产后抑郁症患者局部脑区神经活动变化的静息态功能磁共振成像研究  

Altered spontaneous neural activity in postpartum depression: a resting-state functional magnetic resonance imaging study

作　　者：车凯莉 毛宁[1] 谢海柱[1] 史英红[1] 马恒 孙春娟 刘梅婕 徐晓 白维 王中一 Che Kaili;Mao Ning;Xie Haizhu;Shi Yinghong;Ma Heng;Sun Chunjuan;Liu Meijie;Xu Xiao;Bai Wei;Wang Zhongyi(Department of Medical Imaging,Yantai Yuhuangding Hospital,the Affiliated Hospital of Qingdao University,Yantai 264000,China;Clinical Medical College of Binzhou Medical University,Yantai 264033,China;Department of Medical Imaging of Weifang Medical University,Weifang 261053,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院医学影像科,264000 [2]滨州医学院临床医学院,烟台264033 [3]潍坊医学院医学影像系,261053

出　　处：《中华精神科杂志》2020年第3期243-248,共6页Chinese Journal of Psychiatry

基　　金：山东省自然科学基金(ZR2017PH043);山东省医药卫生科技发展计划(2016WS0713);中国医药教育协会孙思邈中医药专项基金(2016SKT-M034)。

摘　　要：目的探讨产后抑郁症(postpartum depression,PPD)患者静息状态下的局部神经活动变化特征及其与抑郁程度的相关性。方法选取符合DSM-5单相抑郁诊断标准,24项汉密尔顿抑郁量表(24-Item Hamilton Depression Scale,HAMD24)评分>20分,爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)评分≥12分的15例产后抑郁患者(PPD组)及与之年龄等相匹配的16名产后健康产妇(对照组),进行3.0 T静息态功能磁共振成像扫描。采用双样本t检验比较组间低频振幅(amplitude of low-frequency fluctuation,ALFF)和局部一致性(regional homogeneity,ReHo)值,将差异脑区的ALFF值及ReHo值与HAMD24、EPDS评分分别进行Pearson线性相关性分析。结果与对照组相比,PPD组右侧小脑前叶(山顶)和左背外侧前额叶ALFF值增高,右顶叶ALFF值减低(单个体素P<0.005,体素值>10,Alphasim校正);PPD组左侧眶部额上回、眶部额下回、额上回、额中回、楔前叶及顶下小叶ReHo值增高,右侧枕下回、额下回、额叶和左侧小脑下半月小叶的ReHo值减低(单个体素P<0.005,体素值>10,Alphasim校正);左背外侧前额叶ALFF值与PPD组HAMD24评分呈正相关(r=0.585,P=0.022),校正年龄、教育程度和体重指数后,偏相关系数依然有统计学意义(r=0.561,P=0.046)。结论PPD患者存在情绪调节相关脑区神经活动改变;左背外侧前额叶ALFF值越高的患者抑郁程度越严重。Objective This study uses two markers of resting-state functional MRI(r-fMRI)to investigate changes in spontaneous neural activity and their correlation with postpartum depression(PPD)severity.Methods A total of 15 individuals with PPD,who met the diagnostic criteria for DSM-5 unipolar depression,24-Item Hamilton Depression Scale(HAMD24)scores greater than 20,Edinburgh Postnatal Depression Scale(EPDS)score≥12,and 16 postpartum healthy mothers(control group)matched with age and education were examined using r-fMRI.Two-sample t-test was used to compare the amplitude of low-frequency fluctuation(ALFF)and regional homogeneity(ReHo)values between groups.Pearson correlation analysis was used to determine the correlation between the ALFF and ReHo of the abnormal brain region and the HAMD24 and EPDS scores.Results Compared with the healthy control(HC),PPD showed increased ALFF in the right cerebellum anterior lobe culmen and the left dorsolateral prefrontal cortex(DLPFC),and decreased ALFF in the right parietal lobe(individual voxel P<0.005,cluster size>10 voxels,Alphasim correction).PPD had increased ReHo values in the left superior frontal gyrus,orbital part,inferior frontal gyrus,orbital part,middle frontal gyrus,precuneus,inferior parietal lobule than HC.Decreased ReHo values were found in the right inferior occipital gyrus,inferior frontal gyrus,frontal lobule and left cerebellum inferior semi-lunar lobule(individual voxel P<0.005,cluster size>10 voxels,Alphasim correction).The ALFF value of the left DLPFC was positively correlated with the HAMD24 score in PPD(r=0.585,P=0.022).Age,body mass index and education years of each subject was included as covariates,partial correlation coefficient was still statistically significant(r=0.561,P=0.046).Conclusion This r-fMRI study suggested that changes in the spontaneous neural activity of these regions were related to emotional responses.PPD cases with high ALFF values in the left DLPFC had severe depression.

关 键 词：抑郁症 产后 磁共振成像 低频振幅 局部一致性 

分 类 号：R445.2[医药卫生—影像医学与核医学] R749.4[医药卫生—诊断学]