抑郁症治疗前后脑白质弥散张量成像研究  

Brain White Matter Fiber Change in Major Depression before and after Therapy:a Diffusion Tensor Imaging Study

作　　者：刘海燕[1] 姚志剑[1] 滕皋军[2] 卢青[3] 王丽[1] 曹燕翔[1] 刘文[1] 张宁[1] 

机构地区：[1]南京医科大学附属脑科医院,南京210029 [2]东南大学附属中大医院放射科,南京210009 [3]东南大学学习科学研究中心,南京210096

出　　处：《中国心理卫生杂志》2008年第7期513-517,共5页Chinese Mental Health Journal

基　　金：国家自然科学基金项目(30500179);江苏省科学基金项目(BK2005427);南京市医学重点科技发展项目(IKX05003)

摘　　要：目的:探讨中青年重性抑郁症患者治疗前后的脑白质纤维及认知功能变化。方法:对11例重性抑郁症患者分别于治疗前和治疗后10周评定24项汉密尔顿量表(HAMD24)、威斯康星卡片分类测验(WCST)、韦氏记忆量表及弥散张量成像(Diffusion Tensor Imaging,DTI)扫描,并与11例健康对照比较。结果:(1)抑郁组治疗后的WCST成绩(完成分类数:4.0±2.1、应答错误数:43.2±18.8、持续性错误数:22.8±16.0)较治疗前明显改善(1.6±1.6、67.9±20.0、51.5±24.8,P=0.001、0.000、0.003),而瞬时记忆力(顺背及倒背)治疗前后差异均无显著性(P>0.05);HAMD总分治疗后低于治疗前(16±14/54±13,t=6.60,P<0.001);治疗后抑郁组与健康对照组WCST和记忆力得分差异均无显著性(P> 0.05);(2)治疗后抑郁组在右额叶下(26;13;-11,52像素)及左胼胝体区(-8;26;-1,48像素)白质的各向异性(fractional anisotropy,FA)值较疗前升高,但同健康对照组相比,左颞叶下(-32;-52;15,34像素)、右扣带回(18;-25;28,118像素)及右脑岛叶(32;-4;17,39像素)区域白质的FA值仍存在一定程度的降低(JP<0.001,像素>30)。结论:抑郁症患者治疗后认知功能明显改善;治疗后脑白质纤维亦有一定的恢复,但同正常人相比,仍存在一定程度的白质损害。Objective： To study the cognitive function and brain white matter fiber change in major depressive patients prior and post-treatment. Methods： Eleven major depressed patients were given antidepressants for 10 weeks, and their conditions were evaluated using 24-item Hamilton Depression Scale （ HAMD ） . The cognitive function was determined by using Wisconsin Card Sorting Test （ WCST ） , part of Wechsler memory scale and diffusion tensor imaging （ DTI） was scanned before and after treatment. 11 healthy people as control group were involved and given the same tests at the same time. Results： （ 1 ） The WCST scores of patients increased significantly after treatment （ prior treatmentCc ： 1.6±1.6, Re ： 67.9±20.0, Rpe ： 51.5±24.8; post treatment Cc ： 4.0±2.1, Re： 43.2± 18.8, Rpe： 22. 8 ± 16.0, P = 0. 001/0. 000/0. 003 ） . There was no difference in number sequence memory in Wechsler memory scale. No difference was found between patients after treatment and control group in either WCST or number sequence memory. The patients made significant improvement in the total score of HAMD after treatment （ 16 ± 14/54 ± 13, t = 6. 60, P 〈 0. 001 ） ; （ 2 ） The fractional anisotropy （ FA ） was higher in right sub-gyral of frontal lobe （ 26 ; 13 ; - 11, 52 cluster） and left corpus callosum （ - 8 ; 26 ; - 1, 48 cluster） after treatment, but the FA of left sub-gyral of temporal （ - 32 ; - 52 ; 15, 34 cluster）, right cingulate gyrus of limbic lobe （ 18 ; - 25 ; 28, 118 cluster） and right sub-lobar of insula （32; -4; 17, 39 cluster） was still lower than control group. Conclusions： The cognitive function improves in patients major depressive disorder after medication. The brain whiter matter recovers to some extent but white matter abnormal regions still exist compared to healthy control.

关 键 词：弥散张量成像 认知障碍 抑郁症 治疗前后 

分 类 号：R749.41[医药卫生—神经病学与精神病学]