焦虑症右顶叶对情感环路功能影响的病理机制

Anxiety disorders are the most common neuropsychiatric disorders. However, little is known about the neuropathological mechanisms underlying anxiety disorders. Cognitive theories suggest that threat-related attentional bias is likely to directly generate and maintain anxiety. Previous studies suggested that the amygdala in the emotional circuit is critically involved in the neuropathological mechanisms of attentional bias. Moreover, studies have revealed dysfunction of parietal cortex in attention circuit in anxiety disorders. Our previous studies have showed that right parietal cortex is involed in the modulation of anxiety. Therefore, we hypothesize that the parietal cortex modulation of amygdala might be abnormal in anxiety disorders. In the present study, we will investigate the activation of parietal cortex and amygdale in response to emotional information using functional magnetic resonance imaging (fMRI), and then we will test the influence of changes of the activation in the right parietal cortex on the activation of the amygdala through repetitive transcranial magnetic stimulation (rTMS) of the right parietal cortex. Meanwhile, we will analyse the process of emotional information processing in the right parietal cortex and amygdala using magnetoencephalography (MEG), and then through rTMS, we will test the influence of changes of the activation in the right parietal cortex on the activation of the amygdala during the early stage of attention. The present study attempts to find the key point of the neuropathological mechanisms of attentional bias, to elucidate the nature of anxiety disorders to some extent and to provide an important theoretical basis for neuromodulation therapy for anxiety disorders.

焦虑症是当今最为常见的神经精神疾病之一，然而，目前对其神经病理机制所知甚少。认知理论认为，对威胁性信息的注意偏向可导致焦虑并维持其存在。研究表明，情绪环路的杏仁核是参与焦虑症注意偏向病理机制的关键部位，而焦虑症注意环路的顶叶皮层也存在功能异常。我们的前期研究发现，右侧顶叶皮质参与了对焦虑症状的调节，因此，我们推论：焦虑症顶叶皮质对杏仁核的调节功能存在异常。本项目将通过fMRI技术，研究焦虑症顶叶皮质和杏仁核对情绪信息反应的特点，并结合经颅磁刺激（rTMS）技术，观察右顶叶皮质活动的变化对杏仁核活动的影响；同时，应用脑磁图（MEG）技术，解析焦虑症顶叶皮质和杏仁核对情绪信息反应的动态过程，并结合rTMS技术，观察注意加工早期右顶叶对杏仁核活动的影响，试图发现焦虑症注意偏向病理机制的关键环节，以期在一定程度上揭示焦虑症疾病的本质，为在临床上开展神经调控治疗提供重要的理论依据。

焦虑症是当今最常见的神经精神疾病之一，然而目前对其神经病理机制却所知甚少，导致治疗手段匮乏。认知理论认为，注意控制障碍是焦虑症病因的关键环节并维持其症状。本研究发现广泛性焦虑患者任务相关变化状态及双特征变化状态下的N270波幅较对照组下降，而且N270波幅下降与患者的焦虑抑郁症状严重程度呈正相关，但任务不相关变化状态N270波幅与对照组无明显差别，说明广泛性焦虑患者注意控制存在障碍，且N270很好地能够反映出焦虑症患者的注意控制障碍。事件相关电位脑磁图源定位和脑网络连接研究表明广泛性焦虑患者在信息处理过程中顶叶内侧皮层功能亢进连接增强而额叶内侧皮层功能减低连接减弱。此外，我们通过首次在国内实现的TMS-EEG实时无伪差同步采集证明右侧额顶叶网络功能失调是广泛性焦虑患者的重要发病机制。为进一步验证此机制，我们增添了配对经颅磁刺激右侧额顶叶治疗广泛性焦虑障碍的研究、经颅直流电刺激广泛性焦虑障碍的研究、左右侧顶叶脑电生物反馈治疗广泛性焦虑的随机对照开放研究，上述研究取得了显著疗效，进一步证明了右侧额顶叶网络功能失调在焦虑症患者注意控制障碍的病理生理机制中起着关键作用，为揭示焦虑症的病理生理机制提供了重要的理论依据，在一定程度上阐明了焦虑症的本质。

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