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汶川地震幸存者创伤后应激反应症状的行为学分类及其与细胞免疫、体液免疫指标的关联性研究
其他题名The Symptom Structure of Posttraumatic Stress syndrome of 512Wenchuan Earthquake Survivors and the Relationship among the Symptoms of PTSR , the Cellular Immunity and Humoral Immunity
吴坎坎
学位类型硕士
导师张雨青
2010-05
学位授予单位中国科学院研究生院
学位授予地点北京
学位专业心理学
关键词创伤后应激障碍 细胞免疫 体液免疫 T淋巴细胞 白细胞介素
摘要本文首先对中国成人自然灾难后PTSD的症状模型进行了研究,并在此基础上对创伤后应激反应及其各个症状与细胞免疫、体液免疫指标间的关系进行了探讨,不仅强调创伤后应激反应的严重程度与细胞免疫、体液免疫水平之问的关系,而且特别针对创伤后应激反应的不同症状与细胞免疫、体液免疫指标的关系进行了研究,对我国自然灾难后PTSD及其症状的准确诊断和心理干预为进一步的PTSD的病理心理生理机制的研究和干预提供理论基础。研究一,通过对723名512汶川地震极重灾区幸存者的PTSD症状自评量表(PCL)的得分进行验证性因素分析,结果发现:包括闯入、回避、麻木和高警觉的四因素麻木模型具有最好的拟合度,且PCL及其各症状维度都表现出较高的信度水平,表明5.12汶川地震后我国成人幸存者除了表现出典型的PTSD症状如闯入、回避和高警觉之外,还表现出麻木症状。研究二,在地震后18个月时使用PCL对205名极重灾区的成人幸存者进行创伤后应激反应的评估,同时通过采集被试早晨8:00-9:00的空腹血样对其T细胞及其亚群的水平进行化验和分析。首先按照被试在PCL上的得分,以中位数为界将被试分为PCL高分组和PCL低分组。通过对102名PCL高分组被试和103名PCL低分组被试的T淋巴细胞及其亚群进行t检验发现:两组被试在CD3水平上存在显著差异,在CD4/CD8水平上存在边缘性显著差异。进一步的秩和相关分析发现,CD3对创伤后应激反应的四个症状都呈边缘性显著的负相关,而CD4/CD8仅对PTSD中的高警觉症状呈显著负相关,同时发现,CD4、CD8与创伤后应激反应各维度之间没有显著的相关性。表明地震18个月后幸存者的CD3水平可以作为PTSD的生物标记,而CD4:CD8的值则可以作为PTSD的高警觉症状的生物标记。研究三,通过对102名PCL高分组被试和103名PCL低分组被试的白细胞介素水平的U检验发现,PCL高分组和PCL低分组在IL-6水平上存在显著差异,且两组在IL-2水平上存在边缘显著性的差异,但在IL-4水平上并无显著差异,且随后对所有205名被试创伤后应激反应各个症状与细胞因子各指标的秩和相关分析发现,IL-6与闯入症状呈显著负相关,IL-2和IL-4与各症状之间无显著相关性。表明IL-6可以作为创伤后应激反应的严重程度特别是闯入症状的生物标记,而IL-2在创伤后应激反应严重性上的敏感性较低,IL-4则与创伤后应激反应的严重程度无关。本文研究发现,中国成人自然灾难幸存者创伤后应激反应的症状结构为四因素麻木模型,而在细胞免疫、体液免疫水平上,CD3、CD4:CD8的值和IL-6是不同创伤后应激反应严重程度的生物标记,而进一步相关分析发现,CD3可能是PTSD及各症状的生物标记,CD4:CD8的值可能是高警觉症状的生物标记,IL-6可能是闯入症状的生物标记。
其他摘要Firstly, the psychological model of Chinese adult PTSR (Post traumatic stress reaction) patient after natural-disaster was studied. Then, on this basis, we explore the correlation among PTSR severity, the each symptom of PTSR psychological model and the cellular immunity, interleukin. This study can improve the diagnosis of PTSD in the Chinese nature disaster survivors, and explicit the cellular immunity and humoral immunity mechanism of the PTSD in China. This will improve the psychological intervention and medicinal intervention of PTSD in China.
Study 1. The confirmatory factor analysis (CFA) was used to analyze the PCL scores of the 723 survivors after 512Sichuan Earthquake. The four factors numbing model get the best fit index(χ2=715.823,CFI=0.982,RMSEA=0.086,AIC=795.823,BIC=979.159), and the internal consistency reliability coefficient of total PCL, the intrusion symptom, the avoidance symptom, the numbing symptom and the hyperarousal are high enough to believe the PCL and the psychological model of PTSD are reliable. This study showed that the classical PTSD symptoms for the survivors of 512Sichuan Earthquake is important, but the numbing symptoms is also important to them.
Study 2. The relationship between PTSR severity, the each symptom of PTSR psychological model and the cellular immunity was analyzed. First, median split was used to get the high group and low group of PTSR tested by PCL. The t test found that the percentage of CD3 and the ratio of CD4:CD8 are significant variance between the high group and the low group. And the spearman rank correlation found that CD3 is sensitivity to all the symptoms of PTSR. On the other hand, the ratio of CD4:CD8 is only sensitivity to hyperarousal symptom. In the same time, there is no relation among CD4, CD8, the PTSR severity and the each symptom of PTSR. This study showed that maybe CD3 is the biomarker of PTSR and the each symptom of PTSR, in addition, the ration of CD4:CD8 is the biomarker of hyperarousal symptom.
Study 3. The relationship between PTSR severity, the each symptom of PTSR psychological model and the interleukin index was analyzed. The U test found that the IL-6 was significant variance between the high group and the low group. And the spearman rank correlation found that IL-6 is only sensitivity to intrusion symptom. In the same time, there is no significant relationship among IL-2, IL-4, the PTSR severity and the each symptom of PTSR. This study showed that maybe IL-6 is the biomarker of the intrusion symptom.
adult survivors, and the survivors are more difficult to recover from PTSD. The percentage of CD3, the ratio of CD4:CD8 and the IL-6 maybe are the biomarker of PTSR. In particular, the percentage of CD3 is the biomarker of all the symptoms of PTSR, the ratio of CD4:CD8 is the biomarker of hyperarousal symptoms, and IL-6 is the biomarker of the intrusion symptom.
学科领域应用心理学
语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/20415
专题健康与遗传心理学研究室
作者单位中国科学院心理研究所
推荐引用方式
GB/T 7714
吴坎坎. 汶川地震幸存者创伤后应激反应症状的行为学分类及其与细胞免疫、体液免疫指标的关联性研究[D]. 北京. 中国科学院研究生院,2010.
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