皮质-基底神经节-丘脑-皮质环路与抑郁症状调节的机制探讨  

Discussion on the mechanism of cortical-striatum-thalamus-cortical circuit and symptom regulation of depression

作　　者：王芳[1] 沈文超 胡笑楠 朱云程 方贻儒[2,3,4] WANG Fang;SHEN Wen-chao;HU Xiao-nan;ZHU Yun-cheng;FANG Yi-ru(Shanghai Yangpu Mental Health Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200093,China)

机构地区：[1]上海市杨浦区精神卫生中心,200093 [2]上海交通大学医学院附属精神卫生中心 [3]中国科学院脑科学与智能技术卓越创新中心 [4]上海市重性精神病重点实验室

出　　处：《临床精神医学杂志》2021年第4期326-329,共4页Journal of Clinical Psychiatry

基　　金：国家重点研究开发计划(2016YFC1307100);国家自然科学基金(81771465,81930033);上海市卫生健康委员会卫生行业临床研究专项项目(20204Y0025);上海杨浦区卫健系统“好医师”建设工程项目(2020-2023)。

摘　　要：目前的神经科学领域已有对逃避悲伤和寻求犒赏环路的病理机制的描述,即边缘-皮质-基底神经节-丘脑-皮质环路(LCBGTC)功能的病理性增强导致逃避悲伤行为,锥体外系-皮质-基底神经节-丘脑-皮质环路(ECBGTC)功能的病理性增强导致寻求犒赏行为。过度激活逃避悲伤系统导致担惊受怕、消极预期、烦躁不安;而寻求犒赏系统激活不足导致快感缺乏、乏力感和犹豫不决。重性抑郁障碍(MDD)以逃避悲伤环路的活性增高作为主要因素,伴随了很大程度上寻求犒赏环路功能的抑制,在抑郁症临床表现中提示两个环路都存在功能失调。双相障碍(BD)相对低的患病率很可能提示其具有MDD环路机制的差错以外,很可能还有别的神经机制。尽管LCBGTC环路和ECBGTC环路调节两种不同的行为,但是个体表达这些特质时还是具有高度动机性的,这与伏隔核外壳部和核心部有关,外壳部促使逃避悲伤,核心部体验犒赏的满足感。当这些动机突然停止时,就能体验到快乐和满足。The pathological mechanism of misery-fleeing behaviour and reward-seeking behaviour has been described in many neuroscience studies.The pathological increasing of the limbc-cortico-basalganglio-thalamo-cortical(LCBGTC)circuit leads to the misery-fleeing behavior while that of extrapyramidal-cortical-striatum-thalamus-cortical(ECBGTC)circuit results in reward-seeking behavior.Excessive activation of the misery-fleeing system plays an important role in fear,negative expectations,and restlessness while the lack of activation of the reward-seeking system results in anhedonia,fatigue,and indecision.Thus,the increased activity of the misery-fleeing circuit is the main factor of major depressive disorder(MDD),which is accompanied with the suppression of the function of the reward-seeking circuit.To a large extent,it is suggested that both of these circuits are dysfunctional in the clinical manifestations of depression.The relatively low prevalence of bipolar disorder(BD)is likely to indicate that there may be a neural mechanism other than the dysfunctions in the MDD circuit.Although the LCBGTC circuit and the ECBGTC circuit regulate two different kinds of behaviors,individuals express these traits with a high degree of motivation,which is related to the shell and core of nucleus accumbens.The shell promotes misery-fleeing behavior and the core experiences reward satisfaction.Happiness and satisfaction are experienced as soon as these motives suddenly cease.

关 键 词：重性抑郁障碍 双相障碍 神经环路 

分 类 号：R749.4[医药卫生—神经病学与精神病学]