抑郁症患者临床治愈后默认网络的静息态功能连接变化追踪研究  

A study on the change of resting state functional connection of default mode network in clinically remitted patients with major depression disorder

作　　者：韩洋 马辉[2] 王珍珍 钟佳琪 王慧 张宁[2] Han Yang;Ma Hui;Wang Zhenzhen;Zhong Jiaqi;Wang Hui;Zhang Ning(School of Psychology,Nanjing Normal University,Nanjing 210097,China;Medical Psychology Department,Nanjing Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京师范大学心理学院,210097 [2]南京医科大学附属脑科医院医学心理科,210029

出　　处：《中华行为医学与脑科学杂志》2020年第5期394-399,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：江苏省重点研发计划(社会发展)项目(BE2015609);南京市医学科技发展重点项目(ZKX10022);南京医科大学科技发展基金(NMUB2018197)。

摘　　要：目的:探讨抑郁症临床治愈患者的默认网络(default mode network,DMN)功能连接(functional connection,FC)变化及抑郁症康复机制的脑影像基础。方法:采用方便取样方法,在南京医科大学附属脑科医院医学心理科病房收入17例符合入组标准的抑郁症临床治愈患者,分别进行基线期(rMDD)及6个月追踪期(sMDD)的静息态功能磁共振(rs-fMRI)扫描。招募22例性别、年龄、受教育程度与治愈组患者相匹配的健康对照组(HCs组),给予同样脑静息态fMRI扫描。采用独立成分分析方法(ICA)分别提取静息状态下rMDD、sMDD及HCs组的默认网络脑区,以比较抑郁症临床治愈患者治愈及6个月后脑功能FC变化及其与正常对照组的脑网络差异。结果:临床治愈抑郁症患者rMDD期右侧内侧眶额皮质(MNI:x,y,z=3,54,-9)、右侧后扣带回(MNI:x,y,z=6,-51,30)、楔前叶(MNI:x,y,z=9,-54,27)的FC水平显著高于HCs组,未发现FC水平低于HCs组的脑区。sMDD与HCs组比较未发现差异有统计学意义的脑区。sMDD与rMDD比较,sMDD的内侧眶额皮质(MNI:x,y,z=3,54,-9)、左侧内侧前额叶(MNI:x,y,z=-3,66,12)的FC水平显著低于rMDD,左侧角回(MNI:x,y,z=-57,-57,33)的FC水平显著高于rMDD。结论:抑郁症患者达到临床治愈标准后,其DMN网络仍未完全恢复正常水平,在后续的6个月治疗中DMN网络损伤还在不断恢复,提示DMN网络功能恢复迟滞于临床症状恢复,且与抑郁症的康复有关。Objective To explore the functional connection(FC)changes of default mode network(DMN)with the patients who have clinically remitted from major depressed disorder(MDD)and the brain imaging basis of the rehabilitation mechanism of major depression.Methods Seventeen right-handed outpatients in the medical and psychological ward of Nanjing Brain Hospital who met the inclusion criteria were recruited by psychiatrists.MDD subjects after enrollment were scanned by resting-state functional magnetic resonance(fMRI)in baseline period(rMDD)and a 6-month follow-up period(sMDD).Tweenty-two healthy controls(control group,HCs group)matched with the MDD group in gender,age,and educational level were recruited and given the same resting fMRI scan.The independent component analysis(ICA)was used to extract DMN brain regions of rMDD,sMDD and HCs in resting state separately and to compare the changes of DMN functional connectivity in full remitted MDD patients.Results The DMN data showed that the functional connectivity of right orbital middle frontal gyrus(MNI:x,y,z=3,54,-9),right posterior cingulate(MNI:x,y,z=6,-51,30),and precuneus(MNI:x,y,z=9,-54,27)in the rMDD was significantly higher than the HCs group,and no functional connectivity in the rMDD was found to be lower than that in HCs group.Furthermore,no significant difference been found between the sMDD and HCs group.Compared with the rMDD,the functional connectivity of orbital middle frontal gyrus(MNI:x,y,z=3,54,-9)and left medial prefrontal cortex(mPFC)(MNI:x,y,z=-3,66,12)in the sMDD was significantly lower than that in the rMDD,and the functional connectivity of left angular gyrus in the sMDD(MNI:x,y,z=-57,-57,33)was significantly higher than that in the rMDD.Conclusion The DMN network has not fully returned to its normal level though the posttreatment Hamilton Depression Scale-17 score was lower than 7 points,and the injury of FC is still recovering in the following 6 months,suggesting that the recovery of the DMN network function was delayed in the full remission of clini

关 键 词：临床治愈抑郁症 默认网络 静息态功能磁共振 功能连接 独立成分分析 

分 类 号：R74[医药卫生—神经病学与精神病学]