害羞与社交焦虑障碍神经机制的差异——基于脑连接组学的研究

As one of most common psychiatric disorder, social anxiety disorder (SAD) has high prevalence and high risk of comorbidity, which varies widely in severity and symptoms and may go unrecognized, especially in affected in social function. Shyness is one of the personality traits, high shy is intermediate state which transforms from normal personality traits to the SAD and other psychiatric disorders. Previous studies have investigate shyness or SAD from multiple levels, including genes, brain and behavior, however, it is still difficulty to make differential diagnosis for SAD, since these two share strikingly similar features, including the disease gene, symptoms and brain dysfunction. Although most of previous neuroimage studies had revealed the regions brain structural and functional alterations, the dysconnectivity of whole brain networks of SAD and shyness remains unclear. Currently, shyness belongs to normal psychology, while SAD belongings to clinical medicine. The two different areas hinder the understanding of the relationship between shyness and SAD. To clarify the relationship between shyness and SAD, we intend to use control study approach, and implement diffuse tensor image (DTI) and resting-functional MRI to explore the different brain structural and functional network between these two. And then analyze the correlation between these brain differences and clinical and behavior indicators. We further intend to combine support vector machine and brain network indicators to build an individual diagnostic model with significant discriminative power, and investigate the classification and diagnosis capabilities for SAD patients and shyness. The research may help to explore the different neurophysiological mechanisms underlying shyness and social anxiety disorder, and also provide the objective evidence for differential diagnosis and early diagnosis for SAD.

社交焦虑障碍（social anxiety disorder, SAD）作为常见的精神障碍，临床表现多样，社会功能受损严重。害羞是一种稳定的人格特质，严重害羞是正常人格特质向其他精神疾病转化的过渡状态。由于害羞和SAD在致病基因、症状表现和局部脑功能失调等方面存在共同点，加大了SAD从基因、脑、行为等层面鉴别诊断的难度。害羞和SAD分属临床医学和正常心理两个范畴，对二者的研究相对独立，既往脑研究大多聚焦于局域性脑结构和功能性改变，二者脑网络连接的影像学特征尚不明确。本课题采用脑连接组学的最新方法，利用DTI和静息态fMRI的多模态MRI成像手段，探讨二者脑结构和功能网络拓扑属性的差异，分析其与临床指标的相关性；结合支持向量机技术，构建有较高判别力的个体诊断模型，探索害羞和SAD的分类和辅助诊断能力。本课题有助于探索二者的神经生理机制及其差异性，并为SAD的鉴别诊断和早期诊断提供科学依据。

社交焦虑障碍是继重度抑郁和酒依赖之后患病率排名第三的精神障碍。害羞是一种普遍存在的现象，虽然存在高焦虑的生理和心理表现，但害羞属于正常心理范畴。本项目针对社交焦虑和害羞心理的高度重叠以及社交焦虑障碍的鉴别诊断的问题，基于脑连接组学的视角，采用结构和功能脑成像的多模态成像技术，以及脑网络拓扑特性，以及脑功能连接和结构连接网络融合分析方法，在系统水平上揭示社交焦虑障碍的病理生理机制，以及社交焦虑障碍和高焦虑的正常对照之间的行为和脑网络上的差异，通过模式识别技术建立社交焦虑障碍模式识别预测模型。项目主要成果包括：（1）我们纳入了45例社交焦虑障碍个体，以及45例高焦虑（害羞）个体和30例低焦虑的正常对照。采集所有被试的行为和心理学数据，以及脑结构和脑功能影像数据。（2）在脑结构上，我们发现与高焦虑水平的对照组相比，社交焦虑障碍患者额叶皮层多个区域皮层厚度减低，但是皮层表面面积增加，同“气球理论”相吻合，该研究揭示了SAD在额叶区域为主的脑区出现的脑结构变化的特异性特征。此外，我们发现SAD与低焦虑的正常相比，出现了类似的脑皮层厚度变化趋势。（3）在脑功能上，SAD的认知控制网络、情绪网络以及感觉网络功能连接增强的假设：在情绪调节网络中，背侧和腹外侧前额叶以及边缘叶区域之间功能连接的增加有可能反映了认知控制区域对增加的负性情绪的调控，这有可能源于疾病的补偿性的变化；在感知觉和视觉区域，额叶以及后扣带区域之间功能连接的增加，以及额叶和视觉区域功能连接的增加可能反映了过度的情绪唤起对知觉加工的改变,该论文入选ESI高被引论文。依托本项目，项目组在著名国际学术刊物NeuroImage, Ebiomedicine等刊物发表SCI论文4篇，其中1篇文章入选ESI高被引论文。培养研究生2名。项目组通过积极参与相关领域的国内外会议以及国内外学者合作，与国外同行进行了深入的学术交流与合作。