脑白质微结构和压力生活事件对MDD患者复发状态的影响  

Influences of abnormal white matter micro-structures and stressful life events in depression relapse

作　　者：王云[1] 谢杰 王琪 李月峰[1] Wang Yun;Xie Jie;Wang Qi;Li Yuefeng(Department of Radiology,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院医学影像科,镇江212001

出　　处：《中华神经医学杂志》2021年第8期782-786,共5页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81871343);江苏省自然科学基金(BK20181226)。

摘　　要：目的探讨脑白质微结构和压力生活事件对重度抑郁症(MDD)患者复发状态的影响。方法前瞻性收集镇江市精神卫生中心自2017年5月至2018年6月收治的108例MDD患者作为研究对象。患者入组后均接受MRI扫描,治疗后所有患者随访2年(每3个月1次)。采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)的标准来评估患者的复发状况,采用汉密尔顿抑郁评定量表(HDRS)和生活事件量表(LES)评估MDD患者的抑郁程度和压力生活事件经历的存在和水平。比较复发和未复发患者临床资料和脑白质微结构的差异,采用二分类Logistic回归分析确定MDD复发的独立影响因素。采用受试者工作特征(ROC)曲线分析各影响因素对MDD复发的预测效能。采用Pearson相关性分析患者脑白质FA值、随访时LES评分、随访时HDRS评分的相关性。结果最终92例患者进入研究,其中复发患者38例,未复发患者54例。与未复发组比较,复发组患者的发病年龄较小,发病次数较多,病程较长,基线LES评分较高,随访时HDRS评分和LES评分均较高,差异均有统计学意义(P<0.05)。与未复发组相比,复发组患者的右上纵束和胼胝体FA值降低,差异均有统计学意义(P<0.05)。二分类Logistic回归分析显示右上纵束FA值(OR=0.350,95%CI:0.168~0.728,P=0.005)、胼胝体FA值(OR=0.646,95%CI:0.438~0.951,P=0.027)及随访时LES评分(OR=1.483,95%CI:1.226~1.793,P=0.000)是MDD复发的独立影响因素。ROC曲线分析显示右上纵束FA值、胼胝体FA值及随访时LES评分预测MDD复发的曲线下面积(AUC)分别为0.655,0.661,0.841。相关性分析显示MDD患者右上纵束FA值、胼胝体FA值与随访时HDRS评分均呈负相关关系(r=-0.470,P=0.000;r=-0.398,P=0.004),随访时LES评分与随访时HDRS评分呈正相关关系(r=0.429,P=0.000)。结论脑白质微结构和压力生活事件与MDD患者的复发密切相关。Objective To investigate the influences of abnormal white matter micro-structures and stressful life events in relapse status of patients with major depressive disorder(MDD).Methods A prospective sutdy was performed;108 patients with MDD were chosen as study subjects in our hospital from May 2017 to June 2018.All subjects underwent MR imaging scanning,and were followed up for 2 years after treatment(once every 3 months).Their relapse status were assessed by 4th edition of Diagnostic and Statistical Manual of Mental Disorders(DSM-IV)criteria.The degrees of depression and existence and level of stressful life events in MDD patients were assessed by Hamilton Depression Rating Scale(HDRS)and Life Events Scale(LES).The differences of clinical data and white matter micro-structures between relapse and non-relapse patients were compared.Binary Logistic regression analysis was used to determine the independent influencing factors for MDD relapse.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of influencing factors in MDD relapse.The correlations of white matter fractional anisotropy(FA)values with follow-up HDRS scores and follow-up LES scores were analyzed by Pearson correlation analysis.Results In the end,92 patients were enrolled in the study,including 38 relapse patients and 54 non-relapse patients.As compared with those in the non-relapse group,patients in the relapse group showed younger onset age,higher incidence of disease onset,longer course of disease,higher LES scores(baseline),and higher HDRS and LES scores(follow-up),with significant differences(P<0.05).FA values of the right superior longitudinal fasciculus and corpus callosum in the relapse patients were significantly decreased as compared with those in the non-relapse patients(P<0.05).Binary Logistic regression analysis showed that FA values of the right superior longitudinal fasciculus(OR=0.350,95%CI:0.168-0.728,P=0.005)and FA values of the corpus callosum(OR=0.646,95%CI:0.438-0.951,P=0.027),and LES scores(follow-

关 键 词：重度抑郁症 复发 脑白质微结构 压力生活事件 弥散张量成像 

分 类 号：R749.4[医药卫生—神经病学与精神病学]