矿难后急性重性创伤后应激障碍症状激发和创伤有关短期记忆提取的功能性磁共振成像研究

Brain responses to symptom provocation and trauma-related short-term memory recall in coal mining accident survivors with acute severe post traumatic stress disorder

目的 探讨急性重性创伤后应激障碍（post traumatic stress disorder,PTSD）患者的脑功能及执行记忆功能时的脑反应.方法 采用功能磁共振成像技术,对经历矿难的10例急性重性PTSD患者（PTSD组）和7例非PTSD对照（非PTSD组）执行症状激发任务,并首次采用1项创伤有关的短期记忆提取任务进行记忆功能的测定.结果 症状激发试验中,PTSD组负性图片相比中性图片,左侧后扣带回、双侧尾状核和右侧丘脑等脑区激活增强,右侧扣带回和双侧额中回激活下降;PTSD组相比非PTSD组,右侧前扣带回、左侧额下回、双侧额中回及双侧颞中回等脑区激活下降,左侧海马旁回激活增高.短期记忆提取任务中,PTSD组负性图片相比中性图片,右侧后扣带回和双侧海马存在明显激活;PTSD组相比非PTSD组,右侧额下回、右侧额中回、左侧枕中回等脑区激活下降.记忆提取任务相比症状激发任务,PTSD组右侧海马旁回激活下降.结论 急性重性PTSD患者在急性期已存在部分脑区激活的下降以及记忆功能的减退.

Objective To characterize the brain functions of patients with acute severe PTSD and study the brain responses when implementing memory function. Methods Individuals with acute severe PTSD （ n = 10 ） resulting from a mining accident and 7 men exposed to the mining accident without PTSD underwent functional magnetic resonance imaging （fMRI） while performing the symptom provocation paradigm. Memory function was analyzed through a trauma-related short-term memory recall paradigm firstly. Results During symptom provocation paradigm, PTSD subjects （ negative pictures vs. neutral pictures ） showed enhanced responses in left posterior cingulated gyrus, bilateral caudate and right thalamus,and diminished responses in right cingulated gyrus and bilateral middle frontal gyrus. PTSD subjects showed diminished responses in right anterior cingulated gyrus, left inferior frontal gyrus, bilateral middle frontal gyrus and bilateral middle temporal gyrus and enhanced left parahippocampal gyrus response compared with controls. During the short-term memory recall paradigm, PTSD group （ negative pictures vs. neutral pictures ） showed enhanced responses in right posterior cingulated gyrus and bilateral hippocampus; PTSD subjects showed diminished responses in right inferior frontal gyrus, right middle frontal and left middle occipital gyrus etc in comparison with controls. PTSD group exhibited diminished right parahippocampal gyrus response during the memory recall task as compared to the symptom provocation task. Conclusion The decrease of activations in some brain zones and memory function have developed in acute severe PTSD.