抑郁症患者大脑低频振幅对艾司西酞普兰治疗效果的预测作用  

Predictive effects of low frequency brain fluctuation on the therapeutic efficacy of escitalopram in patients with depressive dissorder

作　　者：王赟 周晶晶[1] 陈熊鹰 刘瑞 张志芳 冯媛[1] 周媛 王刚[1,4] Wang Yun;Zhou Jingjing;Chen Xiongying;Liu Rui;Zhang Zhifang;Feng Yuan;Zhou Yuan;Wang Gang(Beijing Key Laboratory of Mental Disorders,National Clinical Research Center for Mental Disorders&National Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing 100088,China;Key Laboratory of Behavioral Science,Institute of Psychology,Chinese Academy of Sciences,Beijing 100101,China;Department of Psychology,University of Chinese Academy of Sciences,Beijing 100049,China;Advanced Innovation Center for Human Brain Protection,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京安定医院、国家精神疾病医学中心、国家精神心理疾病临床医学研究中心、精神疾病诊断与治疗北京市重点实验室,100088 [2]中国科学院心理研究所行为科学重点实验室,北京100101 [3]中国科学院大学心理学系,北京100049 [4]首都医科大学人脑保护高精尖创新中心,北京100069

出　　处：《神经疾病与精神卫生》2024年第3期159-164,共6页Journal of Neuroscience and Mental Health

基　　金：国家自然科学基金(82101597,82071531);北京市医院管理中心“青苗”计划(QML20231901)。

摘　　要：目的基于功能磁共振成像(fMRI)技术分析抑郁症患者大脑低频振幅(ALFF)预测艾司西酞普兰的治疗效果。方法选取2017年4月—2021年6月于首都医科大学附属北京安定医院门诊就诊的87例抑郁症患者为研究对象。所有患者接受12周的艾司西酞普兰药物治疗。于基线期、治疗12周末采用17项汉密尔顿抑郁量表(HAMD-17)评估疗效,将治疗后评分≤7分的患者纳入缓解组(n=42),>7分纳入未缓解组(n=45)。在基线期对两组患者进行静息态fMRI扫描并计算ALFF值,比较两组患者ALFF值存在差异的脑区,采用Pearson相关分析差异脑区ALFF值与HAMD-17评分的相关性,并通过受试者工作特征(ROC)曲线检验差异脑区ALFF值预测艾司西酞普兰治疗效果的效能。结果未缓解组患者基线期双侧距状回/楔叶和右侧舌回/海马旁回的ALFF值高于缓解组,差异有统计学意义(PFWE<0.05)。差异脑区的ALFF值与患者治疗12周末HAMD-17评分呈正相关(P<0.05),与HAMD-17减分率呈负相关(P<0.05)。ROC曲线分析显示,双侧距状回/楔叶和右侧舌回/海马旁回两个差异脑区ALFF值综合预测艾司西酞普兰治疗效果最好,曲线下面积为82.6%,敏感度为60.0%,特异度为95.2%。结论基线期抑郁症患者的局部大脑功能活动特征可作为潜在标志预测抗抑郁剂疗效,视觉网络脑区的功能活动增强可能是艾司西酞普兰治疗效果欠佳的预测因素。Objective To analyze the performance of amplitude of low frequency fluctuation(ALFF)in predicting the therapeutic efficacy of escitalopram in patients with depressive dissorder based on functional magnetic resonance imaging(fMRI)technology.Methods From April 2017 to June 2021,87 patients with depressive disorder who visited the Outpatient Department of Beijing Anding Hospital,Capital Medical University were selected as the research subject.All patients received 12 weeks of treatment with escitalopram.The efficacy was evaluated using the Hamilton Depression Scale-17 items(HAMD-17)at baseline and after 12 weeks of treatment.Patients with a post-treatment score of≤7 points were included in the remission group(n=42),while those with a score greater than 7 points were included in the non-remission group(n=45).During the baseline period,fMRI scans were performed on two groups of patients and ALFF values were calculated.The brain regions with differences in ALFF values between the two groups were compared.Pearson correlation was used to analyze the association between ALFF values in different brain regions and HAMD-17 scores.Receiver operating characteristic(ROC)curve was used to test the performance of differential brain region ALFF values in predicting the therapeutic efficacy of escitalopram.Results The baseline ALFF values of the bilateral calcarine gyrus/cuneiform gyrus and right lingual gyrus/parahippocampal gyrus in the non-remission group were higher than those in the remission group,and the difference was statistically significant(PFWE<0.05).The ALFF values of different brain regions were positively correlated with the HAMD-17 score of patients after 12 weeks of treatment(P<0.05),and negatively correlated with the HAMD-17 score reduction rate(P<0.05),and the differences were statistically significant.ROC curve analysis showed that the comprehensive prediction of the treatment efficacy of escitalopram was best based on the ALFF values of two different brain regions in the bilateral calcarine gyrus/cuneiform gy

关 键 词：抑郁症 功能磁共振成像 低频振幅 疗效预测 

分 类 号：R749.4[医药卫生—神经病学与精神病学]