首发抑郁症前额叶静息态葡萄糖代谢和血流灌注改变及其与临床症状的相关性  

Correlation of region blood perfusion and glucose metabolism of the prefrontal lobes with clinical features in patients with first-episode depression

作　　者：付畅[1] 张红菊[2] 史大鹏[3] 高永举[1] 徐俊玲[1] 

机构地区：[1]郑州大学人民医院核医学科,450000 [2]郑州大学人民医院神经内科,450000 [3]郑州大学人民医院放射科,450000

出　　处：《中华医学杂志》2015年第37期3017-3022,共6页National Medical Journal of China

摘　　要：目的 探讨首发抑郁症患者前额叶脑功能改变及其与临床症状改变之间的关系.方法 2012年11月以来郑州大学人民医院神经心理门诊17例首发抑郁症患者为抑郁组,16名本院实习医生及职工为健康对照组,均签署知情文件且经过伦理委员会批准.静息状态下接受磁共振3D动脉自旋标记（ASL）及18F氟脱氧葡萄糖（FDG）正电子发射断层显像（PET）/计算机体层摄影（CT）扫描,以汉密尔顿抑郁量表（HAMD）评估患者临床症状,以SPM8及SPSS 17.0软件进行影像数据及临床症状相关分析.结果 较之对照组,抑郁组双侧额上、中、下回葡萄糖代谢减低（总体素值462）,左侧额中回及右侧额上、中回血流灌注减低（总体素值136）,二者差异有统计学意义（t=3.89,P=0.02）,左侧额中回的FDG标准化摄取值（SUV）和局部脑血流量值（CBF）改变呈正相关（r=0.63）.患者认知障碍与双侧额中回SUV（r =0.55,0.52,P＜0.05）及右侧额中回CBF（r =0.59,P＜0.05）呈正相关,焦虑与右侧额下回SUV（r=-0.71,P＜0.05）及左侧额中回CBF（r=-0.69,P＜0.05）呈负相关,迟缓与左侧额中回及右侧额下回SUV呈负相关（r=-0.67,-0.64,P＜0.05）,HAMD量表总分与双侧额中回SUV（r=0.58,0.62,P＜0.05）及CBF（r =0.61、0.54,P＜0.05）呈正相关.结论 PET显像能更敏感检出抑郁患者病变脑区;抑郁患者前额叶葡萄糖代谢与血流灌注改变具有相对一致性且与诸多抑郁症状密切相关;左侧额中回可能是抑郁患者前额叶损伤的核心脑区.Objective To explore the cerebral blood flow （CBF） by three-dimensional arterial spin labeling （3D-ASL） and the standardized uptake value （SUV） of 18F-fluorodeoxyglucose （18F-FDG） in the prefrontal lobe of patients with major depression disorder （MDD）,and analyze their correlations with patients＇ depressive symptoms.Methods 3D-ASL and 18F-FDG positron emission tomography/computed tomography （PET/CT） were performed in 17 MDD patients and 16 healthy controls under the resting state.The depressive symptoms were classified into seven factors using Hamilton depression rating scale.Regional cerebral blood flow （CBF） and standardized uptake value （SUV） were compared between the patients and healthy controls using a two-sample t-test,and the correlation between the CBF and SUV with the patient Hamilton scores was examined using Spearman analysis.Results Decreased regional CBF values were present in the bilateral middle and the right superior frontal gyrus in patients,and decreased regional SUVs were observed in the bilateral superior,middle and inferior frontal gyrus.The significant correlation between the CBF and SUV values with the patients＇ Hamilton scores was mainly observed in the left middle,right middle and the right inferior frontal gyrus.Conclusion 18F-FDG PET/CT is more sensitive than ASL in identifying the functional abnormalities in the prefrontal lobe.Decreased CBF and SUV in the prefrontal lobe closely correlate with the Hamilton Depression Rating Scale scores.We speculate that the left middle frontal gyrus may be a key responsible functional region in patients with MDD.

关 键 词：氟脱氧葡萄糖F18 抑郁症 动脉自旋标记 标准化摄取值 脑局部血流量 

分 类 号：R749.4[医药卫生—神经病学与精神病学]