Hawlaha Dayactirka-Gobolka ee Xaaladaha Horudhaca-Bini-aadmiga ah ee Dhibaatada Ciyaarta Internetka: Isbeddelka Daaweynta Dabeecadda Dabeecadda iyo Saadaalinta Jawaabcelinta Daaweynta (2018)

Cudurka maskaxda. 2018 Aug 3; 9: 341. doi: 10.3389 / fpsyt.2018.00341

Han X¹, Wang Y¹, Jiang W², Bao X², Sun Y¹, Ding W¹, Cao M¹, Wu X¹, Du Y², Zhou Y¹.

aan la taaban karin

Daaweynta dabeecadda garashada (CBT) waxay wax ku ool u tahay daaweynta cilad-darrada ciyaaraha internetka (IGD). Si kastaba ha noqotee, hababka ay CBT u hagaajiso astaamaha bukaan-eegtada ee la xiriira 'IGD' wali lama oga. Daraasaddan ayaa looga golleeyahay in lagu helo farsamooyinka daaweynta ee CBT ee maaddooyinka IGD iyadoo la adeegsanayo sawirka sawir-celinta firfircoonaanta magnetic-ka (rsfMRI). Labaatan-iyo-laba maaddo 'IGD' iyo 30 isbarbar dhigaya kontoroolka caafimaadka qaba (HCs) waxay heleen scanf-ka rsfMRI iyo qiimeynno caafimaad; Mawduucyada '20 IGD' ayaa dhammeystiray CBT ka dibna dib ayaa loo baaray. Awoodda isweydaarsiga hooseeya (ALFF) iyo isku xirka waxqabadka (FC) ee u dhexeeya kooxda IGD iyo kooxda HC waxaa la isbarbar dhigey gundhigga, iyo sidoo kale qiyamka ALFF iyo FC kahor iyo kadib CBT ee kooxda IGD. Daaweynta ka hor, kooxda 'IGD' waxay muujisay inay si weyn u kordhisay qiimayaasha ALFF ee labada dhinac, dhinaca saxda ee dhexda orbitofrontal cortex (OFC), isugeynta laba geesoodka ah (SMA), garaaca bidix ee bidix, iyo garabka bidix ee murugada leh (ACC) marka la barbar dhigo kooxda HC. Kooxda HC waxay muujisay inay si weyn u kordhisay qiyamka FC inta udhaxeysa bartamaha bidix ee OFC iyo putamen marka la barbar dhigo kooxda IGD, qiyamka kooxda FC ee kooxda IGD waxay si xun ula xiriireen buundooyinka BIS-11 kahor daaweynta. Ka dib CBT, waqtiga ciyaarta usbuuclaha ah si weyn ayuu u yaraa, iyo buundooyinka CIAS iyo BIS-II aad bey u yaraayeen. Qiimaha ALFF ee maadooyinka IGD ayaa si weyn hoos ugu dhacay dhanka bidix ee sare ee OFC iyo bidixda bidix, iyo xiriirka u dhexeeya FC si weyn ayuu u kordhay ka dib CBT. Heerka isbedelka FC (Δ_{FC / Pre-FC}) waxaa si togan xiriir ula leh heerka isbadalada dhibcaha CIAS (Δ_{CIAS / Pre-CIAS}) maadooyinka IGD. CBT waxay xakamayn kartaa isbeddelada aan caadiga ahayn ee isdaba-marinta caadiga ah ee gobollada hor-dhaca xarigga ee maaddooyinka IGD waxayna horumarin karaan astaamaha la xiriira IGD. Kala-guurka gobolka-ka-hor-tagga ee gobollada hore ayaa laga yaabaa inay daaha ka rogto habka daaweynta ee CBT maadooyinka IGD.

KEYWOOD: amplitude isbeddelada hooseeya; daaweynta garashada dabeecada; isku xirnaanta shaqada; sawir muuqaal celcelis ah magnetic; khamaarka ciyaaraha internetka

PMID: 30123144

PMCID: PMC6085723

DOI: 10.3389 / fpsy.2018.00341

Qodobka PMC ee lacag la'aanta ah

Hordhac

Cillada khamaarka internetka (IGD), oo sidoo kale loo yaqaan dhibaatada isticmaalka internetka, waa isticmaalka xad-dhaafka ah iyo soo noqnoqda ee cayaaraha internetka ee internetka (1). Dhawaan, IGD waxaa loo liis gareeyay dabeecad ciyaar joogto ah ama soo noqnoqota oo lagu garto xakameyn liidata ee ciyaarta; ahmiyad la siinayo khamaarista howlaha kale ilaa iyo inta ciyaartu ay ka hormarinayso danaha kale iyo nashaadaadka maalinlaha ah; iyo sii wadista ciyaaraha inkasta oo ay dhacdo cawaaqib xumo (2, 3). In kasta oo aysan jirin shuruudaha baarista rasmiga ah ee xaaladda dhimirka ee lagu garto qaababka xad-dhaafka ah iyo faragelinta ee isticmaalka internetka ayaa lagu soo daray daabacaaddii afaraad ee Buugga Baadhista iyo Tirakoobka (DSM-IV) (4), guddiga 'DSM-V' wuxuu ka fiirsanayaa inuu adeegsado shuruudaha laga soo saaray aalkolada iyo dhibaatooyinka balwadaha ee loo yaqaan 'IGD' waxaana lagu soo daray qeybta "IGD" ee muujineysa baaritaan dheeri ah (5).

Baarayaasha waxay isbarbar dhig ku sameeyeen IGD iyo ciladaha xakamaynta xakamaynta (6). Daraasadaha neerfaha ayaa lagu ogaaday in ciyaarta internetka ee xad dhaafka ahi ay la xiriirto nashaad aan caadi aheyn oo gobolka ka dhaca, qeybta maskaxda ee mas'uulka ka ah habka garashada, sida xakamaynta xakamaynta (7). Hawsha daciifka ah ee hordhaca (PFC) ayaa laga yaabaa inay la xiriirto dareen sarreeya, oo, taa badalkeed ay gacan ka geysan karto xakameynta xakameyn la'aanta ee la xiriirta IGD (8). Xakameynta garashada ee wax ku oolka ah waxay la xiriirtaa qoritaanka iskudhafan ee kor-hoos, wareega hore ee wareegga (9, 10). Daraasadihii hore ayaa shaaca ka qaaday xiriirka ka dhexeeya qaabdhismeedka iyo qaabdhismeedka caadiga ah ee shaqada 'prefrontal cortex' (PFC) iyo xakameynta xakameysan ee IGD (11-16). Tusaale ahaan, dhumucda dhumucda korriinka iyo kordhinta codka is bedbeddelada hooseeya (ALFF) ee OFC ayaa la ogaaday inay la xiriirto yaraanshaha shaqada kontoroolka garashada ee maaddooyinka da 'yarta leh ee IGD (12). Daraasad la adeegsaday habka loo yaqaan 'Reho' ayaa lagu ogaaday in maadooyinka 'IGD' ay muujiyeen kor u qaadis isweydaarsiga sare ee gulukooska hore marka la barbar dhigo kontaroolada caafimaadka qaba (HCs), kaas oo soo jeediyay in la kordhiyo waxqabadka neural-ka ee la xiriira shaqada xakameynta garashada (17). Ko et al. (10) Wuxuu muujiyey in shaqada daciifka ah ee gobolada hore loo isticmaali karo ay sharxi karto hoos u dhaca awooda xakamaynta ee IGD. Daraasaddan sawirradu waxay muujisay sida qaabdhismeedka labada weji wejiga hore iyo howlahooda loogu baddelo iyadoo la adeegsanayo xakamaynta xakamaynta liita ee IGD. Intaa waxaa sii dheer, shaqada dopamine ee daciifka ah ee wadnaha (hoos udhaca daawada dopamine D2 iyo dhimista daawada dopamine) iyo xiriirka ay la leedahay hoos udhaca gulukoosta gulukooska ee PFC ayaa la arkay (18, 19).

Daaweynta dabeecadda garashada (CBT) ayaa la ogaaday inay waxtar u leedahay daweynta ciladaha xakamaynta jahwareerka, oo ay ku jiraan khamaarka cudurrada lagu daarto (20). Daraasadaha cilmi-baarista maandooriyaha ayaa muujisay in CBT ay ku dhiirrigeliso maadooyinka inay gartaan oo ay ka fogaadaan xaaladaha ay u badan tahay inay u isticmaalaan maandooriyaha iyo inay u isticmaalaan xeeladaha la-tacaalista looga hor-tago isticmaalka daroogada iyo hagaajinta shaqada xakamaynta xakamaynta (21, 22). Daraasad la adeegsanayo hawsha Stroop ayaa lagu ogaadey in CBT laga yaabo inay la xiriirto hoos u dhigida isticmaalka maandooriyaha, waxayna saameyn ku yeelan kartaa nidaamyada neural ee ku lug leh xakameynta garashada, jahwareerka, dhiirigalinta, iyo feejignaanta (23). Daraasad kale oo muuqaal ah magnetic resonance imaging (fMRI) daraasad oo ka shaqeysa dib u dhac dhiirigelin lacageed (MID) hawsha ku tiirsanaanta daroogada cannabis ayaa sheegay in kaqeyb galayaasha cannabis ay muujiyeen hoos udhac xad dhaaf ah oo laba geesood ah kadib CBT, taasoo tilmaamtay in dhinacyada gaarka ah ee shaqada putamen iyo qaab dhismeedku ay la xiriirto daaweynta natiijooyinka (24). Young waxay aaminsan tahay in faragalinta la qabatinka Internetka ee Maandooriyaha Internetka (IA) ay tahay inay diirada saarto xakamaynta adeegsiga Internetka, iyadoo lagu saleynayo tan, wuxuu soo jeedinayaa habka garashada daaweynta dabeecadda-IA (CBT-IA), kaas oo la cadeeyay inuu wax ku ool yahay daaweynta IGD. (6). Kooxda Dr Du waxay ogaadeen in kooxda CBT ee iskuulka ku saleysan ay waxtar u leedahay dhalinyarada qaangaarka ah ee leh IGD, gaar ahaan hagaajinta xaalada shucuurta iyo awooda qaanuunka, habdhaqanka iyo qaabka is-maamul (20). In kasta oo CBT ay soo bandhigtay wax ku oolnimada daaweynta IGD, daraasado yar ayaa baaray habka daaweynta dabiiciga ah ee CBT ee maaddooyinka IGD iyadoo la adeegsanayo fMRI. Baadhitaanka maskaxda ayaa isbeddelay kahor iyo ka dib daaweynta mana hagaajin karto oo keliya fahankeenna ku saabsan cudurka loo yaqaan 'pathogenesis of IGD' iyo habka daaweynta ee CBT ee loo yaqaan 'IGD', laakiin sidoo kale waxay gacan ka geysan kartaa la socodka saameynta daaweynta.

Waxaan u isticmaalnay Barratt impulsiveness Scale-11 (BIS-11) si aan u qiimeyno howsha xakamaynta dabeecadda ee IGD. Iyada oo ku saleysan daraasadihii hore, waxaan qiyaasahay in (1) maadooyinka leh IGD ay muujin karaan waxqabadka maskaxda ee aan caadi ahayn / isku xirnaanta gobollada prefrontal-striatal, kuwaas oo mas'uul ka ah geedi socodka garashada, sida xakameynta xakameynta; (2) CBT waxay xakamayn kartaa shaqada aan caadiga ahayn ee gobollada horay loo yaqaan 'preatal-striatal gobollada'.

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Qalabka iyo hababka

Kaqeybgalayaasha iyo qiimeynta caafimaad

Daraasada hadda jirta waxaa oggolaaday guddiga anshaxa cilmi baarista ee Isbitaalka Ren Ji iyo School of Medicine, Jaamacadda Shanghai Jiao Tong, Shiinaha No. [2016] 097k (2). Dhamaan kaqeyb galayaasha iyo masuulada waxay saxeexeen foomam oggolaansho oo qoraal ah oo la oggolyahay kahor daraasadda. Kaqeybgalayaasha diiwaangashan, xogwaraysiga baaritaanka iyo shuruudaha ka saarista ayaa dhammaantood lagu sharxay daabacaaddeenna hore (15). Laba iyo labaatan maadooyinka IGD ee buuxiyay heerarka Su'aalaha Su'aalaha Diagnostic ee Maandooriyaha Internetka (ie, YDQ) imtixaankan waxaa wax ka badalay Beard iyo Wolf (25) waxaa laga soo qaatay Waaxda Dhakhaatiirta Maskaxda ee Xannaannada Carruurta iyo Dhallinyarda. Soddon jir - iyo jinsi ahaan u dhigma shakhsiyaad caafimaad qaba oo aan lahayn taariikh shaqsiyeed ama qoys qoysnimo ee cudurka dhimirka ayaa loo shaqaaleysiiyaa kooxda xakameynta caafimaadka ah (HC) iyadoo loo sii xayeysiinayo. Marka la eego heerka sare ee IGD ee ragga iyo dumarka, keliya kaqeybgalayaasha ragga ayaa lagu daray (26). Dhammaan kaqeybgalayaasha waxay ahaayeen kuwo gacanta midig ah, midkoodna sigaar cabin.

Dhammaan kaqeybgalayaasha waxaa la mariyey baaritaan sahlan oo jirka ah, oo ay kujiraan cadaadiska dhiigga iyo cabirka heerka garaaca wadnaha, waxaana wareystay dhakhaatiirta cilminafsiyeed ee quseeya taariikhdooda caafimaad ee neerfaha, jirka, dheefshiidka, neefsashada, wareegga dhiigga, maskaxda, kaadi mareenka, iyo dhibaatooyinka taranka. Ka dib waxaa laga baaray cudurada dhimirka wareysiga Mini International Neuropsychiatric Wareysi ee Caruurta iyo dhalinyarada (MINI-KID) (27). Shuruudaha ka-saaristu waxay taariikh u ahayd isticmaalka mukhaadaraadka ama ku tiirsanaanta; isbitaal hore oo lagu daweeyo cudurada dhimirka; ama cilad maskaxeed oo weyn, sida shisoofrani, diiqad, jahwareer, iyo / ama marxalado nafsi ah.

Su'aalo-waydiin aasaasi ah ayaa loo isticmaalay in lagu soo ururiyo macluumaadka dadka sida jinsiga, da'da, sannadka ugu dambeeya ee iskuulka la dhammaystiray, iyo saacadaha isticmaalka internetka asbuucii. Afar su'aalood ayaa loo isticmaalay in lagu qiimeeyo astaamaha caafimaad ee kaqeybgalayaasha, kuwaas oo ah, Qiyaasta Cudurrada Internetka ee Chen (CIAS) (28), Iskeelka Is-qiimeynta Welwelka Is-qiimaynta (SAS) (29), Iskeelka Isugeynta Isu-dhimista Buufiska (SDS) (30), iyo Barratt impulsiveness Scale-11 (BIS-11) (31). CIAS, oo ay soo saartay Chen, ayaa ka kooban waxyaabo ka kooban '26' oo ka kooban afar-qodob oo ah nooca loo yaqaan 'Likert' oo ka tarjumaya darnaanta internetka ee balwadda. SAS iyo SDS ayaa loo adeegsaday in lagu muujiyo in maaddooyinka oo dhan ay la kulmaan shuruudaha ka-mid-ahaanta muddada cilmi-baarista. Dhammaan su'aalaha weydiimaha waxaa markii hore lagu qori jiray Ingiriisiga ka dibna waxaa loo turjumay af Shiinaha. Kadib, maaddooyinka 26 IGD, waalidkood iyo macallimiintooda ayaa ka qaybqaatay kooxda dabagalka ah ee CBT si iskood ah, oo ka kooban fadhiyada 12 (20). Kulan kasta wuxuu socday 1.5 – 2 h. Kulan kasta oo daaweynta kooxeed, mowduuc ka duwan ayaa looga wada hadlay. Mawduucyadan ayaa ka mid ahaa sida loo garto loona xakameeyo dareenkaaga; mabaadii'da xiriirka caafimaad ee ka dhexeeya waalidiinta iyo carruurta; farsamooyinka lagula tacaamulo cilaaqaadyada lagu soo maray internetka; farsamooyinka lagula tacaamulo waxa ku soo maray internetka; farsamooyinka loo xakameeyo dareenkaaga; farsamooyinka lagu aqoonsado marka dabeecad qabatinka ah uu dhacayo; iyo sida loo joojiyo dhaqanka balwada leh. Kalfadhigii ugu dambeeyay wuxuu ahaa fadhiga dib u eegista

Ka dib faragalinta, waxaan qiimeynay astaamaha caafimaad ee maadooyinka 'IGD' mar labaad, iyo labaatan ka mid ah ayaa laga baaray mar kale si mutadawacnimo ah oo lamid ah tan borotokoolka pre-CBT.

Qaadashada xogta MR

Dhammaan maaddooyinka oo dhan ayaa maray gobolka-nasiinada fMRI ee gundhigga u ah nidaamka sawirka 3.0-T MR (GE Signa HDxt3T, USA) oo leh xargaha madaxa caadiga ah. Si looga fogaado mooshinka iyo yareynta dhawaaqa iskaanka, pads jilicsan ayaa la isticmaalay, maaddooyinka waxaa lasiiyay tilmaamo dhameystiran oo ku saabsan dhaqdhaqaaqa baabuurta ee socda inta lagu jiro baarista iyo sharraxaadda sababta mooshinka aan loo doorbidi karin, marka lagu daro tilmaamaha sheegaya in mooshinka xad-dhaafka ahi u horseedi doono rescan. . Xogta gobolka-nasashada ee FMRI waxaa lagu helay iyada oo la adeegsanayo isku-dar-echo echo-planar sida ku qeexan daraasaddeena hore (16). Soddon iyo afar xaleef wareegsan [waqti celcelis [TR] = 2,000 ms; waqtiga echo [TE] = 30 ms; muuqaalka muuqaalka [FOV] = 230 × 230 mm; iyo 3.6 × 3.6 × 4 mm voxel size] oo daboolaya maskaxda oo dhan ayaa laga helay iyada oo la raacayo khadka komishanka ee gudiga hortiis. Tirakoobkan taxanaha ah, qiyaasaha 220 ee waxqabadka ayaa la helay iyada oo maaddooyinka la nasiyey (taasoo ka dhalatay dhererka skaanka ee 440 s). Intii lagu guda jiray iskaanka, kaqeybgalayaashu waxaa la faray inay wali indhohooda kudhaganyihiin, sida ugu dhaqsaha badan, iyo inaysan seexan ama waxkastoo laga fikiro. Sawirka kadib, maaddooyinka waxaa la weydiiyay inay caddeeyaan haddii ay soo jeedeen intii uu socday baaritaanka. Laba kale oo taxane ah ayaa sidoo kale la helay: (1) xaddiga xajmiga xajmiga ah ee 'T1' culeys deg deg ah-echo taxane ah (TR = 1,725 ms; TE = 24 ms; FOV = 256 × 256 mm; 34 gogo '; iyo 0.5 × 0.5 × 4 mm voxel size ) iyo (2) oo ah silsilad xaddiga xajmiga ah ee 'T2-culeys deg deg ah-echo taxane ah (TR = 9,000 ms; TE = 120 ms; FOV = 256 × 256 mm; 34 jeexan; iyo 0.5 × 0.5 × 4 mm voxel size).

Ka hortagga macluumaadka sawirrada shaqeynaya

Hordhaca xogta sawirka waxaa lagu sameeyay iyadoo la adeegsanayo SPM12 oo laga hirgaliyay barnaamijka MATLAB iyo SPM12 ee barnaamijka dheereynta Xogta iyo Falanqaynta Sawirka Maskaxda (DPABI; http://rfmri.org/dpabi) (32). Ka dib markii la tuuray qiyaasta 10 ee ugu horreysa ee taxane kasta oo shaqeynaya, sawirrada 210 ee haray waxaa loo hagaajiyay waqti gogo ', oo loo habeeyay mugga dhexe, iyo dib-u-habeyn iyadoo la adeegsanaayo lix -beegga (jirka adag) isbedelka qadka. Kadib, dhammaan sawirada shaqeynaya ayaa si toos ah loogu celiyay shaashadda EPI, codkastoo mid walbana dib ayaa loogu celiyay 3 × 3 × 3 mm, iyo beddelid jilicsan oo jilicsan ayaa lagu qabtay iyada oo la adeegsanayo xNUMX-mm buuxa oo ballac badhkeeduna yahay ugu badnaan Gaussian. Kadib, Xirmooyinka codadka ee 8 (oo ay kujiraan waqtiga celceliska waqtiga ee calaamadaha laga soo qaatay voxels gudaha maaskaro maaddada cad ah, waqtiga celcelis ahaan ee calaamadaha laga soo bixiyo waraaqaha codbixinta ee ku jira maaskaro CSF, iyo xaddiyadaha dhaqdhaqaaqa Friston 26) dib ayaa loo diiwaangeliyay. Intaa waxaa sii dheer, isbedelka khadka toosan waxaa lagu soo daray kalkaaliye-yaasha maxaa yeelay signalada 'BOLD' waxay muujin kartaa qulqulka-hooseeya.

Ma jiro ka-qaybgale daraasaddan muujiyey dhaqdhaqaaq ka weyn 1.5 mm ee tarjumaadda ugu badan ee ku jirta x, y, ama z faasaska ama wareegga ugu sarreeya ee 1.5 ° mid ka mid ah saddexda faasas. Si loo sii wado meesha ka saarista saameynta haraaga dhaqdhaqaaqa ee talaabooyinka fMRI ee nasashada, celceliska barakicinta qaabdhismeedka (celceliska FD) ee dhaqdhaqaaqa madaxa ayaa la xisaabiyay waxaana loo adeegsaday kala duwanaansho dhammaan falanqaynta waxqabadka kooxda, taas oo laga soo xigtay xididka Jenkinson micnaheedu waa algorithm laba jibbaaran oo loo tixgeliyey kala duwanaanshaha voxelwise ee dhaqdhaqaaqa asal ahaan ka soo jeeda (33); ma jirin kala duwanaansho kooxeed oo laga helay celceliska FD ee u dhexeeya maaddooyinka IGD iyo HC (p = 0.52) gundhigga ama inta udhaxeysa hordhaca CBT iyo waqtiyada ka dambeeya CBT (p = 0.71).

Falanqaynta xogta sawir qaadashada waxqabadka

Falanqaynta ALFF waxaa lagu sameeyay iyadoo la adeegsanayo barnaamijka DPABI. ALFF waxay u dhigantaa xoogga ama xoojinta oscillations-low-ga ah waxaana loo maleynayaa inuu ka tarjumayo waxqabadka laf-dhabarka (34, 35). Marka la soo koobo, ka hor horay u soo sheegida hore, taxanaha waqtiga ee voxel kasta waxaa loo beddelay aagga isdabajoogga iyada oo aan la marin shaandhaynta balastarka, iyo awoodda awoodda ayaa la helay. Ka dib, qaybta awoodda ayaa ahayd xidid laba jibbaaran oo loo beddelay oo celcelis ahaan dhan 0.01-0.08 Hz halkii voxel kasta. Celceliska xididka laba jibbaaran ee awoodda kooxdan soo noqnoqota waxaa loo qaatay inay tahay qiimaha ALFF. Ka dib, iyadoo la raacayo hanaan jaangoyn ah, khariidad kasta oo shakhsiyadeed ALFF waxaa caadi ku ahaa shakhsiga macnahiisu caalami yahay ee ALFF; si khaas ah, celceliska guud ahaan voxels-ka khariidadda ALFF waa la xisaabiyey, oo qiimaha voxel kasta waxaa loo qaybiyay celceliska shaqsi ahaan. Waxaan marka hore isbarbar dhignay aasaasiga ALFF ee kooxda IGD iyo kan kooxda HC si aan u baarno waxqabadka neerfaha ee la beddelay ee maadooyinka IGD iyadoo la adeegsanayo labo-muunad t-tijaabin. Si loo saxo isbarbardhigyada badan ee ka dhasha marinka saxda ah ee p <0.05 ayaa la hirgaliyay, oo leh cabirka ugu yar ee culeyska 42 voxels (AlphaSim-waxaa lagu saxay xuduudaha soosocda: hal voxel p = 0.001; Jilitaannada 5,000; macno ahaan la qiyaasay xiriirinta 8.04 × 10.60 × 10.46 mm FWHM; iyo maaskaro ku xeel dheer maaskaro). Si loo baaro saameynta ay CBT ku yeelan karto maaddooyinka IGD, waa la iswaafajiyey t- waxaa la qabtay si loo xisaabiyo khariidadda farqiga u dhexeeya kooxda ALFF kahor iyo kadib CBT. Si loo saxo isbarbardhigyada badan ee ka dhasha marinka saxda ah ee p <0.05 ayaa la hirgaliyay, oo leh cabirka ugu yar ee culeyska 40 voxels (AlphaSim-waxaa lagu saxay xuduudaha soosocda: hal voxel p = 0.001; Jilitaannada 5,000; macno ahaan la qiyaasay xiriirinta 9.70 × 10.30 × 9.52 mm FWHM; iyo maaskaro ku xeel dheer maaskaro). Kernellada jilicsan ayaa lagu qiyaasey iyadoo lagu saleynayo khariidadda t. Isku-duwayaasha gobollada leh kala duwanaansho kooxeed weyn ayaa laga soo sheegay Machadka Montreal Neurologic Institute (MNI).

Gobollada xiisaha leh (ROIs) waxaa la go'aamiyay inay noqdaan gobollada ay qiimeyaasha ALFF si weyn isu beddeleen inta u dhexeysa xilligii ka horeeyey iyo tii ka dambeysay CBT. Qiyamka FC ee gobollada abuur (bidix ka sarreeya OFC (iskuduwaha MNI: x = −12, y = 24, z = −21, radius = 6 mm)) iyo bidixda bidix (isku-duwayaasha MNI: x = −3, y = 3, z = 9, radius = 6 mm) ayaa laga soo saaray iyadoo la adeegsanayo DPABI. t-Waxaa loo adeegsaday isbarbardhiga qiyamka FC ee udhaxeeya kooxda 'IGD' iyo kooxda HC iyo falanqaynta isfahamka ee Pearson waxaa lagu sameeyay inta u dhexeysa qiyamka FC iyo natiijooyinka CIAS / BIS-11 ee kooxda IGD. Ka dib waa la isku daray t-Tijaabada waxaa loo isticmaalay in lagu barbar dhigo qiyamka FC inta udhaxeysa dhibcaha waqtiga kahor iyo ka dib daaweynta. Falanqaynta isfahamka Pearson waxaa lagu sameeyay inta udhaxeysa heerka isbedelka ku yimid qiyamka FC laga soosaaray (Δ_{ALFF / pre − ALFF} ama Δ_{FC / Pre − FC}) iyo heerka dhimista dhibcaha CIAS (Δ_{CIAS / Pre − CIAS}) / BIS-11 (Δ_{BIS − 11 / Pre − BIS − 11}) natiijooyinka si loo baaro haddii isbeddelada FC ay saadaalin doonaan dhimista astaamaha iyada oo loo marayo CBT, marka loo eego qaababka lagu sharxay daraasadihii hore (36). Laba-taayir ah p-value of 0.05 waxaa loo tixgaliyey inay tahay mid si muuqata ahaan muhiim u ah.

Falanqaynta tirakoobka ee tirakoobka dadka iyo cabbiraadaha caafimaad

Laba sambal t-tijaabooyinka waxaa lagu fuliyay iyada oo la adeegsanayo SPSS (Xirmooyinka Tirakoobka ee Sayniska Sayniska Bulshada, nooca SPSS 19, IBM, USA) oo loogu talagalay doorsoomayaasha joogtada ah si loo qiimeeyo farqiga u dhexeeya kooxda IGD iyo kooxda HC. Wadaag t-tests ayaa loo adeegsaday in lagu baaro saameynta ay CBT ku yeelato astaamaha kiliinikada ee u dhexeeya waqtiyada kahor iyo kadib-CBT.

Tag:

Natiijooyinka

Juquraafiyada iyo tillaabooyinka caafimaad ee maadooyinka IGD iyo HC

Maadooyinka IGD iyo HC kuma kala duwanayn da 'da' midkood (p = 0.31) ama waxbarasho (p = 0.10). Sidii la filaayay, maadooyinka IGD waxay muujiyeen dhibco aad u sarreysa oo ah CIAS, SAS, SDS, iyo buundooyinka BIS-II (p <0.001, p = 0.02, 0.04, 0.001), iyo sidoo kale waqti isbuuc isbuuc dheeri ah oo ka badan maadooyinka HC ay sameeyeen (p <0.001; Miis Table11).

Shaxda 1

Astaamaha dadka iyo dabeecadaha kooxda IGD iyo kooxda HC.

SD, leexashada heerka; IGD, khamaarka ciyaaraha internetka; HC, xakameyn caafimaad; CBT, daaweynta dabeecada garashada.

ALFF iyo FC farqiga u dhexeeya maadooyinka IGD iyo HC

Marka la barbardhigo maadooyinka HC, maadooyinka IGD waxay muujiyeen inay si weyn u kordheen qiimayaasha ALFF ee labada dhinac, qeybta midig ee OFC, qeybta muruqyada ee labada dhinac ah (SMA), garaaca bidix ee bidix, iyo garabka bidix ee murugada leh (ACC; Shaxda) Table2,2, Jaantus Jaantus1) .1). Gobolka nasashada ee udhaxeeya bartamaha bidix ee OFC iyo putamen ayaa si aad ah hoos ugu dhacay kooxda IGD (p = 0.002).

Shaxda 2

Gobollada muujinaya kala duwanaanta kooxda ee ALFF u dhexeeya kooxda IGD iyo kooxda HC.

BA, aagga Brodmann; IGD, khalkhalka ciyaaraha internetka; HC, xakameyn caafimaad leh. Laba tijaabo-T ah P <0.05, AlphaSim-la saxay (P <0.001, cabirka voxel> 42).

Jaantuska 1

Gobollada maskaxda ee muujiyay qiyamka ALFF ee ka sarreeya kooxda IGD marka loo eego kooxda HC aasaasiga ah (p <0.05, AlphaSim-saxay). Qaybta bidix ee shaxanka waxay u taagan tahay ka qaybgalaha dhinaca midig, qeybta midigna waxay u taagan tahay ka qeybgalaha dhanka bidix. ALFF, baaxadda isbedbeddelka hiwaayadda hooseeya; IGD, khalkhalka ciyaaraha internetka; HC, xakameyn caafimaad leh.

Juquraafiyada iyo tillaabooyinka caafimaad kahor iyo kadib CBT

Ka dib CBT, waqtiga ciyaarta isbuuclaha iyo natiijada CIAS iyo BIS-11 si weyn ayaa loo dhimay (dhammaantood ps = 0.001). Natiijooyinkaas waxay muujinayaan in CBT ay ku fiicneyd daaweynta maaddooyinka 'IGD' (Jadwalka (Table33).

Shaxda 3

Astaamaha dadka iyo dabeecada ka hor iyo ka dib daaweynta daaweynta dabeecadda garashada (CBT) ee kooxda IGD.

SD, leexashada heerka; IGD, khamaarka ciyaaraha internetka.

Isbedelada howlaha nasiinada gobolka ka hor iyo ka dib CBT

Kadib CBT, qiimayaasha ALFF ayaa si weyn hoos ugu dhacay bilawga bidix ee OFC iyo putamen (Shaxda (Table4,4, Jaantus Jaantus3) .3). Intaa waxaa sii dheer, gobolka nasashada ee udhaxeeya bartamaha bidix ee OFC iyo putamen si weyn ayaa loo kordhiyay.

Shaxda 4

Gobollada muujinaya kala duwanaanta kooxda ee ALFF inta u dhaxaysa pre-CBT iyo post-CBT ee kooxda IGD.

BA, aagga Brodmann; CBT, daaweynta dabeecada garashada, IGD, jahwareerka ciyaaraha internetka

Tijaabada la isku daray-T P <0.05, AlphaSim-la saxay (P <0.001, cabirka voxel> 40).

Jaantuska 3

Gobollada maskaxda ee muujiyey hoos u dhaca qiimaha ALFF ee kooxda IGD ka dib daaweynta dabeecadda garashada (p <0.05, AlphaSim-saxay). Qeybta bidix ee sawirka ayaa mataleysa dhanka midig ee kaqeybgalaha, qeybta midigna waxay mataleysaa dhanka bidix ee kaqeybgalaha. IGD, Dhibaatada ciyaaraha internetka; ALFF, baaxadda isbedbeddelka hiwaayadda hooseeya.

Cabiraada cilaaqaadka

Kooxda IGD, qiyamka kooxda FC ee udhaxeeya bidixda bidix ee OFC iyo putamen waxay si xun ula xiriireen buundooyinka BIS-11 (r = -0.733, p <0.001; Jaantus Jaantus2) .2). Isbeddelka ku yimid qiyamka FC laga soosaaray (Δ_{FC / Pre − FC}) inta udhaxeysa bidix ee sare ee OFC iyo bidixda bidixda ayaa si wanaagsan xiriir ugu leh heerka cabbirka dhimista dhibcaha CIAS (Δ_{CIAS / Pre − CIAS}; r = 0.707, p <0.001; Jaantus Jaantus4) .4). Ma jiro xiriir muhiim ah oo ka dhexeeya isbeddelada qiimaha FC (Δ_{FC / Pre − FC}) iyo cabirka dhimista dhibcaha BIS-11 ((_{BIS − 11 / Pre − BIS − 11}) la ogaaday (r = 0.396, p = 0.084).

Jaantuska 2

Kooxda IGD, qiyamka kooxda FC ee udhaxeeya bidixda bidix ee OFC iyo putamen waxay si xun ula xiriireen buundooyinka BIS-11 (r = -0.733, p <0.001). IGD, Dhibaatada ciyaaraha internetka; FC, isku xirnaanta shaqada; OFC, kiliyaha orbitofrontal; BIS-11, Qiyaasta Barratt Is-beddelka-11.

Jaantuska 4

Isbeddelka ku yimid qiyamka FC (ΔFC / Pre-FC) ee udhaxeysa bidix ee sare ee OFC iyo bidixda bidixda ayaa si wanaagsan loola xiriiriyay heerka hoos u dhaca dhibcaha CIAS ee maadooyinka IGD. (ΔCIAS / Pre-CIAS; r = 0.707, p <0.001). FC, isku xirnaanta shaqada; OFC, kiliyaha orbitofrontal; CIAS, Iskeelka Maandooriyaha Internetka ee Chen; IGD, Dhibaatada ciyaaraha internetka.

Tag:

Dood

Daraasaddan dheer, ALFF iyo FC waa loo isticmaalay si loo baaro isbeddellada maskaxda ee u dhaxeeya IGD iyo kooxda HC iyo habka daaweynta CBT ee maadooyinka IGD. Waxaan ogaannay in maadooyinka IGD ay muujiyeen shaqooyin aan caadi ahayn oo ka mid ah gobollada qaarkood oo ku xiran maadooyinka HCC iyo in CBT laga yareeyn karo isbeddelada foosha ee OFC iyo saameynta iyo kordhinta isdhexgalka iyaga u dhaxeeya, marka lagu daro hagaajinta astaamaha IGD.

Daraasaddan, FC-ka dawlad-qaran ee u dhexeeya dhinaca dhexdhexaadinta OFC-ga iyo saamiga ayaa si weyn hoos ugu dhacay kooxda IGD. BIS-11 waxay isku xiran yihiin isbeddelka FC taas oo muujisay in naafanimada ku jirta wareegyada hore ee xuduudaha laga yaabo in ay saameyn ku yeelan karaan dabeecadaha aan habooneyn ee maadooyinka IGD. Daraasado horay loo ogaanayey neuroimaging ayaa sheegay in naafanimada maskaxeed ee gobollada PFC ay la xiriirtay isku-buuqa sare ee IGD (37). Xuduudaha horay loo soo marey ayaa waxaa ka mid ah khadka garashada, taas oo inta badan isku xirta calaameedka iyo dhejiska ee gobollada horay loo yaqaan. Isbedelka natiijooyinka baadhitaanada dareen-wadareedyadii dhawayd, isbeddellada hawlaha ayaa lagu arkay gobollo badan oo hor leh (oo ay ku jiraan saxda ah OFC, labada SMA iyo ACC bidixda) iyo gobollada basal ganglia (ee putamen ee labada dhinac) ee xanuunka halista ah, oo ay ku jiraan IGD (12, 38, 39). Volkow et al. waxaa lagu soo bandhigay shabakadaha neurooniga ee maadooyinka daroogada ku jira, oo ay ku jiraan OFC-, ACC-, caleemaha hoose ee curyaaminta (IFG) -, iyo koontooyinka hore ee dorsada hore (DLPFC), oo laga yaabo inay ka tarjunaan dabeecadaha la arko, sida is-xakamaynta isdhexgalka iyo dabeecadda karti la'aan (40) iyo dhibaatooyinka samaynta go'aano wanaagsan, oo tilmaamaya mukhaadaraadka; marka shakhsiyaadka IGD ay sii wadaan ciyaaraha inkasta oo ay la kulmaan cawaaqib xumo, taasi waxay noqon kartaa mid la xiriirta hawlaha naafanimada ee wareegyada hore (41). Mid ka mid ah dabeecadaha udub dhexaadka ah ee IGD waa soosaarida kontaroolada iyada oo aan la xakameyn karin xakameynta ciyaaraha ciyaaraha internetka. Daraasad hore oo isku-darka ah ee loo yaqaan 'vexel-based morphometric morphometric (VBM) iyo falanqaynta FC ayaa shaaca ka qaaday ku lug lahaanshaha dhowr qaybood oo prefrontal iyo wareegyada la xiriira prefrontal-striatal circuit (ACC-, OFC-, iyo DLPFC-striatal circuit) habka IGD waxayna soo jeediyeen IGD waxay la wadaagi karaan habab la mid ah sheyga ku tiirsanaanta heerka wareega (41). Helitaanka hadda waa muhiim, maaddaama wax beddelka dhaqdhaqaaqa maskaxda / isku xirnaanta ee wareegga hore ee xargaha hore loo arkay dovetails daraasadihii hore. Intaa waxaa sii dheer, SMA waxaa lagu soo daray shabakada salience, taas oo nidaamisa shaqada shabakadaha kale marka isbeddelada deg degga ah ee dabeecadda loo baahan yahay, sida marka si dhaqso ah loola socdo kombuyuutarka inta aad ciyaareyso ciyaaraha (42). Yuan et al. soo sheegay qiimayaasha sare ee ALFF ee SMA maaddooyinka IGD (12), oo waxaan ka helnay natiijo la mid ah daraasaddan, oo soo jeedisay in SMA ay noqon karto gobol muhiim u ah dabeecadaha balwada leh (41).

Ilaa hada, kooxda 'CBT' ayaa la muujiyay inay waxtar u leedahay inay ka caawiso dhalinyarada qaangaarka ah balwadda internetka (20). Daraasadda hadda jirta, ciyaarta isbuuclaha ee isbuuclaha ah si weyn ayey uga yaraayeen, iyo natiijooyinka CIAS iyo BIS-II ayaa si weyn hoos loogu dhigay ka dib CBT. Waxay soo jeedisay in cawaaqib xumada la laaban karo haddii qabatinka Internetka lagu soo celiyo muddo gaaban. Waxaan aragnay hoos u dhaca qiimaha ALFF ee dhanka bidix ee sare ee OFC iyo bidixda bidix iyo kororka isku xirnaanta OFC-putamen ka dib CBT, kuwaas oo ah natiijooyin la waafajiyay aragtidoodii hore ee soo jeedinayey in wareegga OFC-striatal uu noqon karo bartilmaameedsiga daweynta guud ee balwadaha. cilladaha (43). Xafiiska OFC wuxuu ku lug leeyahay xeer-is-daba-marin ah marka lagu daro go'aan qaadashada, markaa xiriirka ka dhexeeya OFC iyo goamen ayaa muujinaya in si fiican loo xakameynayo dabeecadaha xun ee maadooyinka IGD (44). Waxay la jaanqaadeysaa natiijada hoos udhaca dhibcaha BIS-11 daaweynta ka dib. The putamen waa mid ka mid ah waaxaha 'striatum' wuxuuna ahaa gobol maskaxeed oo laxiriira geedi socodka garashada oo inta badan lala wadaago maadada 'caudate nucleus'. Si gaar ah, putamen wuxuu la xiriiray xakameynta dabeecadaha caado iyo ficillada hadafka lagu hagayo (45). Waxaan ogaanay in heerka sare ee ALFF uu hoos u dhacay qeybta bidix ka dib CBT, isagoo soo jeedinaya in CBT laga yaabo inay gacan ka geysato kor u qaadista xakameynta dabeecadaha caado iyo ficillada ujeeddooyinka hadafka ee maadooyinka IGD. Taas macnaheedu waa in CBT ay awoodi karto inay ka hor tagto isticmaalka dabeecadda caadifadda aan caadiga ahayn iyadoo la beddelayo isdhexgalka isugeynnada wareegga hore ee preatalal-striatal. Daraasadihii hore ee CBT waxay soo sheegeen in CBT ay wax ka beddesho dhaqdhaqaaqa nasiinada-gobolka ee kortiga prefrontal iyo in CBT ay saxaan geedi socodyada garashada dysfunctional (46). Dhanka kale, isbeddelada isku xirnaanta OFC-putamen ayaa saadaalin kara saameynta CBT.

Yaraanta daraasaddan ayaa ahayd in maadooyinka 'IGD' aan si aan kala sooc lahayn loogu meelayn laba kooxood (hal koox oo ka mid ah kaqeybgaleyaasha ayaa heli doona CBT, halka koox kale oo aan helin daweynta ay u adeegi doonto xakameyn). Marka labaad, waxaan shaqaaleysiinay ragga oo keliya; sidaas darteed, daraasado dheeri ah oo lala yeelanayo kaqeybgalayaasha haweenka ayaa loo baahan yahay si loo xaqiijiyo loona dheereysto natiijooyinka hadda jira. Saddexaad, cabirka muunadda xaddidan wuxuu kordhiyey halista fikradaha beenta ah wuxuuna ku adkeeyay tijaabada si loo qiimeeyo xiriirka ka dhexeeya isbeddelada qiimaha FC iyo saameynta daaweynta. Tan afraad, waxaa lagama maarmaan ah in la saxo isbarbardhigyada badan si loo xakameeyo qaladka beenta ah. Sixitaanka AlphaSim waxaa loo isticmaalay halkan maxaa yeelay wax koox ah lama heli karo marka la isticmaalayo hababka FWE ama FDR. Si kastaba ha noqotee, waxaan u maleyneynaa in sixitaanka AlphaSim lagu aqbali karo daraasaddeena sahaminta maxaa yeelay waa mid ka mid ah xulashooyinka ugu caansan ee sixitaanka isbarbardhigyada badan waxaana loo adeegsaday daraasado badan (34).

Soo koobitaan ahaan, natiijooyinkeenu waxay muujiyeen in IGD ay la xiriirto isbedelka xaddiga qaar ka mid ah xayndaabyada horay loo hormariyay iyo in CBT ay labaduba ka soo horjeesan karaan isbedelka hawlaha OFC iyo saameynta iyo kordhinta isdhexgalka iyaga u dhaxeeya. Natiijooyinkaas waxaa laga yaabaa inay saldhig u noqdaan soo bandhigida habka daaweynta CBT ee maadooyinka IGD waxayna u adeegaan sida biomarkers oo laga yaabo inay saadaaliso calaamadaha soo fiicnaanaya kadib CBT ee maadooyinka IGD.

Tag:

Abaalmarinta qoraaga

YZ, YD waxay mas'uul ka ahaayeen fikradda daraasadda iyo qaabeynta. YD, WJ, XB, MC, XW, iyo WD waxay gacan ka geysteen helitaanka xogta. YS, XH, iyo YW waxay gacan ka geysteen falanqaynta xogta iyo tarjumaadda natiijooyinka. XH wuxuu diyaariyey qoraal gacmeed. Dhammaan qoraayaashu waxay si aad ah u eegeen waxyaabaha la soo koobay iyo nooca ugu dambeeya ee la ansixiyay ee daabacaadda.

Khilaafka dulmiga xiisaha

Qorayaashu waxay caddeeyeen in cilmi-baaristaan ​​lagu sameeyey maqnaansho xiriir ganacsi ama dhaqaale oo laga yaabo inay noqon karto khilaafka xiisaha leh.

Tag:

Qoraalada

Maalgelinta. Shaqadan waxaa taageeray Mu'asasada Qaranka ee Sayniska Dabiiciga ah ee Shiinaha (No.81571650), Mashruuca Tilmaanta Caafimaadka ee Golaha Sayniska iyo Teknolojiyada ee Bukaanka Caafimaadka (dawada reer galbeedka; No.17411964300), iyo Gudiga Waxbarshada Dowlada Hoose ee Magaalada-Gaofeng Deeqda Daawada Daawada. ), Mu'asasada cilmi baarista ee cilmiga Injineerinka Caafimaadka ee Jaamacada Shanghai Jiao Tong (Maya. YG20172013QN2017), iyo Sanduuqa Cilmi baarista ee Isbitaalka Ren Ji, School of Medicine, Jaamacada Shanghai Jiao Tong (RJZZ47-17). Barnaamijka kadhigista cilmibaarista caafimaadka iyo curinta cusbitaalka Ren Ji Hospital, Iskuulka caafimaadka, jaamacada Shanghai Jiao Tong (PYIII-016-17, PYIV-027-17). Maalgaliyeyaasha wax door ah kama lahan naqshadeynta daraasadda, aruurinta macluumaadka iyo falanqaynta, go'aanka la daabaco, ama diyaarinta qoraalka.

Tag:

tixraacyada

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5. Ururka AP. Buugga Baadhista iyo Buugga Istaatistikada ee Xanuunnada Maskaxda, 5th Edn Washington, DC: Ururka Caafimaadka Maskaxda ee Mareykanka; (2013).

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