双相障碍患者3种临床相静息态脑功能局部一致性研究  

Resting-state regional homogeneity changes across three mood states of bipolar disorder

作　　者：吴艳坤 陈超[1] 李茜[1] 李科 曾亚伟 苏允爱[1] 司天梅[1] Wu Yankun;Chen Chao;Li Qian;Li Ke;Zeng Yawei;Su Yun'ai;Si Tianmei(Peking University Sixth Hospital,Peking University Institute of Mental Health,NHC Key Laboratory of Mental Health(Peking University),National Clinical Research Center for Mental Disorders(Peking University Sixth Hospital),Beijing 100191,China;PLA Strategic Support Force Characteristic Medical Center,Beijing 100101,China)

机构地区：[1]北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100191 [2]战略支援部队特色医学中心放射诊断科,北京100101

出　　处：《中华精神科杂志》2022年第1期38-46,共9页Chinese Journal of Psychiatry

基　　金：国家自然科学基金(81630031,81771468,81601184);首都卫生发展科研专项重点攻关项目(2020-2-4113);北京市重大科技专项(Z171100000117016);国家科技支撑计划项目(2015BAI13B01)。

摘　　要：目的探究不同临床相双相障碍患者的静息态脑功能局部一致性特征,寻找双相障碍的素质性影像学标记。方法采用横断面研究,纳入符合DSM-Ⅳ-TR诊断标准的169例处于不同临床相的双相障碍患者[双相障碍组,其中双相抑郁组68例、双相(轻)躁狂组29例、双相缓解组72例]及性别、年龄与之匹配的113名对照者(对照组)。采用17项汉密尔顿抑郁量表评估患者组的抑郁症状严重程度,采用杨氏躁狂评定量表评估躁狂症状严重程度,采用正性和负性情感量表评估正性和负性情绪程度;同时采集所有被试者的静息态功能磁共振成像数据,并对数据进行预处理,最终64例双相抑郁患者、28例双相(轻)躁狂患者、66例双相缓解患者和112名对照者纳入分析。采用局部活动一致性(regional homogeneity,ReHo)分析静息态脑功能影像学特征,对4组被试者的ReHo值进行协方差分析,提取差异有统计学意义的脑区ReHo值进行事后检验,并分析4组患者静息态脑功能影像学特征与临床病理特征的关系。结果双相障碍组和对照组的ReHo值差异脑区为双侧小脑后部(左侧F=11.41,右侧F=10.45)、双侧距状皮质(左侧F=10.60,右侧F=9.59)和右侧颞上回(F=10.58)。与对照组相比,双相抑郁组、双相(轻)躁狂组、双相缓解组左侧小脑后部ReHo值降低(均P<0.01),右侧小脑后部(均P<0.05)、双侧距状皮质和右侧颞上回(均P<0.01)ReHo值升高。双相障碍患者右侧距状皮质ReHo值与负性情绪程度呈显著负相关(r=-0.17,P=0.04,未校正)。结论双相障碍患者各临床相均呈现双侧小脑后部、双侧距状皮质和右侧颞上回局部活动一致性改变,提示小脑、视觉网络和感觉运动网络的脑功能改变可能是双相障碍的素质性神经病理学改变。Objective To investigate resting-state regional homogeneity in patients with bipolar disorder in different mood states and the potential trait imaging markers of bipolar disorder.Methods This is a cross-sectional study involving 169 patients who met the diagnosis criteria of bipolar disorder in DSM-Ⅳ-TR(including 68 patients with bipolar depression,29 patients with bipolar(hypo)mania,72 patients with bipolar euthymia)and 113 controls matched by age and gender.The severity of depression,mania,and the positive and negative affects were assessed by the Hamilton Depression Scale(HAMD17),Young Mania Rating Scale(YMRS),and Positive and Negative Affect Schedule(PANAS).Resting-state fMRI data were obtained.After fMRI data processing,64 patients with bipolar depression,28 patients with bipolar(hypo)mania,66 patients with bipolar euthymia,and 112 controls were included in the final analysis.The regional homogeneity(ReHo)values were computed,and analysis of covariance was performed on ReHo values among the four groups.Post hoc analysis was conducted based on the ReHo values extracted from the brain regions with significant differences.The relationship between the ReHo values and clinical scores was examined.Results Significant ReHo differences were observed in the bilateral posterior cerebellum(F=11.41 for left,F=10.45 for right),bilateral calcarine cortex(F=10.60 for left,F=9.59 for right),and right superior temporal gyrus(F=10.58).Compared to controls,bipolar patients in all mood states demonstrated decreased ReHo in the left posterior cerebellum(P<0.01 for all)and increased ReHo in the right posterior cerebellum(P<0.05 for all),bilateral calcarine cortex and right superior temporal gyrus(P<0.01 for all).The clinical score of negative affects was negatively correlated with the ReHo values in the right calcarine cortex(r=-0.17,P=0.04,uncorrected).Conclusions Bipolar disorder is characterized by regional homogeneity changes in the bilateral posterior cerebellum,bilateral calcarine cortex and right superior temporal gyrus

关 键 词：双相情感障碍 磁共振成像 局部一致性 素质性特征 

分 类 号：R749.4[医药卫生—神经病学与精神病学]