高精度经颅直流电刺激治疗青少年心境障碍抑郁发作患者疗效相关的脑影像标记研究  

Study on neuroimage features related to the efficacy of high-definition transcranial direct current stimulation for adolescents with mood disorder during depressive episode

作　　者：张中国 段佳 位彦鸽 赵鹏飞 王宁[4] 秦士森 朱荣鑫[1] 张婧[1] 王菲 ZHANG Zhong-guo;DUAN Jia;WEI Yan-ge;ZHAO Peng-fei;WANG Ning;QIN Shi-shen;ZHU Rong-xin;ZHANG Jing;WANG Fei(Department of Early Intervention,Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院早期干预科,210029 [2]盐城市第四人民医院精神科 [3]新乡医学院第二附属医院 [4]新乡医学院

出　　处：《临床精神医学杂志》2023年第5期351-355,共5页Journal of Clinical Psychiatry

基　　金：国家杰出青年科学基金(81725005);国家自然科学基金集成项目(U20A6005);江苏省卫健委重点项目(ZD2021026)。

摘　　要：目的:研究高精度经颅直流电刺激(HD-tDCS)对青少年心境障碍抑郁发作患者的疗效及其对应的脑影像特征。方法:纳入青少年心境障碍目前为抑郁发作的患者28例,以左侧背外侧前额叶(DLPFC)为治疗靶点,给予20次HD-tDCS治疗,分别采集所有患者治疗前及治疗后17项汉密尔顿抑郁量表(HAMD-17)总分并完成静息态功能磁共振扫描,根据治疗前后HAMD-17减分率是否≥50%将患者分为有效组、无效组,分析组间治疗前低频振幅(ALFF)差异,以显著差异脑区的治疗前ALFF值为自变量,疗效为因变量,构建回归预测模型。结果:相对于治疗前,治疗后所有患者HAMD-17总分显著降低(t=-11.383,P<0.001),右侧中央前回、右侧回直肌ALFF显著降低(t_(峰点)=-3.816,P<0.05;t_(峰点)=-4.077,P<0.05);与无效组对比,有效组治疗前的右侧楔前叶ALFF显著升高(t_(峰点)=3.816,P<0.05)、左侧距状裂周围皮层ALFF显著降低(t_(峰点)=-4.127,P<0.05);回归分析显示:治疗前右侧楔前叶ALFF值越大,HD-tDCS治疗越有效。结论:HD-tDCS可以作为青少年心境障碍抑郁发作的辅助治疗策略;治疗前右侧楔前叶ALFF值可辅助临床早期预测HD-tDCS治疗的疗效。Objective:To investigate the efficacy of high-definition transcranial direct current stimulation(HD-tDCS)and its corresponding neuroimage features in adolescents with mood disorders during depressive episodes.Method:28 adolescents with mood disorders during depressive episodes were treated with 20 sessions of HD-tDCS targeting the left dorsolateral prefrontal cortex(DLPFC).Hamilton Depression Scale-17 Item(HAMD-17)scores were collected before and after treatment,and resting-state functional magnetic resonance imaging(fMRI)was performed.Patients were divided into effective and ineffective groups based on a≥50%reduction in HAMD-17 scores.The differences in the amplitude of low-frequency fluctuations(ALFF)before treatment between the two groups were analyzed.A regression prediction model was constructed using significant ALFF values before treatment as independent variables and treatment efficacy as the dependent variable.Results:After treatment,all patients showed a significant reduction in HAMD-17 scores(t=-11.383,P<0.001).ALFF values in the right anterior cingulate gyrus and right rectus femoris were significantly decreased(t_(peak)=-3.816,P<0.05:t_(peak)=-4.077,P<0.05).Compared to the ineffective group,the effective group showed a significant increase in ALFF values in the right anterior cingulate gyrus and a significant decrease in ALFF values in the left paracingulate cortex before treatment(t_(peak)=3.816,P<0.05:t_(peak)=-4.127,P<0.05).Regression analysis showed that the larger the ALFF value in the right anterior cingulate gyrus before treatment,the more effective the HD-tDCS treatment was.Conclusion:HD-tDCS can be used as an adjunctive therapy for adolescents with mood disorders during depressive episodes.The ALFF value in the right anterior cingulate gyrus before treatment can assist in the early prediction of HD-tDCS treatment efficacy.

关 键 词：高精度经颅直流电刺激 青少年心境障碍 功能磁共振 疗效预测 

分 类 号：R749.4[医药卫生—神经病学与精神病学]