应对方式在失独所致创伤后应激障碍发生发展中作用的脑结构研究

Role of coping styles in development of post-traumatic stress disorder in patients lost their only child:a brain structure study

目的探讨应对方式对失独所致创伤后应激障碍(PTSD)患者大脑灰质体积的影响, 探讨大脑灰质体积在应对方式影响PTSD患者临床症状中的作用。方法选择来自中国江苏省、自2016年9月至2017年3月失独的父母219例, 根据受试者是否伴PTSD将其分为伴PTSD组(57例)和不伴PTSD组(162例)。采集受试者静息态脑功能MRI数据。采用体素多元回归分析确定受试者应对方式主效应、诊断主效应及交互作用对大脑灰质体积影响显著的脑区, 采用相关性分析评估与应对方式有关的脑区灰质体积、应对方式评分、临床用PTSD诊断量表(CAPS)评分及各项目评分之间的相关性;采用结构方程模型建模的方法, 分析脑区灰质体积在应对方式对失独致PTSD者临床症状的影响中发挥的中介作用。结果 (1)所有受试者的应对方式主效应对大脑灰质体积的影响不显著, 诊断主效应对右侧舌回灰质体积影响显著;积极应对方式与诊断的交互作用对右侧距状裂周围皮层及右侧舌回灰质体积影响显著。伴PTSD组受试者的积极应对方式对右侧距状裂周围皮层及右侧舌回灰质体积影响显著。(2)伴PTSD组受试者的积极应对方式评分与右侧距状裂周围皮层及右侧舌回灰质体积呈正相关关系(P<0.05), 积极应对方式评分、右侧距状裂周围皮层及右侧舌回灰质体积均与CAPS-C5评分呈负相关关系(P<0.05), 积极应对方式评分、右侧距状裂周围皮层及右侧舌回灰质体积均与CAPS-C评分呈负相关关系(P<0.05)。(3)伴PTSD组受试者中, 积极应对方式可以正向预测受试者右侧距状裂周围皮层及右侧舌回灰质体积(P<0.05), 右侧距状裂周围皮层及右侧舌回灰质体积可以反向预测回避相关症状(P<0.05)。结论积极应对方式影响失独致PTSD患者的右侧距状裂周围皮层及右侧舌回灰质体积;较少采取积极应对方式可能通过影响相关脑区, 从而使其回避相关症状加重。

Objective To investigate the effect of coping style on the gray matter volume in patients with post-traumatic stress disorder(PTSD)who lost their only child,and the mediating role of gray matter volume in evaluating the influence of coping style in clinical symptoms of these parents.Methods A total of 57 parents with PTSD(PTSD group)and 162 parents without PTSD(non-PTSD group)who lost their only child from September 2016 to March 2017 were enrolled from Jiangsu Province,China.Brain MRI data at resting state were collected.Voxel-based multiple regression analysis was performed to confirm the brain areas in which coping style main effect,diagnosis main effect and their interaction had significant influences in gray matter volumes.Correlations among gray matter volume of brain areas related to coping style,coping style scale scores,and clinician-administered PTSD scale(CAPS)scores were analyzed.Structural equation modeling was used to analyze the mediating role of gray matter volume in the influence of coping style in clinical symptoms of parents lost their only child.Results(1)The coping style main effect did not significantly influence the gray matter volume in all subjects,and the diagnosis main effect had significant influence in gray matter volume in the right lingual gyrus;their interaction had significant influence in gray matter volume in the right peritalar fissure cortex and lingual gyrus.The positive coping style in the PTSD group had significant influence in the gray matter volumes of the right peritalar fissure cortex and lingual gyrus.(2)In the PTSD group,the scores of positive coping style were positively correlated with the gray matter volumes of the right talus fissure and the lingual gyrus(P<0.05);the scores of positive coping style,and the gray matter volumes of the right talus fissure and the lingual gyrus were negatively correlated with scores of CAPS-C5 and CAPS-C(P<0.05).(3)In the PTSD group,positive coping style can positively predict the gray matter volumes of the right talus fissure and the lingual gyrus;the gray matter volumes of the right talus fissure and the lingual gyrus can negatively predict the avoidance-related symptoms.Conclusion Positive coping style has influence in the gray matter volumes of the right talar fissure and lingual gyrus of PTSD patients lost their only child;and less positive coping style may affect the brain areas related to visual information processing,thus aggravating avoidance-related symptoms of PTSD patients.