氟西汀治疗神经性贪食患者的功能磁共振成像初步研究  

Functional magnetic resonance imaging research on bulimia nervosa with fluoxetine therapy

作　　者：曹静[1] 吴宇洁[1] 王美娟[1] 石中永[2] 朱荣申[1] 申远[1] 

机构地区：[1]上海市第十人民医院精神科,200072 [2]同济大学医学院

出　　处：《中华行为医学与脑科学杂志》2014年第2期136-139,共4页Chinese Journal of Behavioral Medicine and Brain Science

摘　　要：目的 探讨抗抑郁剂氟西汀对神经性贪食（bulimia nervosa,BN）患者脑功能的影响.方法 符合中国精神障碍分类和诊断标准第三版（CCMD-3） BN诊断标准的患者7例,分别于治疗开始前和氟西汀（20 mg/d）治疗3个月后进行功能磁共振成像（functional magnetic resonance imaging,fMRI）检查.正常对照7例,于人组时接受一次fMRI检查.功能成像为组块设计,包括食物图片序列和非食物图片序列,均来自国际情绪图片系统（international aective picture system,IAPS）,由计算机自动呈现.所有受试者完成汉密尔顿焦虑量表（Hamilton anxiety scale,HAMA）、17项汉密尔顿抑郁量表（Hamilton depression scale,HAMD17）和对fMRI刺激图片的Likert Scale-likelihood态度评估.结果 BN患者治疗前脑激活强度和体积均较正常对照减小（P＜0.05）,在食物图片刺激下双侧前额叶及左侧杏仁核激活增强；经氟西汀治疗后脑激活强度和体积较治疗前显著增加（P＜0.01）,食物图片下激活最强的脑区为右侧颞叶、小脑坡、双侧前额叶,杏仁核未出现阈值以上激活.结论 氟西汀可改善BN患者贪食症状,同时使前额叶及边缘系统的异常激活减弱,其作用机制可能与前额叶及边缘系统的5-羟色胺能系统功能变化相关.Objective To explore the effect of fluoxetine on the brain function of bulimia nervosa （BN） patients.Methods Seven female BN patients,who met criteria of the 3rd version Chinese Criteria of Mental Diseases （CCMD-3）,accepted functional magnetic resonance imaging （fMRI） examinations before and after the antidepressant treatment （fluoxetine （20 mg/day）） for three months.Seven normal controls accepted the same fMRI examination only at baseline.fMRI imaging was block-design.Blocks of food or non-food stimulus containing pictures selected from International Affective Picture System （IAPS） which were shown by computer automatically.All subjects were evaluated by Hamilton anxiety scale （HAMA）,Hamilton depression scale （HAMD17） and Likert Scale-likelihood evaluation to the same pictures in the fMRI imaging blocks.Results The average intensity and volume activated in BN before treatment were both significantly lower than that in the control （P＜0.05）.But under stimulus of food pictures,bilateral prefrontal cortex and left amygdala of BN patients were significantly activated.After fluoxetine treatment,the intensity and volume activated both increased significantly （P＜0.01） and the main areas being activated were right temporal,cerebellum and bilateral prefrontal cortex.Conclusion Fluoxetine improves the bulimic symptoms of BN patients and decreases abnormal activation of prefrontal and limbic in these areas.The underline mechanism may be related to functions of serotonin system in prefrontal-limbic path.

关 键 词：氟西汀 神经性贪食 功能磁共振成像 

分 类 号：R749[医药卫生—神经病学与精神病学]