改良电休克疗法治疗重性抑郁症的静息态功能磁共振分析  

Resting-state functional magnetic resonance imaging analysis of modified electroconvulsive therapy in the treatment of major depressive disorder

作　　者：侯强强 吴越[1] 吕华明 张婷[1] 谢雯 柏同健 田仰华[1] Hou Qiangqiang;Wu Yue;Lyu Huaming;Zhang Ting;Xie Wen;Bai Tongjian;Tian Yanghua(Department of Neurology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Neurosis,Anhui Mental Health Center,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022 [2]安徽省精神卫生中心神经症科,合肥230022

出　　处：《中华医学杂志》2021年第39期3221-3226,共6页National Medical Journal of China

基　　金：国家自然科学基金(32071054);安徽省自然科学基金杰出青年基金(1808085J23)。

摘　　要：目的探索改良电休克(MECT)对重性抑郁症(MDD)大脑静息状态功能连接的影响。方法纳入2017年10月至2019年5月于安徽省精神卫生中心住院的MDD患者,通过静息态功能磁共振的方法,以双侧伏隔核为种子点分析MDD患者MECT前、后功能连接(FC)的变化;并将(脑区之间)有显著改变(P<0.05)的FC的变化与患者17项汉密尔顿抑郁量表(HRSD-17)评分的变化做相关性分析。结果 40例接受MECT治疗的MDD患者,男10例,女30例,年龄(38±11)岁。在MECT治疗之后,MDD患者右伏隔核与右额上回(P<0.001)、右缘上回(P<0.001)、右角回(P= 0.017)、右顶下回(P=0.017)、左额上回(P<0.001)、左颞中回(P= 0.017)及左角回(P= 0.012)等多个脑区的FC明显强于MECT前(P<0.05)。并且右伏隔核-左额上回(r=-0.454,P=0.003)、右伏隔核-右角回(r=-0.437,P=0.005)及右伏隔核-左角回(r =-0.383,P = 0.015)FC的改变和患者的HRSD-17评分改变呈负相关。结论 MECT可能通过调节右伏隔核和双侧角回和左额上回之间的功能连接缓解重性抑郁症。Objective To explore the effect of modified electroconvulsive therapy(MECT)on resting-state functional connectivity(RSFC)in patients with major depressive disorder(MDD).Methods Patients with MDD from Anhui Mental Health Center from October 2017 to May 2019 were included.Using bilateral nucleus accumbens(NAcc)as seed points,changes of RSFC were investigated before and after MECT through resting-state functional magnetic imaging(fMRI).Antidepressant effects were measured by 17 items of Hamilton Depressive Rating Scale(HDRS-17).Correlation analysis was performed between changed HRSD-17 scores and changes of functional connectivity.Results A total of 40 MDD patients(10 males and 30 females),aged(38±11)years,who received MECT were included in the study.After MECT,patients showed increased RSFC in the right NAcc(rNAcc)and superior frontal gyrus(P<0.001),right supramarginal gyrus(P<0.001),right angular gyrus(rAG)(P=0.017),right inferior parietal lobule(P=0.017),left superior frontal gyrus(LSFG)(P<0.001),left middle temporal gyrus(P=0.017)and left angular gyrus(LAG)(P=0.012),respectively.The RSFC changes of rNAcc-LSFG(r=-0.454,P=0.003),rNAcc-rAG(r=-0.437,P=0.005)and rNAcc-lAG(r=-0.383,P=0.015)were negatively correlated with the changes of HRSD-17 scores.Conclusions MECT may alleviate major depression by regulating the functional connectivity between the rNAcc and bilateral angular gyrus and left superior frontal gyrus.

关 键 词：电惊厥疗法 重性抑郁症 伏隔核 奖赏系统 自身前后对照研究 

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]