伴轻躁狂症状的抑郁症患者脑功能磁共振低频振幅研究  

Amplitude of low-frequency fluctuation in major depressive patients with hypomanic symptoms： a fMRI study in resting-state

作　　者：杨海晨[1] 李琳玲[3] 彭红军 刘铁榜[2] 秋云海[3] 荣晗[2] 冀二妮[2] 毕建强[2] 张建[2] 李凌江[1,2] 

机构地区：[1]中南大学湘雅二医院精神卫生研究所,长沙410011 [2]深圳市精神卫生中心情感障碍科 [3]中国科学院深圳先进技术研究院神经工程研究中心 [4]广州惠爱医院

出　　处：《中华精神科杂志》2015年第5期284-291,共8页Chinese Journal of Psychiatry

基　　金：深圳市科技计划项目（201302134）;广东省医学科学技术研究基金（WSTJJ20131222371082198110318913）

摘　　要：目的 探讨伴轻躁狂症状的抑郁症患者在静息状态下脑功能磁共振低频振幅的特异性.方法 对54例处于抑郁发作的抑郁症患者及36名健康对照者进行静息态脑功能磁共振扫描.抑郁症患者经HCL-32自评,＜12分为抑郁症不伴轻躁狂症状,≥12分为抑郁症伴轻躁狂症状.HCL-32评分＜12分31例,≥12分23例,考虑性别、年龄等因素匹配,最后纳入分析的抑郁症不伴轻躁狂症状组及抑郁症伴轻躁狂症状组每组各19例,相匹配的健康对照者19名（对照组）.利用静息态脑功能活动低频振幅指标,对被试者的静息态脑功能活动进行分析和比较.抑郁症患者的HCL-32评分与全脑的低频振幅值进行相关分析.结果 抑郁症患者与健康对照者相比,低频振幅值在较多脑区差异有统计学意义.与不伴轻躁狂症状的抑郁症患者比较,伴轻躁狂症状的抑郁症患者在双侧眶额皮质[左眶额回：MNI坐标（x、y、z）：-34、56、-10,t=5.26;右眶额回：MNI坐标（x、y、z）：20、66、-2,t=4.93]、额上回[左额上回：MNI坐标（x、y、z）：-4、66、8,t=4.12;右额上回：MNI坐标（x、y、z）：14、56、18,t=3.97]低频振幅值显著增高（P＜0.05）;而在双侧丘脑、左侧梭回则显著降低（P＜0.05）.抑郁症患者的HCL-32评分与全脑的低频振幅值的相关分析显示,HCL-32评分与双侧眶额皮质（左额中回、右额中回、右上额回）的低频振幅值呈正相关（r=0.363、0.426、0.405,均P＜0.05）,与左侧丘脑、左侧梭回低频振幅值呈负相关（r=-0.352,P＜0.05;r=-0.468,P＜0.01）.结论 与不伴轻躁狂症状的抑郁症患者相比,伴轻躁狂症状的抑郁症患者静息态脑低频振幅具有特异性,尤其表现为双侧眶额回低频振幅值增高,左侧丘脑及左侧梭回低频振幅值降低.该结果或许可以作为HCL-32筛查阳性抑郁症患者的生物学标记.Objective To investigate the characteristics of hypomanic symptoms （HS） to the brain neural activity in the resting-state of the patients with major depressive disorder （MDD）.Methods Twenty-three patients from 54 patients with MDD were defined as MDD with HS because their HCL-32 scores were higher than or equal to 12.The rest 31 patients were defined as MDD patients without HS because of the lower scores.After checking the match of the factors such as gender and age et al,there were 19 MDD patients with HS,19 patients without HS and 19 healthy controls in the final analysis.We analyzed the impact of HS to the regional brain function of the patients with MDD by amplitude of low-frequency fluctuation （ALFF）.Results The patients with MDD had abnormal resting-state brain activity in a diffuse brain areas compared to healthy controls by the ALFF analysis.Compared to the patients without HS,the ALFF of the depressed MDD patients with HS were significantly higher in the bilateral orbitofrontal cortex （OFC;left OFC：MNI（x,y,z）：-34,56,-10;t=5.26;right OFC：MNI（x,y,z）：20,66,-2;t=493） and superior frontal cortex （SFC;left SFC：MNI（x,y,z）：-4,66,8;t=4.12;right SFC：MNI（x,y,z）：14,56,18,t=3.97,all P〈 0.05）;while lower in bilateral thalamus and left fusiform gyrus （P〈0.05）.Correlation analysis of ALFF at each voxel in the whole brain against the HCL-32 in the patients with MDD revealed significantly positive correlation in OFC （r=0.363,0.426,0.405,all P〈0.05）,negative correlation in left thalamus and left fusiform gyrus （r=-0.352,P〈0.05;r=-0.468,P〈0.01）.Conclusions The study suggested that there were differences between the two subgroups patients with MDD defined by the HCL-32.Compared to the MDD without HS patients,MDD with HS patients showed increase ALFF in bilateral frontal cortex （especially the OFC）,and decrease ALFF in left thalamus and left fusiform gyrus.These features may be regarded as the biomarker of the MDD patients who were positive to HCL-3

关 键 词：重性抑郁障碍 轻躁狂症状 静息态 功能磁共振 低频振幅 

分 类 号：R749.4[医药卫生—神经病学与精神病学]