学内涵，创新肝脏象理论。

目的: 研究表明PMDD发病关键环节与脑关系密切，但涉及哪些脑区及差异脑区间的功能连接特征尚不清楚。以经前情感障碍症（premesnstrual dysphoric disorder，PMDD）肝气逆、郁两证为切入点，探寻与该病证发病主要脑区及其差异脑区功能连接特征，深层次揭示肝疏泄失常发病中枢机制，阐明肝主疏泄调畅情志的科学内涵，深化对该理论的认识。. 方法：采用BLOD-功能磁共振成像，探寻与该病证发病脑区定位；采用静息状态功能磁共振成像（Resting state functional magnetic resonance imaging，rfMRI）技术，探查PMDD肝气逆、郁两证脑功能连接特征；使用SPM8 软件进行数据统计。. 结果：任务态下，PMDD肝气逆证组在额中回、颞叶上部、左小脑活动增强与楔前叶、额上回、和右小脑部位活动减弱，上述也是该病证的主要脑区。PMDD肝气郁证组主要脑区位于额中回、额中和扣带回，在此基础上发现，上述脑区功能增强。说明该患者黄体中晚期上述脑区功能异常出现调节情绪能力及注意力分配方面出现改变。.静息态下，PMDD肝气逆证组后扣带回（posterior cingulate cortox,PCC）作为ROI与全脑功能连接有差异（P<0.05），PCC与顶叶、楔前叶、边缘叶功能连接减弱，与右脑、右侧颞叶功能连接增强，提示PMDD肝气逆证患者在黄体期出现易激惹，影响学习能力、认知能力，是由于上述脑功能连接障碍所致。.静息态下，PMDD肝气郁证组后扣带回（posterior cingulate cortox,PCC）作为ROI与全脑功能连接有差异（P<0.05）， PCC与额叶、颞叶、边缘叶、楔前叶及侧海马回脑区的信号同步性（功能连接）增高是PMDD肝气郁证患者在黄体中晚期出现抑郁、郁怒（怒的表达方式：指向自我）等负性情绪的神经环路机制。. 结论：依据研究发现，发现肝疏泄失常典型情志病证PMDD肝气逆证和肝气郁证发病主要脑区及其功能连接障碍，从而明确肝主疏泄调畅情志的调控中枢及机制，深化了对该理论的认识，也为我们团队提出的 “肝主疏泄功能调控在中枢相关脑区”新科学假说提供充分的可视化科学证据。