改良电休克治疗对抑郁症脑结构影响的磁共振成像研究  

Effect of modified electroconvulsive therapy on brain structure in patients with major depression

作　　者：刘丹[1] 李鹏[2] 蒙华庆[1] 曾金坤 史丹丹[1] 陆林 罗庆华[1] 

机构地区：[1]重庆医科大学附属第一医院,心理卫生中心,放射科,重庆400016 [2]北京大学第六医院,北京大学精神卫生研究所,卫生部精神卫生学重点实验室(北京大学),神经影像中心,北京100191

出　　处：《中国心理卫生杂志》2016年第4期299-305,共7页Chinese Mental Health Journal

基　　金：基金项目:具有自杀意念抑郁症早期优化治疗策略 ( X1748)

摘　　要：目的：分析改良电休克治疗（MECT）治疗前后抑郁症患者脑体积的变化,探讨MECT发挥抗抑郁作用的神经影像学机制。方法：采用自身对照设计,根据DSM-IV诊断标准共纳入13例抑郁症患者,分别在治疗前和治疗第3周末（完成8次MECT）使用汉密尔顿抑郁量表（HAMD）进行临床症状评估,同时采用GE 3.0T磁共振获得影像学数据。采用基于体素的全脑形态学测量方法比较MECT治疗前后脑灰质和脑白质的改变。结果：HAMD评分的减分率为（61.8±20.4）%,其中4例〉75%,7例为50%~75%,1例为25%~50%,1例〈25%,有效率为84.6%。与M ECT治疗前相比,患者左侧颞上回、顶下小叶、枕中回、右侧颞中回以及小脑前叶的脑灰质体积增加（均P〈0.05）。同时左侧顶上小叶脑灰质体积减少（P〈0.05）,左侧额叶和右侧楔前叶的脑白质体积降低（均P〈0.05）。结论：改良电休克治疗可能改变抑郁症患者前额叶、颞叶及顶叶等多个脑区的脑体积,提示神经可塑性作用可能参与了MECT发挥抗抑郁作用的过程。Objective： Modified electroconvulsive therapy（ MECT） is an effective therapy for depression. In this study,structural changes of brain in patients w ith major depression w ere examined before and after M ECT treatment in order to elucidate the mechanism of M ECT. Methods： Within subject comparison w as used to investigate the relationship betw een brain structural changes and M ECT response in patients w ith major depressive disorder. Totally 13 individuals w ith major depression meeting the Diagnostic and Statistical M anual of M ental Disorders,Fourth Edition（ DSM-IV） criteria w ere included in this study. At baseline, the Hamilton Depression Scale（ HAM D） w as used to assess clinical symptoms and T1-w eighted structural images w ere obtained using a 3. 0 Tesla GE Sigma scanner. After 3-w eek treatment,patients w ere retested using HAM D and structural imaging. Results： The reduction rate of HAM D scores w as（ 61. 8 ± 20. 4） %,in w hich 4 patients＇ rates of more than 75%,7 patients of50% to 75%,1 patient of 25% to 50% and 1 patient of less than 25%. The response rate of M ECT w as 84. 6%.The grey matter volumes of left superior temporal gyrus, left inferior parietal lobule, left middle occipital gyrus,right middle temporal gyrus and cerebellum anterior lobe w ere significantly increased after M ECT treatment（ Ps 0. 05）. M eanw hile,the grey matter volumes of left superior parietal lobule w as significantly decreased（ P〈0. 05）.The w hite matter volume of left middle frontal gyrus and right precuneus w ere also significantly decreased after treatment（ Ps 0. 05）. Conclusion： It indicates that there are changes of brain volume in frontal lobe, temporal lobe,and parietal lobe after M ECT treatment,suggesting that a neural plastic effect of M ECT could play a role in its therapeutic effect.

关 键 词：抑郁症 改良电休克治疗 磁共振成像 基于体素的全脑形态学分析 

分 类 号：R749.41[医药卫生—神经病学与精神病学] R749.054[医药卫生—临床医学]