抑郁症首次发作患者情绪偏向任务的脑功能磁共振成像研究  

The neural substrate of bias mood-processing in patients with first-episode depression： a functional magnetic resonance imaging study with emotional picture stimuli

作　　者：彭代辉 江开达[1] 徐一峰[1] 方贻儒[1] 刘军[2] 刘树永[2] 耿道颖[2] 

机构地区：[1]上海交通大学医学院附属精神卫生中心,200030 [2]复旦大学附属华山医院影像科

出　　处：《中华精神科杂志》2008年第2期68-72,共5页Chinese Journal of Psychiatry

基　　金：上海市科委“登山行动计划”项目基础研究重点资助项目（06JC14061）志谢复旦大学华山医院精神卫生教研室的指导,中国科技大学马宁博士对影像数据的处理

摘　　要：目的研究抑郁症首次发作（以下简称首发）患者对不同性质情绪线索的差异脑激活反应，以探讨抑郁症患者“负性情绪偏向性”的脑活动特征。方法14例抑郁症首发患者与14名配对健康对照者，接受国际情绪图片系统中正性-中性-负性三组图片刺激的脑功能磁共振成像（fMRI）扫描，任务为组块设计；以文拉法辛（75～150mg／d，口服）治疗患者，随访12周；以汉密尔顿抑郁量表（HAMD17）减分率评估疗效；用神经功能影像分析（AFNI）软件处理影像数据。结果（1）文拉法辛治疗8周时有效率为58％；12周时有效率为92％，HAMD17总分减分率为60％。（2）两组均激活的脑区包括双侧额中回、双侧背外侧前额叶皮质、左侧丘脑、双侧岛叶、双侧颞叶、双侧杏仁核和海马。（3）在正性／中性图片激活的脑区中，患者组双侧额中回（右侧0．11％，左侧0．09％）及左侧丘脑（0．31％）激活强度均低于对照组（分别为0．98％，1．17％和1．32％；P〈0．05）；左侧岛叶（1．03％）及双侧杏仁核（右侧0．47％，左侧0．11％）的激活强度高于对照组（分别为0．45％，-0．34％和-0.49％；P〈0．05）。对于负性图片，患者组左侧额中回（2．77％）、左背外侧前额叶皮质（0．18％）、左侧岛叶（1.36％）、左侧颞叶（0．33％）和右侧杏仁核（0．44％）的激活强度高于对照组（分别为1．91％，-0．32％，0．91％，-0．31％，-0．29％；P〈0.05）；患者组左侧丘脑激活强度（-0．79％）低于对照组（1．15％；P〈0．05）。（4）治疗后，对于正性图片，患者组左侧、右侧额中回及左侧丘脑激活增加为1．21％，1．14％及1.23％（P〈0.05）。对于负性图片，左侧额中回（2．05％）、左外侧前额叶皮质（-0．42％）及左侧岛叶（0.73％）的激活降低（P〈0．05）；左侧丘脑（1．53％）激活增加（Objective To explore the neural substrate of bias mood-processing in depression by probing the differences of neural activation associated with reactivity to different affective stimuli clues. Methods Forteen patients with depressive disorder and 14 healthy subjects were scanned with functional magnetic resonance imaging （fMRI） on three occasions based on block-design, during which positive, neutral and negative affective visual stimuli from International Affective Pictures System （IAPS） were presented. Patients were then treated with venlafaxine （75-150 mg/d） for 12 weeks, and the symptoms were evaluated with the Hamilton Depression Scale （ HAMD17 ） . The Analyze of functional neural image （AFNI） was used to examine the fMRI data. Results The respective response rates were 58% and 92% after 8-and 12- week venlafaxine treatment, with the total reduction rate of HAMD17 score of 60%. The activated cerebral regions in both patients and controls included bilateral middle frontal gyrus, bilateral dorsolateral prefrontal cortex, left thalamus, bilateral insular, bilateral temporal, bilateral amygdale and hippocampus. For positive pictures, the activation intensity levels in right middle frontal gyrus, left middle frontal gyrus and left thalamus in patients were 0. 11%, 0.09% and 0. 31% respectively, which were significantly lower than that in controls （ 0.98% , 1.17% and 1.32% respectively; P 〈 0. 05 ） , and the activation intensity levels in left insular, right amygdale and left amygdale were 1.03% , 0. 47% and 0. 11% in patients, which were significantly higher than that in controls （0.45%, -0. 34% and -0.49% respectively; P 〈 0.05）. For negative pictures, the activation intensity levels in left middle frontal gyrus, left dorsolateral prefrontal cortex, left insular, left temporal and right amygdale were 2.77%, 0. 18%, 1.36%,0.33% and 0.44%, which were higher than that in controls （1.91%, -0.32%, 0.91%, -0.31%, -0.29% respectively; P 〈 0. 05） ; the activation intensity level in l

关 键 词：抑郁症 磁共振成像 国际情绪图片系统 文拉法辛 

分 类 号：R686[医药卫生—骨科学]