精准重复经颅磁刺激治疗前后抑郁症患者脑网络特征的变化  

Changes of brain network characteristics in patients with depression before and after precise repetitive transcranial magnetic stimulation

作　　者：杨勇锋[1] 靳雪艳 刘冰 樊令仲[3] 于洪岩[1] 王秀娟[1] 李文强[1] 吕路线[1] 蒋田仔[3] Yang Yongfeng;Jin Xueyan;Liu Bing;Fan Lingzhong;Yu Hongyan;Wang Xiujuan;Li Wenqiang;Lyu Luxian;Jiang Tianzai(Department of Psychiatry,Henan Key Laboratory of Biological Psychiatry,the Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China;State Key Laboratory of Cognitive Neuroscience and Learning,Beijing Normal University,Beijing 100875,China;Brainnetome Center and Institute of Automation,Chinese Academy of Sciences,Beijing 100190,China)

机构地区：[1]新乡医学院第二附属医院精神科,河南省生物精神病学重点实验室,新乡453002 [2]北京师范大学认知神经科学与学习国家重点实验室,北京100875 [3]中国科学院自动化研究所脑网络组研究中心,北京100190

出　　处：《中华医学杂志》2022年第43期3449-3456,共8页National Medical Journal of China

基　　金：国家自然科学基金(81971252,82171498);河南省科技攻关项目(212102310589)。

摘　　要：目的探讨精准重复经颅磁刺激(rTMS)治疗前后抑郁症患者脑网络特征的变化。方法2018年2月至2019年3月,在新乡医学院第二附属医院招募抑郁症患者,在新乡市社区招募健康对照者,通过全新的人类脑网络组图谱精确选择左侧背外侧前额叶皮质为刺激靶点,结合大脑结构相数据,在近红外导航引导下实现精准的rTMS治疗,对抑郁症患者rTMS治疗前后存在显著改变的脑区作功能连接分析。结果最终纳入抑郁症患者19例,男11例,女8例,年龄(34±11)岁;健康对照组22名,男9名,女13名,年龄(30±9)岁。以岛叶为目标区域的功能连接分析发现,抑郁症患者岛叶功能连接降低(P<0.05);抑郁症患者的岛叶到中额叶和上顶叶的功能连接在rTMS治疗前降低(P<0.05),而在rTMS治疗之后功能连接增强(P<0.05)。岛叶的亚区dIg_L到右侧中前额叶的功能连接与rTMS治疗前的贝克焦虑自评量表(BAI)和治疗后的贝克抑郁自评量表(BDI)存在相关性(r=0.737,P=0.003;r=0.696,P=0.005)。结论岛叶功能连接的异常可能是rTMS治疗的脑影像学机制,基于人类脑网络组图谱的精准脑区选择为临床rTMS精准治疗提供了新的技术方法。Objective To investigate the changes of brain network characteristics in patients with depression before and after precise repetitive transcranial magnetic stimulation(rTMS)treatment.Methods Patients with depression in the Second Affiliated Hospital of Xinxiang Medical University and healthy volunteers in the community of Xinxiang city from February 2018 to March 2019 were simultaneously recruited.The left dorsolateral prefrontal cortex was precisely selected as the stimulation target through the latest Human Brainnetome Atlas,and the near infrared navigation was used to achieve accurate brain stimulation treatment in combination with the structural magnetic resonance data.Moreover,functional connectivity was analyzed before and after rTMS treatment in significantly altered brain areas of patients with depression.Results Nineteen patients(11 males and 8 females)with depression were included,aged(34±11)years.Meanwhile,22 healthy controls(9 males and 13 females),aged(30±9)years,were also enrolled.Functional connectivity of insular cortex was decreased in depression patients when the insula was analyzed as the target area(P<0.05).The functional connection from insula to middle frontal lobe and superior parietal lobe in patients with depression decreased before rTMS treatment(P<0.05),but increased after rTMS treatment(P<0.05).The functional connection between dIg_L of the insula and the right middle prefrontal lobe was correlated with Beck Anxiety Index(BAI)before rTMS treatment and Beck Depression Index(BDI)after rTMS treatment(r=0.737,P=0.003;r=0.696,P=0.005).Conclusions Abnormal functional connectivity of insula may be the brain imaging mechanism of rTMS treatment.Precise brain region selection based on Human Brainnetome Atlas provides a new technical method for clinical rTMS precision treatment.

关 键 词：抑郁症 重复经颅磁刺激 功能连接 岛叶 病例对照研究 

分 类 号：R749.4[医药卫生—神经病学与精神病学]