认知行为疗法治疗抑郁症的脑影像学研究进展  

Research progress of brain imaging in cognitive behavioral therapy for depression

作　　者：和曼玉 王慧颖 李晏[3] 王欣宇 邱晨 余姿含 付怡芳 张金玉 王亚丽[1] 王长虹[1] He Manyu;Wang Huiying;Li Yan;Wang Xinyu;Qiu Chen;Yu Zihan;Fu Yifang;Zhang Jinyu;Wang Yali;Wang Changhong(Department of Psychiatry,the Second Affiliated Hospital of Xinxiang Medical University(Henan Mental Hospital),Xinxiang 453002,China;Henan Key Laboratory of Biological Psychiatry,Xinxiang 453002,China;Public Health College of Zhengzhou University,Zhengzhou 450000,China;The Second Clinical College,Xinxiang Medical University,Xinxiang 453002,China)

机构地区：[1]新乡医学院第二附属医院精神科(河南省精神病医院),新乡453002 [2]河南省生物精神病学重点实验室,新乡453002 [3]郑州大学公共卫生学院,郑州450000 [4]新乡医学院第二临床学院,新乡453002

出　　处：《中华行为医学与脑科学杂志》2023年第12期1148-1152,共5页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：河南省重点研发专项(221111311000);河南省重点研发与推广专项(科技攻关、软科学研究)(222102310555);河南省高等学校重点科研项目(23A320057);新乡医学院第二附属医院精神神经学科开放课题(2022-xyefykfkt-001);新乡医学院大学生创新创业训练计划项目(202210472023)。

摘　　要：抑郁症患病率和复发率高,识别及治愈率低,早期干预可改善抑郁症患者的生活质量。临床实践发现,心理治疗能够有效改善抑郁症状及预后,其中认知行为疗法(cognitive behavior therapy,CBT)在抑郁症治疗中应用较为广泛,但是目前其治疗的机制尚不明确。本文综述了抑郁症患者CBT前后神经影像学方面的研究,对抑郁症患者CBT前后不同脑区的结构和功能改变进行了阐述。结果表明CBT通过增加背外侧前额叶的灰质体积、激活水平和功能连接强度,降低杏仁核、海马旁回的激活水平以及恢复异常的脑网络活动或功能连接来改善抑郁症状。治疗前较大的前扣带回灰质体积与较高的海马、杏仁核的激活水平能够有效预测抑郁症患者CBT治疗的效果。未来可将机器学习与脑影像学数据相结合对CBT治疗抑郁症的疗效进行更精准的预测。The prevalence and recurrence rate of depressive disorder are high,while the recognition and cure rate are low.Early intervention can improve the quality of life of patients with depression.In clinical practice,it has been found that psychological treatments can effectively improve the symptoms and prognosis of depression.Cognitive behavior therapy(CBT)has been widely used in the treatment of depression,however,its mechanisms are still unclear.In this paper,the neuroimaging studies of patients with depression before and after CBT were summarized,and the structural or functional changes of different brain regions in patients with depression before and after CBT were described.The findings suggest that CBT improved depressive symptoms by increasing gray matter volume,activation level,and functional connectivity strength in the dorsolateral prefrontal cortex,reducing activation levels in the amygdala and parahippocampal gyrus,and restoring abnormal brain network activity or functional connectivity.Larger gray matter volume in anterior cingulate gyrus and higher activation levels in hippocampus and amygdala before treatment can effectively predict the effect of CBT in depressed patients.In the future,machine learning could be combined with brain imaging data to more accurately predict the effectiveness of CBT in treating depression.

关 键 词：认知行为疗法 磁共振成像 抑郁症 机制 

分 类 号：R749.4[医药卫生—神经病学与精神病学]