肝气郁结和心脾两虚型抑郁伴焦虑患者前额叶白质的脑波谱研究  

Brain spectral study of prefrontal white matter in patients with major depression accompanied by anxiety of liver-qi stagnation and heart-spleen deficiency syndrome

作　　者：杜仪[1] 赵静洁[1] 王永志[1] 韩玉 邓力刚[3] 李丽[4] DU Yi;ZHAO Jing-jie;WANG Yong-zhi;HAN Yu;DENG Li-gang;LI Li(Department of Traditional Chinese Medicine,Beijing Friendship Hospital Affiliated to the Capital Medical University,Beijing 100050,China;Your Health&Wellness International Medical Clinic,Beijing 100005;Department of Radiology,Beijing Friendship Hospital Affiliated to the Capital Medical University,Beijing 100050;International Medical Department,BeijingFriend ship Hospital Affiliated to the Capital Medical University,Beijing 100050)

机构地区：[1]首都医科大学附属北京友谊医院中医科,北京100050 [2]优和维尔门诊部,北京100005 [3]首都医科大学附属北京友谊医院放射科,北京100050 [4]首都医科大学附属北京友谊医院国际医疗部,北京100050

出　　处：《北京中医药》2021年第3期232-236,共5页Beijing Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(81673737);北京市中医药科技发展基金资助项目(JJ2018-51);北京市自然科学基金资助项目(7172063);北京市属医院科研培育计划项目(PZ2020001)。

摘　　要：目的探讨肝气郁结和心脾两虚型抑郁伴焦虑患者前额叶白质氢质子波谱(1H-MRS)代谢产物的差异及特点,为抑郁伴焦虑患者的中医证型研究提供数据支持。方法运用汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)对40例抑郁焦虑共病患者(肝气郁结组20例,心脾两虚组20例)及19例健康者(对照组)进行测评,并应用1H-MRS技术对3组受试者的前额叶白质进行扫描,进而对N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酐(Cr)、肌醇(MI)等指标进行检测分析。结果心脾两虚组的HAMD和HAMA的评分显著高于肝气郁结组(P<0.05);肝气郁结组的Cho/Cr值、心脾两虚组NAA/Cr值和Cho/Cr值均显著低于正常对照组(P<0.05),且心脾两虚组NAA/Cr值显著低于肝气郁结组(P<0.05),而3组MI/Cr差异无统计学意义。结论抑郁伴焦虑的发生可能与患者双侧前额叶白质NAA、Cho含量的减低有关,提示此类患者的抑郁焦虑症状可能较重且容易复发;心脾两虚型患者的抑郁焦虑症状及神经元功能损伤可能较肝气郁结患者更为严重。Objective To explore the differences and characteristics of metabolites of hydrogen proton magnetic resonance spectroscopy(1H-MRS)in the prefrontal white matter in patients with major depression accompanied by anxiety(MDA)of liver-qi stagnation(LQS)and heart-spleen deficiency(HSD)syndrome,and to provide data support for the study of TCM syndrome patterns of depression.Methods Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were used to evaluate 40 depression patients with anxiety(20 LQS patients and 20 HSD patients)and 19 healthy controls(NC).1H-MRS was used to scan the white matter of prefrontal lobe of three groups,and then n-acetylaspartic acid(NAA),choline(CHO),creatinine(CR),Inositol(MI)and other indicators were detected and analyzed.Results The scores of HAMD and HAMA in the HSD group were significantly higher than those in the LQS group(P<0.05);the values of NAA/Cr and Cho/Cr in HSD group,Cho/Cr in the LQS group were significantly lower than those in the NC group(P<0.05),while the values of NAA/Cr in the HSD group were significantly lower than those in the LQS group(P<0.05),the difference of MI/Cr of three groups were not statistically significant.Conclusion The occurrence of depression with anxiety may be related to the decrease of NAA and Cho contents in bilateral prefrontal cortex,which suggests that the depression and anxiety of these patients may be very serious and easy to recur,the depression and anxiety symptoms and neuron function damage in HSD patients were more serious than those in LQS patients.

关 键 词：抑郁 焦虑 中医证型 前额叶 氢质子波谱 

分 类 号：R277.7[医药卫生—中医学]