Front Psychiatry. 2018 Pherekhong 3; 9: 341. doi: 10.3389 / fpsyt.2018.00341
Monghali X1, Wang Y1, Jiang W.2, Bao X2, Letsatsi Y1, Ding W1, Cao M1, Wu X1, Du Y2, Zhou Y1.
inahaneloang
Phekolo ea boits'oaro ba kelello (CBT) e sebetsa bakeng sa kalafo ea lefu la lipapali la inthanete (IGD). Leha ho le joalo, mekhoa eo CBT e ntlafatsang matšoao a amanang le kliniki ea IGD ha e tsejoe. Phuputso ena e ne e ikemiselitse ho fumana mokhoa oa kalafo oa li-CBT lithutong tsa IGD ho sebelisa setšoantšo sa phomolo se sebetsang sa mmuso oa matla a khoheli (rsfMRI). Lithuto tse mashome a mabeli a metso e tšeletseng tsa IGD le li-30 tse tsamaisanang le taolo e phetseng hantle (HCs) li fumane rsfMRI scan le liteko tsa bongaka; Lithuto tse 20 tsa IGD li phethile CBT ebe li hlahlojoa hape. Boemo ba boleng ba maqhubu a tlase (ALFF) le khokahano e sebetsang (FC) lipakeng tsa sehlopha sa IGD le sehlopha sa HC li ile tsa bapisoa le metheo, hammoho le litekanyetso tsa ALFF le FC pele le kamora CBT sehlopheng sa IGD. Pele ho kalafo, sehlopha sa IGD se ne se bonts'a haholo keketseho ea boleng ba ALFF ho putamen ea linaha tse peli, medial orbitofrontal cortex (OFC) e nepahetseng, sebaka se kopaneng sa motor motor (SMA), gyrus ea postcentral le le letšehali anterior cingulate (ACC) ha e bapisoa le sehlopha sa HC. Sehlopha sa HC se bontšitse keketseho e phahameng haholo ea boleng ba FC lipakeng tsa medial ea le letšehali le putamen ha e bapisoa le sehlopha sa IGD, litekanyetso tsa FC tsa sehlopha sa IGD li ne li amahanngoa hampe le lintlha tsa BIS-11 pele ho kalafo. Kamora 'CBT, nako ea papali ea beke le beke e ne e le khuts'oane haholo, mme lintlha tsa CIAS le BIS-II li ne li le tlase haholo. Litekanyetso tsa ALFF lithutong tsa IGD li ile tsa fokotseha haholo ka lehlakoreng le letšehali la OFC le ka letsohong le letšehali, 'me FC lipakeng tsa bona e ile ea eketseha haholo kamora CBT. Tekanyo ea liphetoho tsa FC (ΔFC / Pele ho FC) e ne e hokahane hantle le boholo ba liphetoho tsa lintlha tsa CIAS (ΔCIAS / Pele ho CIAS) lithutong tsa IGD. CBT e ka laola ho feto-fetoha ho sa tloaelehang ha maqhubu a tlase libakeng tse etsoang pele ho nako lithutong tsa IGD mme e ka ntlafatsa matšoao a amanang le IGD. Liphetoho tse ling tsa mmuso oa phomolo libakeng tse etsoang pele ho moo li ka senola mekhoa ea kalafo ea CBT lithutong tsa IGD.
LINKOTSO: boholo ba ho fetoha ha maqhubu a tlase; kalafo ea boits'oaro ba boits'oaro; khokahano e sebetsang; litšoantšo tse sebetsang tsa matla a khoheli; bothata ba lipapali tsa inthanete
PMID: 30123144
PMCID: PMC6085723
DOI: 10.3389 / fpsyt.2018.00341
Selelekela
Mathata a lipapali tsa inthanete (IGD), a tsejoang hape e le ts'ebeliso e thata ea Marang-rang, ke ts'ebeliso e fetelletseng le e iphetang ea lipapali tsa inthanete tsa inthanete (1). Haufinyane tjena, IGD e ne e thathamisitsoe e le boits'oaro bo phehellang kapa bo etsahalang khafetsa bo khetholloang ke taolo e sa sebetseng lipapaling; keketseho ea mantlha e fuoang papali ho feta mesebetsi e meng ho fihlela papali e etella pele lithahasello tse ling le mesebetsi ea letsatsi le letsatsi; le ntšetso-pele ea papali leha ho bile le litlamorao tse mpe (2, 3). Leha ho se na litekanyetso tsa semmuso tsa tlhahlobo ea mafu a kelello tse khetholloang ka mekhoa e fetelletseng le e sitisang ea ts'ebeliso ea Marang-rang li kenyelelitsoe khatisong ea bone ea Diagnostic and Statistical Manual (DSM-IV) (4), komiti ea DSM-V e ntse e nahana ho sebelisa mekhoa e hlahisitsoeng ea ts'ebeliso ea lithethefatsi le ts'ebeliso ea lithethefatsi mme e kenyelelitse IGD karolong e supang lipatlisiso tse ling5).
Bafuputsi ba tšoantšitse IGD le mathata a ho laola maikutlo (6). Liphuputso tsa Neuroimaging li fumane hore papali e fetelletseng ea inthanete e ne e amahanngoa le ketsahalo e sa tloaelehang ea ho phomola maemong a ka pele, sebaka sa boko se ikarabellang bakeng sa ts'ebetso ea kelello, joalo ka thibelo ea thibelo (7). Ts'ebetso e senyehileng ea prefrontal (PFC) e kanna ea amana le ho se ts'oanehe ho hoholo, e leng hona ho ka tlatsetsang taolong e holofetseng ea thibelo e amanang le IGD (8). Taolo e sebetsang ea ts'ebeliso ea kelello e amahanngoa le ho hira ho hokahaneng ha lipotoloho tse fapaneng tse holimo holimo ho isa holimo,9, 10). Boithuto ba pejana bo senotse kamano lipakeng tsa sebopeho se sa sebetseng le se sebetsang sa prefrontal cortex (PFC) le taolo e sa sebetseng ea thibelo ho IGD (11-16). Mohlala, phokotso ea "cortical thickness" le "amplitude" ea "frequency frequency fluctuation" (ALFF) "e fumanoeng e hokahane le ho senyeha ha ts'ebetso ea taolo ea kelello lithutong tse nyane tse nang le IGD (12). Phuputso e sebelisang mokhoa oa Reho e fumane hore lithuto tsa IGD li bonts'a khokahano e eketsehileng ho gyrus e kaholimo-limo ha e bapisoa le taolo e phetseng hantle (HCs), e khothalelitseng keketseho ea ts'ebetso ea methapo e amanang le ts'ebetso ea taolo ea kutloisiso (17). Ko et al. (10) e bontšitse hore ts'ebetso e holofetseng libakeng tse etsoang pele ho moo e ka hlalosa phokotso ea matla a thibelo ho IGD. Lithuto tsena tsa ho nka litšoantšo li bontšitse kamoo likarolo le likarolo tsa lobe tse ka pele li fetotsoeng li tsamaisana le taolo e holofetseng ea thibelo ho IGD. Ntle le moo, ts'ebetso ea dopamine e holofetseng ho striatum (phokotso ea li-receptor tsa dopamine D2 le phokotso ea tokollo ea dopamine) le kamano ea eona le metabolism ea glucose ea mantlha e fokotsehileng ho PFC e ile ea bonoa (18, 19).
Phekolo ea boits'oaro ba kelello (CBT) e fumanoe e sebetsa hantle ho phekoleng mathata a ho laola maikutlo, ho kenyelletsa le papali ea chelete ea ho becha (20). Boithuto ba bokhoba ba lithethefatsi bo bontšitse hore CBT e khothaletsa bafo ho amohela le ho qoba maemo ao ho ona ba ka sebelisang lintho le ho sebelisa maano a ho sebetsana le ts'ebeliso ea lithethefatsi le ho ntlafatsa ts'ebetso ea taolo ea thibelo (21, 22). Phuputso e sebelisang mosebetsi oa Stroop e fumane hore CBT e kanna ea amahanngoa le phokotso ea ts'ebeliso ea lithethefatsi, mme e ka ama mekhoa ea methapo e amehang taolong ea kutloisiso, ho se ts'oenyehe, ho susumetsa le ho tsepamisa maikutlo (23). Phuputso e 'ngoe e sebetsang ka matla ea ho ts'oara litšoantšo (fMRI) e sebelisitseng ts'ebetso ea ho hlohlelletsa chelete (MID) ts'ebetsong ea kannete e tlalehile hore barupeluoa ba itšetlehileng ka kannete ba bontšitse ho fokotseha ha li-putamen tse latelang ka CBT, tse bonts'ang hore likarolo tse ling tsa ts'ebetso ea putamen le sebopeho li amana le kalafo. liphetho (24). Young o lumela hore ho kenella ho Internet Addiction (IA) ho lokela ho shebana le thibelo ea ts'ebeliso ea Marang-rang, ho ipapisitsoe le sena, o etsa tlhahiso ea ts'ebetso ea ts'ebetso ea boits'oaro ba kalafo-IA (CBT-IA), e pakiloeng e sebetsa kalafo ea IGD (6). Sehlopha sa Dr Du se fumane hore sehlopha sa sekolo sa CBT se sebetsa hantle bakeng sa bacha ba nang le IGD, haholoholo ho ntlafatsa maemo a maikutlo le bokhoni ba taolo, boits'oaro le boits'oaro ba boits'oaro (20). Le ha CBT e bonts'itse katleho e kholo kalafong ea IGD, liphuputso tse 'maloa li batlisitse mokhoa oa kalafo oa CBT lithutong tsa IGD tse sebelisang fMRI. Patlisiso ea liphetoho tsa boko pele le kamora kalafo e ke ke ea ntlafatsa kutloisiso ea rona feela ea pathogenesis ea IGD le mokhoa oa kalafo oa CBT ho IGD, empa hape e ka thusa ho lekola litlamorao tsa kalafo.
Re sebelisitse Barratt Impulsiveness Scale-11 (BIS-11) ho lekola ts'ebetso ea boits'oaro ea IGD. Ho ipapisitsoe le lithuto tsa pejana, re ile ra nahana hore (1) lithuto tse nang le IGD li ka bonts'a ts'ebetso e sa tloaelehang ea boko / khokahano libakeng tsa pele ho moo, tse ikarabellang ts'ebetsong ea ts'ebetso, joalo ka taolo ea thibelo; (2) CBT e ka laola ts'ebetso e sa tloaelehang ea libaka tsa pele ho sebaka sa pele.
Lisebelisoa le mekhoa
Barupeluoa le liteko tsa bongaka
Phuputso ea hajoale e amohetsoe ke Komiti ea Boitšoaro ea Lipatlisiso ea Sepetlele sa Ren Ji le Sekolo sa Bongaka, Univesithi ea Shanghai Jiao Tong, Chaena No. [2016] 097k (2). Bohle bankakarolo le bahlokomeli ba saena liforomo tsa tumello tse ngotsoeng tse nang le tsebo pele ho thuto. Barupeluoa ba ngolisitseng, lipotso tsa lipotso tsa tlhahlobo le litekanyetso tsa ho khetholla kaofela li hlalositsoe phatlalatsong ea rona e fetileng (15). Lithuto tse mashome a mabeli a metso e tšeletseng tsa IGD tse fihlelletseng litekanyetso tsa tlhahlobo ea tlhahlobo ea ts'oaetso ea inthanete (ke hore, YDQ) e fetotsoeng ke Beard le Wolf (25) ba ile ba hiroa Lefapheng la Bana le Bacha ba Psychiatry ba Setsi sa Bophelo bo Botle ba Kelello ba Shanghai. Batho ba phetseng hantle ba lilemo tse mashome a mararo le banna ba phetseng hantle ba se nang nalane ea botho kapa ea malapa ea mafu a kelello ba ile ba hiroa e le sehlopha sa taolo e phetseng hantle (HC) ka lipapatso. Ka lebaka la ho ata ho hoholo ha IGD ho banna le basali, ke barupeluoa ba batona feela ba kenyellelitsoeng (26). Barupeluoa bohle ba ne ba le ka letsohong le letona, 'me ha ho le ea mong oa bona ea tsubang.
Barupeluoa bohle ba ile ba etsa tlhahlobo e bonolo ea 'mele, e neng e kenyelletsa khatello ea mali le litekanyo tsa lebelo la pelo, mme ba botsoa lipotso ke ngaka ea mafu a kelello mabapi le nalane ea bona ea bongaka ea methapo, makoloi, tšilo ea lijo, ho hema, ho potoloha ha mali, endocrine, ho ntša metsi le mathata a ho ikatisa. Eaba ba hlahlojoa mathata a kelello le Puisano ea Mini International Neuropsychiatric bakeng sa Bana le Bacha (MINI-KID) (27). Mekhoa ea ho khetholla e ne e le nalane ea ts'ebeliso e mpe ea lithethefatsi kapa ts'ebeliso e mpe ea lithethefatsi; ho kena sepetlele nakong e fetileng bakeng sa mafu a kelello; kapa lefu le leholo la kelello, joalo ka schizophrenia, khatello ea maikutlo, lefu la ho tšoenyeha, le / kapa linako tsa kelello.
Ho ile ha sebelisoa lipotso tsa mantlha tsa tlhaiso-leseling ho bokella tlhaiso-leseling e mabapi le bong, lilemo, selemo sa ho qetela sa sekolo se phethiloeng le lihora tsa ts'ebeliso ea inthanete ka beke. Ho ile ha sebelisoa lipotso tsa lipotso tse 'ne ho lekola likarolo tsa bongaka tsa bankakarolo, e leng, Chen Internet Addiction Scale (CIAS) (28), Boemo ba ho Tšoenyeha ba Boithati (SAS) (29), Boemo ba khatello ea maikutlo ba boithaopo (SDS) (30), le Barratt Impulsiveness Scale-11 (BIS-11) (31). CIAS, e ntlafalitsoeng ke Chen, e na le lintho tsa 26 sekaleng sa Likert se nang le lintlha tse nne mme e bonts'a ho tiea ha bokhoba ba inthanete. SAS le SDS li sebelisitsoe ho bonts'a hore lithuto tsohle li fihlela maemo a kenyellelitsoeng nakong ea lipatlisiso. Li-questionnaires tsohle li ne li ngoloa ka Senyesemane qalong ebe li fetoleloa ka Sechaena. Ebe lithuto tsa 26 IGD, batsoali ba bona le matichere a bona ba nkile karolo sehlopheng se latelang sa CBT ka boithatelo, se nang le mananeo a 12 (20). Seboka ka seng se nkile 1.5-2 h. Thutong e 'ngoe le e' ngoe ea kalafo ea sehlopha, ho ile ha tšohloa sehlooho se fapaneng. Lihlooho tsena li ne li kenyelletsa mokhoa oa ho hlokomela le ho laola maikutlo a hau; metheo ea puisano e ntle lipakeng tsa batsoali le bana; mekhoa ea ho sebetsana le likamano tse ntlafalitsoeng ka marang-rang; mekhoa ea ho sebetsana le litaba tse fumanehang ka har'a marang-rang; mekhoa ea ho laola maikutlo a hau; mekhoa ea ho lemoha ha boitšoaro bo lemalang bo etsahala; le ho khaotsa boitšoaro bo lemalloang. Lenaneo la ho qetela e ne e le lenaneo la tlhahlobo.
Kamora ho kenella, re ile ra lekola litšobotsi tsa bongaka tsa lithuto tsa IGD hape, mme tse mashome a mabeli tsa tsona li ile tsa hlahlojoa hape ka boithaopo ka tsela e ts'oanang le ea protocol ea pre-CBT.
Boitsebiso ba MR
Lihlooho tsohle li ile tsa phomola-state fMRI maemong a mantlha ka sistimi ea ho nka litšoantšo ea 3.0-T MR (GE Signa HDxt3T, USA) ka coil e tloaelehileng ea hlooho. Ho qoba ho sisinyeha le ho fokotsa lerata la li-scanner, ho ile ha sebelisoa li-pads tse bonolo, 'me lithuto tsa fuoa litaelo tse phethahetseng tsa ho thibela ho sisinyeha nakong ea scan le litlhaloso tsa hore na hobaneng ho sisinyeha ho sa ratehe, ntle le litaelo tsa hore ho sisinyeha ho feteletseng ho ka lebisa ho rescan . Lintlha tsa fMRI tsa naha ea phomolo li fumanoe ho sebelisoa tatellano ea gradient-echo echo-planar joalo ka ha ho hlalositsoe thutong ea rona e fetileng (16). Lilae tse mashome a mararo a metso e mene tse parolang [nako ea ho pheta-pheta [TR] = 2,000 ms; nako ea echo [TE] = 30 ms; tšimo ea pono [FOV] = 230 × 230 mm; le 3.6 × 3.6 × 4 mm boholo ba voxel] bo koahelang boko bohle bo fumanoe hammoho le mohala oa pele oa thekiso ea morao-rao. Bakeng sa tatellano ena ea scan, ho ile ha fumanoa meqolo e 220 e sebetsang ha lithuto li ntse li phomotse (tse hlahisang bolelele ba lisenthimithara tse 440). Nakong ea scanning, barupeluoa ba ile ba laeloa hore ba khutse ka mahlo a koetsoe, ba sa sisinyehe kamoo ho ka khonehang, le hore ba se ke ba robala kapa ba nahana ka eng kapa eng. Kamora ho skena, lithuto li ile tsa botsoa ho netefatsa hore na ba lula ba falimehile nakong ea scan. Ho ile ha boela ha fumanoa tatellano e 'ngoe e latelang: (1) tatelano ea axial T1 e boima bo potlakileng ea spin-echo (TR = 1,725 ms; TE = 24 ms; FOV = 256 × 256 mm; likhae tse 34; le boholo ba voxel ba 0.5 × 0.5 × 4 mm ) le (2) tatelano ea axial T2 e boima bo potlakileng ba spin-echo (TR = 9,000 ms; TE = 120 ms; FOV = 256 × 256 mm; likhae tse 34; le boholo ba voxel ba 0.5 × 0.5 × 4 mm).
Ho etsoa esale pele ha data e sebetsang ea ho nka litšoantšo
Ho etsoa pele ha data ea litšoantšo ho entsoe ho sebelisoa SPM12 e kentsoeng tšebetsong ea MATLAB le SPM12's software Processing and Analysis of Brain Imaging (DPABI; http://rfmri.org/dpabi) (32). Kamora ho lahla meqolo ea pele ea 10 letotong ka leng la nako e sebetsang, linepe tse setseng tse 210 li ile tsa lokisoa ka nako ea selae, tsa abeloa bophahamo ba modumo o bohareng, 'me tsa hlophisoa bocha ka ho sebelisa phetoho e tatileng ea li-parameter (' mele o thata). Joale, litšoantšo tsohle tse sebetsang li ile tsa hlophisoa ka kotloloho ho template ea EPI, voxel e ngoe le e ngoe e ile ea hlophisoa bocha ho 3 × 3 × 3 mm, 'me phetoho ea boreleli ea sebaka e ile ea etsoa ka 8-mm e bophara bo felletseng ba halofo ea Gaussian kernel. Ka mor'a moo, li-covariate tse 26 tse khathollang (ho kenyeletsoa le nako e bolelang ea lipontšo tse tsoang ho li-voxels tse ka har'a mask ea litaba tse tšoeu, nako e bolelang ea lipontšo tse tsoang ho li-voxels ka har'a mask ea CSF, le mekhahlelo ea motsamao ea Friston 24) e ile ea felisoa. Ntle le moo, moetlo o ne o kenyellelitsoe joalo ka regressor ho tloha ha lets'oao la BOLD le ka bonts'a ho kheloha ha maqhubu a tlase.
Ha ho motho ea nkang karolo thutong ena ea bonts'itseng motsamao o fetang 1.5 mm oa phetolelo e phahameng ho x,y, kapa z lilepe kapa potoloho e lebetsoeng le ea 1.5 ° ho efe kapa efe ea lilepe tse 3. Ho tsoela pele ho hlakola phello ea masalla a mehato ea mmuso ea phomolo ea fMRI, ho fallisoa ho bolelang mohala (ho bolelang FD) ea motsamao oa hlooho ho ile ha sebetsoa mme ha sebelisoa e le covariate litlhahlobong tsohle tse sebetsang tsa sehlopha sa voxelwise, tse nkiloeng ka motso oa Jenkinson. e bolela algorithm e sekwere mme e nahane ka phapang ea voxelwise ha e tsamaea ha e tsoa (33); ha ho na liphapang tsa sehlopha tse fumanoeng ho FD e bolelang lipakeng tsa lithuto tsa IGD le HC (p = 0.52) qalong kapa lipakeng tsa nako ea pele ho CBT le kamora 'CBTp = 0.71).
Ts'ebetso ea data ea imaging e sebetsang
Litlhahlobo tsa ALFF li entsoe ka software ea DPABI. ALFF e lekana le matla kapa matla a ho khutsuoa ha maqhubu a tlase mme ho nahanoa hore e bonts'a ts'ebetso ea boits'oaro ba methapo (34, 35). Ka bokhutšoanyane, kamora ho lokisoa pejana ho boletsoeng pejana, lethathamo la linako tsa voxel e 'ngoe le e' ngoe le ile la fetoloa hore e be leqhubu la maqhubu ntle le ho sefa li-bandpass, 'me matla a motlakase a fumanoa. Joale, ponahalo ea motlakase e ne e le motso o sekwere o fetotsoe mme o lekantsoe ho feta 0.01-0.08 Hz ho voxel e ngoe le e ngoe. Motsoako o lekantsoeng oa motlakase sehlopheng sena sa maqhubu o nkuoe e le boleng ba ALFF. Joale, ka ts'ebetso ea maemo, 'mapa o mong le o mong oa ALFF o ne o hlophisitsoe ke ALFF ea lefats'e ea motho ka mong; ka ho khetheha, moelelo oa li-voxels tsa 'mapa oa ALFF o baliloe,' me boleng ba voxel ka 'ngoe bo arotsoe ke moelelo ka bonngoe. Pele re ile ra bapisa motheo oa ALFF oa sehlopha sa IGD le oa sehlopha sa HC ho lekola tšebetso e fetotsoeng ea methapo ea kutlo lithutong tsa IGD ka mehlala e 'meli. t-teko. Khalemelo ea lipapiso tse ngata e hlahisang moeli o lokisitsoeng oa p <0.05 e kentsoe tšebetsong, ka boholo ba sehlopha sa li-voxels tse 42 (AlphaSim-e lokisitsoe ka mekhahlelo e latelang: voxel e le 'ngoe p = 0.001; Liketsiso tsa 5,000; khakanyo e hakantsoeng ea sebaka sa 8.04 × 10.60 × 10.46 mm FWHM; le maske ea taba e bohlooho ea lefats'e). Ho lekola litlamorao tsa CBT lithutong tsa IGD, ka bobeli t-teko e entsoe ho lekola 'mapa oa phapang ea sehlopha sa ALFF pele le kamora' CBT. Khalemelo ea lipapiso tse ngata e hlahisang moeli o lokisitsoeng oa p <0.05 e kentsoe tšebetsong, ka boholo ba sehlopha sa li-voxels tse 40 (AlphaSim-e lokisitsoe ka mekhahlelo e latelang: voxel e le 'ngoe p = 0.001; Liketsiso tsa 5,000; khakanyo e hakantsoeng ea sebaka sa 9.70 × 10.30 × 9.52 mm FWHM; le maske ea taba e bohlooho ea lefats'e). Kernel e boreleli e hakantsoe ho ipapisitsoe le 'mapa oa t. Lihokela tsa libaka tse nang le liphapang tse kholo tsa sehlopha li tlalehiloe sebakeng sa Montreal Neurologic Institute (MNI).
Libaka tsa lithahasello (li-ROI) li ne li ikemiselitse ho ba libaka tseo litekanyetso tsa ALFF li fetohileng haholo lipakeng tsa nako ea pele le ea kamora 'CBT. Litekanyetso tsa FC tsa libaka tsa peo (mohokahanyo o kaholimo oa OFC (MNI o hokahanya: x = -12, y = 24, z = -21, radius = 6 mm) le putamen ea leqele (MNI e hokahanya: x = -3, y = 3, z = 9, radius = 6 mm) li ntšitsoe ho sebelisoa DPABI. t-Test e sebelisitsoe ho bapisa boleng ba FC lipakeng tsa sehlopha sa IGD le sehlopha sa HC le litlhahlobo tsa Pearson tsa khokahano li entsoe lipakeng tsa boleng ba FC le lintlha tse ngata tsa CIAS / BIS-11 sehlopheng sa IGD. Ebe e kopantsoe t-teko e sebelisitsoe ho bapisa litekanyetso tsa FC lipakeng tsa lintlha tsa nako ea pele le kamora 'kalafo. Litlhahlobo tsa Pearson Correlation li ne li etsoa lipakeng tsa phetoho ea litekanyetso tse ntšitsoeng tsa FC (ΔALFF / Pele ho ALFF kapa ΔFC / Pele-FC) le sekhahla sa phokotso ea lintlha tsa CIAS (ΔCIAS / Pele ho − CIASEA-11-BISBIS-11 / Pele-BIS-11Lintlha tsa ho fuputsa hore na liphetoho tsa FC li ka bolela phokotso ea matšoao ka CBT, ho latela mekhoa e hlalositsoeng thutong e fetileng (36). Mehatla e mmedi pBohlokoa ba 0.05 bo ne bo nkuoa e le ba bohlokoa.
Tlhahlobo ea lipalo-palo ea litekanyetso tsa palo ea batho le tsa bongaka
Mehlala e 'meli t-liteko li ile tsa etsoa ho sebelisoa SPSS (Statistical Package for the Social Sciences software, SPSS version 19, IBM, USA) bakeng sa mefuta e tsoelang pele ho lekola phapang lipakeng tsa sehlopha sa IGD le sehlopha sa HC. Tse di kopantsweng t-liteko li ne li sebelisetsoa ho lekola litlamorao tsa CBT ho litšobotsi tsa kliniki lipakeng tsa nako ea pele le ea kamora 'CBT.
Results
Palo ea batho le mehato ea bongaka ea lithuto tsa IGD le HC
Litaba tsa IGD le HC li ne li sa fapana ka lilemo tse peli (p = 0.31) kapa thuto (p = 0.10). Joalokaha ho lebelletsoe, lithuto tsa IGD li bontšitse lintlha tse phahameng haholo tsa CIAS, SAS, SDS, le BIS-II (p <0.001, p = 0.02, 0.04, 0.001), hammoho le nako e telele ea ho bapala ea beke le beke ho feta lithuto tsa HC (p <0.001; Tafole Lethathamo11).
Lethathamo 1
Litšobotsi tsa palo ea batho le boits'oaro ba sehlopha sa IGD le HC.
IGD (n = 26) | HC (n = 30) | P-senolo | |
|---|---|---|---|
(Bolela ± SD) | (Bolela ± SD) | ||
| Lilemo (yeas) | 16.81 ± 0.75 | 17.00 ± 0.89 | 0.31 |
| Thuto (ee) | 11.53 ± 0.70 | 11.20 ± 0.81 | 0.10 |
| Nako ea ts'ebeliso ea inthanete ka beke (lihora) | 32.54 ± 10.34 | 1.70 ± 5.36 | |
| Tekanyo ea Bokhoba ba Inthanete ea Chen (CIAS) | 71.88 ± 5.56 | 41.97 ± 11.31 | |
| Tekanyo ea ho Tšoenyeha ka Boithati (SAS) | 45.65 ± 10.24 | 40.10 ± 7.28 | 0.02 |
| Tekanyo ea ho tepella maikutlo (SDS) | 48.23 ± 8.34 | 43.43 ± 8.97 | 0.04 |
| Tekanyo ea Barratt Impulsiveness-11 (BIS-11) | 59.62 ± 9.11 | 52.27 ± 6.90 | 0.001 |
SD, Ho kheloha ho tloaelehileng; IGD, bothata ba papali ea inthanete; HC, taolo e phetseng hantle; CBT, kalafo ea boits'oaro ba boits'oaro.
Phapang ea ALFF le FC lipakeng tsa lithuto tsa IGD le HC
Ha li bapisoa le lithuto tsa HC, lithuto tsa IGD li bontšitse keketseho e phahameng ea litekanyetso tsa ALFF ho putamen ea linaha tse peli, medial e nepahetseng ea OFC, sebaka se kopaneng sa makoloi (SMA), gyrus e ka morao ea postcentral, le anterior anterior cingate (ACC; Tafole Lethathamo2,2, Setšoantšo Figure1) .1). FC ea boemo ba phomolo lipakeng tsa medial ea le letšehali le putamen e ne e le tlase haholo sehlopheng sa IGD (p = 0.002).
Lethathamo 2
Libaka tse bonts'ang liphapang tsa sehlopha ho ALFF lipakeng tsa sehlopha sa IGD le sehlopha sa HC.
| Tlhaloso ea Cluster | BA | MNI e hokahanya | Saese ea sehlopheng | Peak t Laduma | ||
|---|---|---|---|---|---|---|
X | Y | Z | ||||
| Putamen (L) | -33 | 0 | -3 | 95 | 6.02 | |
| Putamen (R) | 33 | 3 | -3 | 56 | 5.19 | |
| Lebokose la medial orbitofrontal (R) | 11 | 12 | 60 | 3 | 214 | 5.33 |
| Likoloi tse tlatselletsang (L) | 6 | -12 | -7 | 56 | 464 | 7.21 |
| Gyrus ea Postcentral (L) | 6 | -42 | -15 | 45 | 103 | 7.91 |
| Ka pele ho cingulate (L) | 24 | -6 | 14 | 31 | 62 | 6.26 |
| Likoloi tse tlatselletsang (R) | 6 | 12 | 9 | 57 | 276 | 6.16 |
BA, sebaka sa Brodmann; IGD, bothata ba papali ea inthanete; HC, taolo e phetseng hantle. Teko ea sampuli-T e 'meli P <0.05, e lokisoe ke AlphaSim (P <0.001, voxel size> 42).
Libaka tsa boko tse bonts'itseng litekanyetso tse phahameng tsa ALFF sehlopheng sa IGD ho feta sehlopheng sa HC qalong (p <0.05, AlphaSim-e lokisitsoe). Karolo e ka letsohong le letšehali ea setšoantšo e emela lehlakore le letona la monkakarolo, mme karolo e nepahetseng e emetse lehlakore la leqele la monka karolo. ALFF, boholo ba ho fetoha ha maqhubu a tlase; IGD, bothata ba papali ea inthanete; HC, taolo e phetseng hantle.
Palo ea batho le mehato ea bongaka pele le kamora 'CBT
Kamora 'CBT, nako ea papali ea beke le beke le lintlha tsa CIAS le BIS-11 li ile tsa fokotsoa haholo (kaofela ps = 0.001). Liphuputso tsena li bontšitse hore CBT e ne e sebetsa hantle kalafong ea lithuto tsa IGD (Lethathamo (Tafole33).
Lethathamo 3
Litšobotsi tsa palo ea batho le boits'oaro pele le kamora kalafo ea boits'oaro ba boits'oaro (CBT) sehlopheng sa IGD.
Pele ho CBT (n = 26) | Kamora 'CBT (n = 26) | P-senolo | |
|---|---|---|---|
(Bolela ± SD) | (Bolela ± SD) | ||
| Nako ea ts'ebeliso ea inthanete ka beke (lihora) | 32.54 ± 10.34 | 27.27 ± 9.36 | 0.001 |
| Tekanyo ea Bokhoba ba Inthanete ea Chen (CIAS) | 71.88 ± 5.56 | 50.00 ± 11.99 | 0.001 |
| Tekanyo ea ho Tšoenyeha ka Boithati (SAS) | 45.65 ± 10.24 | 44.65 ± 10.24 | 0.630 |
| Tekanyo ea ho tepella maikutlo (SDS) | 48.23 ± 8.34 | 46.77 ± 9.89 | 0.500 |
| Tekanyo ea Barratt Impulsiveness-11 (BIS-11) | 59.62 ± 9.11 | 52.69 ± 10.04 | 0.001 |
SD, Ho kheloha ho tloaelehileng; IGD, bothata ba papali ea inthanete.
Liphetoho liketsahalong tsa boemo ba ho phomola ba naha pele le kamora 'CBT
Kamora CBT, litekanyetso tsa ALFF li ile tsa fokotseha haholo ho medial OFC le putamen (Tafole (Tafole4,4, Setšoantšo Figure3) .3). Ntle le moo, FC ea naha ea phomolo lipakeng tsa medial ea le letšehali le putamen e eketsehile haholo.
Lethathamo 4
Libaka tse bonts'ang liphapang tsa sehlopha ho ALFF lipakeng tsa pre-CBT le post-CBT sehlopheng sa IGD.
| Tlhaloso ea Cluster | BA | MNI e hokahanya | Saese ea sehlopheng | Peak t Laduma | ||
|---|---|---|---|---|---|---|
X | Y | Z | ||||
| Karolo e phahameng ea orbitofrontal cortex (L) | 11 | -12 | 24 | -21 | 41 | -5.18 |
| Putamen (L) | -15 | 12 | -4 | 68 | -6.19 | |
BA, sebaka sa Brodmann; CBT, kalafo ea boits'oaro ba boits'oaro, IGD, bothata ba papali ea inthanete
Teko ea Paired-T P <0.05, AlphaSim-e lokisitsoe (P <0.001, voxel size> 40).
Libaka tsa boko tse bontšitseng ho fokotseha ha litekanyetso tsa ALFF sehlopheng sa IGD kamora kalafo ea boits'oaro ba boits'oaro (p <0.05, AlphaSim-e lokisitsoe). Karolo e ka letsohong le letšehali e emela lehlakore le letona la monkakarolo, mme karolo e nepahetseng e emetse lehlakore la leqele la monka karolo. IGD, bothata ba papali ea inthanete; ALFF, bophahamo ba phallo ea maqhubu a tlase.
Mekhoa ea bongaka ea likamano
Sehlopha sa IGD, litekanyetso tsa FC lipakeng tsa medial ea leqele ea OFC le putamen li ne li amahanngoa hampe le lintlha tsa BIS-11 (r = -0.733, p <0.001; Setšoantšo Figure2) .2). Liphetoho ho boleng ba FC bo ntšitsoeng (ΔFC / Pele-FC) lipakeng tsa OFC e ka letsohong le letšehali le putamen ea leqeleng li ne li tsamaellane hantle le sekhahla sa phokotso ea lintlha tsa CIAS (ΔCIAS / Pele ho − CIAS; r = 0.707, p <0.001; Setšoantšo Figure4) .4). Ha ho na kamano e bohlokoa lipakeng tsa liphetoho tsa boleng ba FC (ΔFC / Pele-FC) le sekhahla sa phokotso ea lintlha tsa BIS-11 (ΔBIS-11 / Pele-BIS-11e fumanoe (r = 0.396, p = 0.084).
Sehlopha sa IGD, litekanyetso tsa FC lipakeng tsa medial ea leqele ea OFC le putamen li ne li amahanngoa hampe le lintlha tsa BIS-11 (r = -0.733, p <0.001). IGD, bothata ba papali ea inthanete; FC, khokahano e sebetsang; OFC, orbitofrontal cortex; BIS-11, Barratt Impulsiveness Scale-11.
Liphetoho tsa boleng ba FC (ΔFC / Pre-FC) lipakeng tsa OFC e kaholimo le leqele le putamen li ne li hokahane hantle le sekhahla sa phokotso ea lipalo tsa CIAS lithutong tsa IGD. (ΔCIAS / Pele ho CIAS; r = 0.707, p <0.001). FC, khokahano e sebetsang; OFC, orbitofrontal cortex; CIAS, Chen Internet Addiction Scale; IGD, bothata ba lipapali tsa inthanete.
Puisano
Thupong ena ea nako e telele, mokhoa oa ALFF le FC o ile oa sebelisoa ho batlisisa mekhoa e sebetsang ea boko pakeng tsa sehlopha sa IGD le HC sehlopha le mokhoa oa phekolo oa CBT lihloohong tsa IGD. Re fumane hore litlaleho tsa IGD li bonts'a mosebetsi o sa tloaelehang oa libaka tse ling tsa libaka tsa pele-pele tse amanang le HC le hore CBT e ka hlokomoloha maemo a sa sebetseng ho OFC le putamen le ho eketsa likamano pakeng tsa bona, ntle le ho ntlafatsa matšoao a IGD.
Phuputsong ena, FC e phomolang pakeng tsa OFC e kahare le mehla ea setamen e ne e le tlase haholo ho sehlopha sa IGD. Likamano tsa BIS-11 tsa liphetoho tsa FC li bontšitse hore ho senyeha ha lipotoloho tsa prefrontal-striatal ho ka ba le tšusumetso ea boitšoaro bo sa tsitsang ba litaba tsa IGD. Liphuputso tse fetileng tsa nakoana li tlalehile hore ho ba le tšenyo e sebetsang libakeng tsa PFC ho ne ho amahanngoa le tšusumetso e phahameng ea IGD (37). Masekete a pele ho nako a kenyelletsa mokokotlo oa kutlo, o hokahanyang haholo le caudate le putamen le libaka tsa pele. Tumellanong le liphuputso tsa lithuto tsa morao-rao tse sebetsang tsa neuroimaging, liphetoho tse sebetsang li ile tsa bonoa libakeng tse 'maloa tsa pele ho naha (ho kenyeletsoa le medial e nepahetseng ea OFC, SMA ea linaha tse peli le ACC ka letsohong le letšehali) le libaka tsa basal ganglia (bilateral putamen) mathateng a lemalloang, ho kenyeletsoa le IGD (12, 38, 39). Volkow et al. e ile ea fana ka tlhahiso ea marang-rang a nang le lithethefatsi litabeng tsa lithethefatsi tse nang le lithethefatsi, ho akarelletsa le OFC-, ACC-, e leng tlaase e nyenyane ea gyrus (IFG) -, le li-cirorits tsa dorsolateral prefrontal cortex (DLPFC), tse ka bonahatsang boitšoaro bo bonahalang, tse kang ho itšoara le ho itšoara hampe ho se sekisehe (40) le mathata ho etsa liqeto tse ntle, tse bontšang ho lemala; ha batho ba nang le IGD ba tsoela pele ho bapala lipapali le hoja ba tobane le liphello tse mpe, sena se ka 'na sa amana le ho se sebetse ha lipotoloho tsa prefrontal-striatal (41). E 'ngoe ea boits'oaro ba mantlha ba IGD ke likhaello tsa taolo ea tšusumetso le ho hloka taolo ea papali ea papali ea inthanete. Phuputso e fetileng e kopantseng voxel-based morphometric (VBM) le litlhahlobo tsa FC li senotse ho nka karolo ha libaka tse 'maloa tsa pele le lisekete tse amanang le tsa pele (ACC-, OFC-, le li-circuits tsa striatal tsa DLPFC) ts'ebetsong ea IGD mme ea fana ka maikutlo a hore IGD e ka arolelana mekhoa e tšoanang ea methapo ea kutlo le ts'ebeliso ea lithethefatsi maemong a potoloho (41). Sephetho sa hajoale se bohlokoa, joalo ka liphetoho tsa tšebetso ea boko / khokahano lipotolohong tsa pele ho nako tse neng li bonoa li kopana le lithuto tsa pejana. Ntle le moo, SMA e kenyellelitsoe marang-rang, a laolang ts'ebetso ea marang-rang a mang ha liphetoho tse potlakileng tsa boits'oaro li hlokahala, joalo ka ha o laola khiboto kapele ha o ntse o bapala lipapali (42). Yuan et al. e tlalehile litekanyetso tse phahameng tsa ALFF ho SMA lithutong tsa IGD (12), 'Me re fumane sephetho se ts'oanang thutong ena, se khothalelitseng hore SMA e kanna ea ba sebaka se ka bang bohlokoa ho boitšoaro bo lemalloang (41).
Ho fihlela joale, sehlopha sa CBT se bontšitsoe se sebetsa hantle ho thusa bacha ba nang le bokhoba ba inthanete (20). Thutong ea hajoale, nako ea papali ea beke le beke e ne e le khuts'oane haholo, mme lintlha tsa CIAS le BIS-II li ile tsa fokotsoa haholo kamora CBT. E khothalelitse hore litlamorao tse mpe li ka khutlisoa haeba bokhoba ba inthanete bo ka ts'oaroa ka nako e khuts'oane. Re hlokometse ho fokotseha ha litekanyetso tsa ALFF ka lehlakoreng le letšehali la OFC le putamen ea leqele le khokahano e eketsehileng ea OFC-putamen kamora CBT, e leng liphetho tse lumellanang le lipono tse fetileng tse khothalelitseng hore potoloho ea OFC-striatal e kanna ea ba sepheo sa kalafo ho feta ts'ebeliso e lemalloang mathata (43). Ofisi ea OFC e kenyelletsoa molaong oa tšusumetso ho phaella ho etsa liqeto, kahoo ho hokahanya pakeng tsa OFC le putamen ho fana ka maikutlo a ho laola boitšoaro bo sa tsitsang ba litaba tsa IGD (44). E lumellana le sephetho sa ho fokotseha ha lintlha tsa BIS-11 kamora kalafo. Putamen ke e 'ngoe ea likarolo tsa striatum mme e bile sebaka sa boko se amanang le lits'ebetso tsa kutloisiso tse arolelanoang haholo le khubu ea caudate. Haholo-holo, putamen e amahanngoa le taolo ea boits'oaro le liketso tse tataisoang ke sepheo (45). Re hlokometse hore ALFF e phahameng e fokotsehile ka letsohong le letšehali kamora CBT, e fana ka maikutlo a hore CBT e ka thusa ho matlafatsa taolo ea boits'oaro le liketso tse tataisoang ke lithuto tsa lithuto tsa IGD. Sena se bolela hore CBT e ka khona ho thibela tšebeliso ea papali e se nang maikutlo ka ho fetola likamano tsa lipotoloho tsa pele ho nako. Liphuputso tse fetileng tsa CBT li tlalehile hore CBT e fetola ts'ebetso ea ho phomola ha mmuso ho preortal cortex le hore CBT e lokisa lits'ebetso tse sa sebetseng tsa kutloisiso (46). Khabareng, liphetoho khokahanong ea OFC-putamen li ka bolela phello ea CBT.
Bofokoli ba thuto ena e ne e le hore lithuto tsa IGD li ne li sa abeloa lihlopha tse peli ka mokhoa o sa reroang (sehlopha se le seng sa bankakarolo se ne se tla amohela CBT, ha sehlopha se seng se sa fumaneng kalafo se ne se tla sebetsa joalo ka taolo). Ea bobeli, re ile ra thaotha feela bankakarolo ba banna; ka hona, lithuto tse tsoelang pele le barupeluoa ba basali lia hlokahala ho netefatsa le ho holisa liphetho tsa hajoale. Taba ea boraro, boholo bo lekanyelitsoeng ba sampole bo ekelitse kotsi ea liphoso tsa bohata mme bo thibela teko ho lekola likamano lipakeng tsa liphetoho ho boleng ba FC le litlamorao tsa kalafo. Ea bone, ho hlokahala hore ho lokisoe bakeng sa lipapiso tse ngata ho laola phoso e nang le bohata. Khalemelo ea AlphaSim e sebelisitsoe mona hobane ha ho sehlopha se ka fumanoang ha ho sebelisoa mekhoa ea khalemelo ea FWE kapa FDR. Leha ho le joalo, re nahana hore khalemelo ea AlphaSim e ka amoheloa thutong ea rona ea ho hlahloba hobane ke e 'ngoe ea likhetho tse tsebahalang haholo bakeng sa khalemelo ea lipapiso tse ngata hape e sebelisitsoeng lithutong tse ngata (34).
Ka bokhutšoanyane, liphuputso tsa rona li bontšitse hore IGD e amahanngoa le mosebetsi o fetotsoeng oa lipotoloho tse ling tsa pele-pele le hore CBT e ka hlokomelisa boitsebiso bo sa sebetseng ba OFC le putamen le ho eketsa likamano pakeng tsa tsona. Liphuputso tsena li ka fana ka motheo oa ho senola mokhoa oa ho phekola oa CBT lihloohong tsa IGD mme o sebetsa e le lisebelisuoa tse ka hlalosang matšoao a ka fetolang matšoao a latelang a CBT lihloohong tsa IGD.
Menehelo ea Mongoli
YZ, YD ba ne ba ikarabella molemong oa mohopolo le moralo. YD, WJ, XB, MC, XW, le WD li kentse letsoho ho fumanoeng ha data. YS, XH, le YW ba thusitse ka tlhahlobo ea lintlha le tlhaloso ea liphetho. XH e ngotse buka e ngotsoeng ka letsoho. Bangoli bohle ba ile ba hlahlobisisa se hlahang 'me ba amohela mofuta oa hoqetela oa ho hatisoa.
Khohlano ea polelo ea thahasello
Bangoli ba bolela hore lipatlisiso li ne li etsoa ka ho se be le likamano leha e le life tsa khoebo kapa tsa lichelete tse ka nkoang e le khohlano e ka 'nang ea e-ba le thahasello.
Mongolo o botlaaseng ba leqephe
Lithuso. Mosebetsi ona o ne o tšehelitsoe ke Setsi sa Naha sa Saense ea Tlhaho ea Chaena (No. 81571650), Morero oa Tataiso ea Bongaka ea Saense ea Theknoloji le Theknoloji (bongaka ba bophirima; No. 17411964300), le Khomishene ea Thuto ea Masepala ea Shanghai-Gaofeng Clinical Medicine Grant Support (No. 20172013 ), Medical Engineering Cross Research Foundation ea Shanghai Jiao Tong University (Che. YG2017QN47), le Letlole la Lipatlisiso la Peo ea Sepetlele sa Ren Ji, Sekolo sa Bongaka, Univesithi ea Shanghai Jiao Tong (RJZZ17-016). Lenaneo le Kenyelletsoang la Patlisiso ea Bongaka le Ntlafatso ea Sepetlele sa Ren Ji, Sekolo sa Bongaka, Univesithi ea Shanghai Jiao Tong (PYIII-17-027, PYIV-17-003). Bafani ba lichelete ba ne ba sena karolo ho moralo oa boithuto, pokello ea lintlha le tlhahlobo, qeto ea ho e phatlalatsa kapa ho hlophisa sengoloa.
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