广泛性焦虑障碍肝郁化火与心脾两虚情绪记忆提取的脑功能与结构差异研究

Generalized anxiety disorder (GAD) is a kind of diseases with emotional problem. The GAD not only shows physical and psychological symptoms but also companies with cognitive impairment. Brain imaging studies have revealed that the cognitive impairment of GAD related with the symptoms (eg, anxiety level and worry). However, it is not clear whether there are different cognitive problems for subtypes of GAD which divided by physical and psychological symptoms. It will provide a new perspective, if we study the differences of cognitive processing among the syndromes of GAD in TCM. In this study, we will enroll three group to study the abnormal brain function and structure of GAD’s syndromes during emotional autobiographical memory retrieval. The three groups are the group of GAD with fire syndrome caused by liver-qi stagnation, the group of GAD with heart-spleen deficiency syndrome and the group of healthy controls. Each group will enroll twenty subjects. According to our previous studies, we first proposes the pathways of the emotional information processing during autobiographical memory retrieval, which is "triggered - Assessment - Control - Expression". And then we assume that abnormal process of “control” could explain the "liver" dysfunction of the GAD with fire syndrome caused by liver-qi stagnation, while the abnormal process of “assessment” could explain the "heart" dysfunction of the GAD with heart-spleen deficiency syndrome. After that, we will test these assumptions by adopting an autobiographical memory recall and inhibition tasks. In details, we will focus the cognitive processing of suppression condition for the GAD with fire syndrome caused by liver-qi stagnation, and focus the cognitive processing of recall condition for the GAD with heart-spleen deficiency syndrome. We will also study the neural function of these cognitive processing, and explore whether these neural function could predict the improvement of symptoms after Chinese medicine treatment. Finally, we will study the abnormal brain structure of GAD’s syndromes. This study may provide support for TCM therapy for GAD in the field of drug therapy, psychological treatment and prevention.

广泛性焦虑障碍（GAD）是情感类疾病，既有躯体和心理症状，也存在认知损害。脑成像研究已揭示了GAD认知损害与症状（如焦虑水平和过分担忧）有相关性，尚不清楚GAD躯体与心理症状的亚型是否有认知加工的差异。研究GAD中医证候间的认知差异，可为这类研究提供新视角。项目拟纳入GAD肝郁化火证、心脾两虚证和健康对照（各20例），研究GAD不同证候在情绪自传体记忆提取过程中异常的脑功能活动和结构特征。首先根据申请人的前期研究，提出记忆情绪信息的表征为“引发-评估-控制-表达”；并提出肝郁化火证“肝”功能失调表达为“控制”失败，心脾两虚证“心”功能失调主要表达为“评估”过度；再用自传体记忆回忆与抑制任务加以验证，重点考察肝郁化火证组在抑制条件、心脾两虚证在回忆条件的脑功能活动，并考察哪些脑功能活动能预测中药治疗后症状的改善；最后考察脑器质性损害。项目可为中医对GAD的临床用药、心理治疗及预防提供依据。

广泛性焦虑障碍（GAD）是情感类疾病，既有躯体和心理症状，也存在认知损害。脑成像研究已揭示了GAD认知损害与症状（如焦虑水平和过分担忧）有相关性，尚不清楚GAD躯体与心理症状的亚型是否有认知加工的差异。研究GAD中医证候间的认知差异，可为这类研究提供新视角。项目纳入GAD肝郁化火证、心脾两虚证（各20例）和健康对照（25例），研究GAD不同证候在情绪自传体记忆提取过程中异常的脑功能活动和结构特征。研究结果发现，健康对照组与GAD肝郁化火证组相比，在正性AM中左侧梭状回和左侧海马回钩激活强度显著增强，而在负性AM中右侧的楔前叶、右侧颞横回和后扣带回激活强度显著增强。健康对照组与GAD心脾两虚证组相比，在正性AM中右侧颞上回激活强度显著增强，在负性AM中右侧的额下回和左侧的脑岛激活强度显著减弱。GAD心脾两虚证组比肝郁化火证组相比，在负性AM中左侧丘脑显著激活。研究证实了肝郁化火证和心脾两虚证在记忆情绪信息的表征“引发-评估-控制-表达”中存在不同环节的认知损害。研究还发现，对于心理健康人群体，正性记忆的情绪一致性较高，而负性记忆的情绪一致性较差。影像学结果显示，无论在正性还是在负性记忆条件中，楔前叶均与自我相关网络的核心脑区—内侧前额叶皮层相连接，与负性记忆条件相比，楔前叶与顶下小叶的连接强度在正性记忆条件中较大。因此，在正性AM中楔前叶为情绪一致性的关键脑区。这个脑区或许参与通过强化正性AM来维持积极自我意象。在脑结构的研究中并没有显示出GAD肝郁化火证、GAD心脾两虚证和健康对照组的差异。然而，应用多元机器学习方法可以基于脑白质束微结构完整性来预测焦虑的核心症状——过度担忧。研究证明了机器学习模型能够从广泛分布的脑白质管道的微观结构特性中解码个体的焦虑分数，包括内囊、前放射冠、大脑脚，以及对情绪处理和调节至关重要的皮质边缘通路。项目可为中医对GAD的临床心理治疗及预防提供依据。