抑郁症首次发病与复发患者静息态功能磁共振低频振幅比率的差异

目的:探讨首发与复发中青年抑郁症患者静息态下功能磁共振脑区低频振幅比率(fALFF)特征的差异,以及与症状严重程度和发作次数的相关性。方法:对16例首发抑郁患者(首发抑郁症组),16例复发抑郁患者(复发抑郁症组)和16名健康对照进行3.0T静息态功能磁共振扫描。结果在方差分析的基础上进行两两双样本t检验,将差异脑区与汉密尔顿抑郁量表总分及抑郁发作次数进行相关分析。结果:3组间fALFF值差异有统计学意义的脑区是左颞横回/左脑岛、左壳核、左前扣带回、左额上回及额中回(P<0.05,Alphasim矫正)。复发抑郁组与首发抑郁组相比,复发抑郁组左壳核、左前扣带回、左额中回及左脑岛fALFF值升高(P<0.05,Alphasim矫正);复发抑郁组与健康对照组相比,复发抑郁组左额上回及左前扣带回fALFF值升高(P<0.05,Alphasim矫正)。抑郁症差异脑区与临床症状相关分析显示,左脑岛和左侧壳核fALFF值与发作次数正相关(r=0.450,P=0.021;r=0.535,P=0.004)。结论:复发抑郁患者脑区fALFF升高,从能量的角度提示首发与复发抑郁存在差异,并表现出与复发抑郁患者更易复发的临床现象相关。     

抑郁症自杀意念与静息态功能磁共振关联性研究

目的 探讨静息状态下脑功能变化与抑郁症患者自杀意念的关联。方法 对42例抑郁症患者采用贝克自杀意念问卷中文版（Beck scale for suicide ideation-Chinese version,BSI-CV）评估并分组,伴有自杀意念组23例,无自杀意念组19例。采用汉密尔顿抑郁量表（Hamilton depression scale,HAMD）评估抑郁症状的严重程度,并行脑静息态功能磁共振成像扫描（resting-state functional magnetic resonance imaging,rs-fMRI）,计算静息态分数低频振幅（fractional amplitude of low-frequency fluctuations,fALFF）值,将两组差异脑区作为种子点,进行全脑静息态功能连接分析。提取差异脑区fALFF值为因变量,建立多因素线性回归方程,分析自杀意念与fALFF值的关联性。结果与无自杀意念抑郁症组相比,伴自杀意念组右侧岛叶fALFF值升高（t=4.49,P<0.05,GRF校正）,岛叶与右侧眶部额下回（t=4.28,P<0.05,G...     

首发Tourette综合征患者静息态功能磁共振低频振幅比率的研究

目的:探讨首发Tourette综合征(TS)患者静息态功能磁共振(fMRI)脑低频振幅比率(fALFF)特征。方法:对16例首发TS患儿(TS组)进行fMRI扫描;计算0.01～0.1 Hz频段fALFF值,并与性别、年龄等相匹配的正常对照者(对照组,16人)比较。结果:TS组fALFF值在左侧梭状回(t=4.36,P0.05)、右侧壳核(t=3.81,P0.05)脑区明显强于对照组;左侧额下回三角部(t=-6.13,P0.05)、右侧额中回(t=-4.35,P0.05)、左侧额上回(t=-4.51,P0.05)、左侧枕中回(t=-6.13,P0.05)、左侧罗兰迪克岛盖(t=-4.58,P0.05)、右侧罗兰迪克岛盖(t=-4.28,P0.05)脑区明显弱于对照组。结论:首发TS患者存在多部位脑功能活动的异常。     

首发Tourette综合征静息态功能磁共振脑比率低频振幅的研究

目的 探讨首发Tourette综合征(TS)静息态下功能磁共振(fMRI)脑比率低频振幅(fALFF)的特征.方法 16例TS患儿(研究组)和16例良好匹配的健康受试者(对照组)均接受静息态功能共振(fMRI)扫描.在0.01～0.1 Hz频段内计算fALFF值,两组进行独立样本t检验.结果 研究组患儿基于BOLD信号的fALFF值在如下脑区强于对照组:左侧梭状回(t =4.36,P＜0.05)、右侧壳核(t=3.81,P＜0.05);研究组患儿基于BOLD信号的fALFF值在如下脑区弱于对照组:左侧额下回三角部(t=-6.13,P＜0.05)、右侧额中回(t=-4.35,P＜0.05)、左侧额上回(t=-4.51,P＜0.05)、左侧枕中回(t=-6.13,P＜0.05)、左侧罗兰迪克岛盖(t=-4.58,P＜0.05)、右侧罗兰迪克岛盖(t=-4.28,P＜0.05).结论 首发Tourette综合征患儿在一些脑区存在脑功能活动的异常,有助于揭示Tourette综合征的神经生理机制.     

早期精神分裂症患者静息态脑功能低频振幅研究

目的:通过静息态功能磁共振探讨早期精神分裂症患者脑功能低频振幅变化。方法:对首次发病未用药早期精神分裂症患者(急性期组)、经药物治疗临床症状缓解的早期精神分裂症首次发病患者(缓解期组)以及性别、年龄、受教育年匹配的健康对照者(对照组)各17例,进行静息态功能磁共振扫描,并计算低频振幅(ALFF),比较3组ALFF变化。结果:三组间ALFF有差异的脑区为左侧直回、梭状回/舌回、右侧颞下回、左侧顶叶、枕叶、楔叶、中央后回、小脑;与健康对照组相比,两病例组ALFF降低的脑区集中在左侧半球,为左侧顶叶小叶,左侧颞下回;而缓解期与急性期组相比,ALFF增加的脑区为右侧壳核,ALFF降低的脑区为直回、楔前叶、梭状回/舌回、左侧颞叶、左侧中央前回和后回、左侧枕中回。结论:精神分裂症患者早期阶段存在多个脑区静息态低频振幅异常,低频振幅降低的脑区主要分布在左侧大脑半球。     

早发精神分裂症静息态脑功能低频振幅研究

目的通过静息态功能磁共振研究早发未用药精神分裂症患者局部脑功能低频振幅(amplitude of low-frequency fluctuation,ALFF)的变化,探讨其静息态下功能异常的脑区。方法收集20例早发未用药精神分裂症患者与20名性别、年龄、受教育年限相匹配的正常对照,分别对其进行全脑静息态功能磁共振扫描,计算ALFF值。结果与对照组相比,患者组左侧额上回、左侧楔前叶、左侧扣带回、左侧枕叶、左侧海马旁回、左侧距状沟ALFF值增高(P0.05,Alpha Sim校正),右侧颞上回和右侧小脑后叶ALFF值降低(P0.05,Alpha Sim校正)。结论早发精神分裂症患者在静息态下有多处脑区ALFF值改变,提示其在静息态下存在脑功能异常。     

伴非自杀性自伤的抑郁发作患者静息态功能磁共振低频振幅特征的研究

目的:探讨伴非自杀性自伤(non-suicidal self-injury, NSSI)抑郁发作患者静息态下脑区低频振幅(amplitude of low frequency fluctuation, ALFF)的特征。方法:招募58例伴NSSI的抑郁发作患者,62例不伴NSSI的抑郁发作患者,及84名健康对照者。将3组受试进行3.0 T静息态功能磁共振扫描,计算全脑ALFF,进行单因素方差分析,使用高斯随机场(GRF)的方法进行多重比较矫正,在有差异脑区的基础上两两比较。结果:3组ALFF有显著差异的脑区是右海马旁回、左枕中回、左后扣带回、右额上回、左中央后回和左额上回(P0.05,GRF矫正)。伴NSSI的抑郁发作患者较不伴NSSI的抑郁发作患者左枕中回、左后扣带、左缘上回、左额上回和左中央后回ALFF增高;伴NSSI的抑郁发作患者较健康对照者左枕中回、左中央后回ALFF增高;不伴NSSI的抑郁发作患者较健康对照者在右海马旁回、右额上回ALFF增高,在左后扣带、左额上回ALFF降低(P0.05,GRF矫正)。结论:伴NSSI的抑郁发作患者静息态脑活动特征在左枕中回、左后扣带、左缘上回、左额上回和左中央后回局部脑功能存在异常,支持伴NSSI的抑郁发作患者在基础状态下执行控制相关脑区存在损害。     

强迫症首次发病未服药患者脑静息态低频振幅研究

目的 探讨强迫症首次发病未服药患者静息脑神经活动的特点.方法 采用磁共振成像低频振幅(ALFF)方法,对昆明医学院第一附属医院22例强迫症患者(患者组)和22名健康志愿者(对照组)静息态脑血氧水平依赖(BOLD)信号活动的改变进行分析;采用功能磁共振成像技术进行数据采集,计算出各受试者的ALFF值;采用两样本t检验,以P<0.001水平统计患者组与对照组的差异.结果 与对照组比较,患者组BOLD信号ALFF改变只存在增高的区域,主要分布在左前扣带回和左中扣带回;未发现患者组左前中扣带回的ALFF值与病程(r=0.004,P=0.985)、年龄(r=0.090,P=0.689)和受教育程度(r=0.048,P=0.831)、Yale-Brown强迫量表总分(r=0.007,P=0.977)、强迫思维分量表分(r=0.140,P=0.530)和强迫行为分量表分(r=0.100,P=0.660)的相关性.结论 静息状态下强迫症患者脑神经活动的ALFF存在异常,ALFF增高可能反映了患者大脑异常的情绪及行为监控.

Abstract：

Objective To study the changes of amplitude of low-frequency fluctuation (ALFF) of the resting-fMRI in the patients with obsessive-compulsive disorder (OCD). Methods The resting-fMRI data of 22 OCD patients and 22 healthy controls were performed ALFF analysis. The amplitude of the blood oxygenation level dependent activation of the resting-state brain was investigated. Results The increased ALFF was only found in first-episode, drug-native OCD group compared with controls. The regions with increased ALFF were the left anterior cingulate and left middle cingulate gyrus (P<0. 001, corrected,K≥33). No significant correlations between ALFF value in these regions and course of disease (r = 0. 004,P = 0. 985) , age (r = 0. 090, P = 0. 689) and level of education (r = 0. 048 , P =0. 831) , no significant correlations between ALFF value and Y-BOCS score (r= 0.007, P= 0.977) , obsessive score (r=0. 140,P =0.530) and compulsive score (r=0. 100, P = 0.660) were found. Conclusion Abnormal ALFF may exist in OCD in the resting-state. The increased ALFF might reflect the strengthening of the emotional management and action monitoring.     

5年随访未转相的抑郁症患者基线脑低频振幅及功能连接特征研究

目的:探讨5年随访未转相的抑郁症患者基线脑低频振幅及功能连接特征。方法:35例抑郁症患者(抑郁组)和27名性别、年龄和受教育年限相匹配的健康对照者(对照组)进行3.0 T静息态功能磁共振扫描,比较两组脑区低频振幅(ALFF)值,将有统计学差异的脑区对全脑进行功能连接(FC)分析。结果:与对照组相比,抑郁组左后扣带回和左丘脑ALFF值降低,左后扣带回和左额中回、左丘脑和左额眶回间FC增强,左后扣带回和左舌回、左丘脑和左小脑脚间FC减弱(P0.05,Alphasim矫正)。左后扣带回和左额中回FC值与17项汉密尔顿抑郁量表(HAMD-17)总分正相关(r=0.351,P=0.038)。结论:5年随访未转相的抑郁症患者基线期存在边缘局部脑区异常,同时与全脑FC存在异常,可能是抑郁症发病的重要因素之一。     

男性偏执型精神分裂症患者静息态功能磁共振脑自发低频振幅的变化

目的:利用静息态功能性磁共振成像(fMRI)技术观察男性偏执型精神分裂症患者脑自发低频振幅(ALFF)的变化。方法:对36例男性偏执型精神分裂症患者(病例组)和19名年龄、利手、性别、受教育程度相匹配的健康者(对照组)进行静息态fMRI扫描;分析两组全脑各区域ALFF的差异。结果:与对照组比较,病例组双侧额中回、右颞中回、右顶下回、左中央前回ALFF明显减低;右颞上回、双侧颞下回、左枕下回ALFF明显增强(P均0.01)。结论:男性偏执型精神分裂症患者脑部广泛区域存在ALFF异常。     

伴有暴力倾向的精神分裂症患者低频振幅与分数低频振幅静息态功能影像学研究

目的探讨伴有暴力倾向的精神分裂症患者静息状态下脑自发神经活动特征以及其脑功能异常的神经病理生理机制。方法纳入符合ICD-10诊断标准的精神分裂症患者35例(男24例、女11例)。采用PANSS评分评估患者临床症状严重程度。利用修订版外显攻击行为量表(Modified Overt Aggression Scale,MOAS)评分将患者分为暴力组和无暴力组。应用静息态功能磁共振成像(resting state functional magnetic resonance imaging,rs-fMRI)技术,采集所有患者静息状态下脑fMRI数据,基于DPABI V2.3(Data Processing&Analysis of Brain Imaging,DPABI)软件,对数据进行预处理后得到低频振幅(amplitude of low-frequency fluctuation,ALFF)及分数低频振幅(fractional amplitude of low-frequency fluctuation,fALFF)图,采用双样本t检验比较2组图像差异。提取所有患者全脑区的ALFF、fALFF值与PANSS评分进行Pearson相关分析。结果暴力组(n=18)较无暴力组(n=17)右侧顶上回、右侧顶下缘角回ALFF值减低,而右侧小脑下部、左侧小脑下部和左侧丘脑的fALFF值增高(均经GRF校正,体素水平P<0.01,簇水平P<0.05)。Pearson相关分析显示,精神分裂症患者(n=35)右侧小脑下部、小脑蚓部、右侧颞中回ALFF值与PANSS阴性症状评分呈正相关(r=0.437、0.610、0.656);右侧角回fALFF值与PANSS阴性症状评分呈负相关(r=-0.723);左侧内侧额上回fALFF值与PANSS敌对性评分呈正相关(r=0.647,均经GRF校正,体素水平P<0.01,簇水平P<0.05)。结论相较于无暴力患者,伴有暴力倾向的精神分裂症患者多个脑区ALFF、fALFF值存在差异,提示伴有暴力行为的患者多个脑区自发神经活动异常。     

Method of assessment determines prevalence of suicidal ideation among patients with depression

BackgroundHow different ways of assessing suicidal ideation influence its prevalence, correlates and predictive validity among patients with major depressive disorder (MDD) remains unclear.MethodsWithin the Vantaa Primary Care Depression Study (PC-VDS, 91 patients) and the Vantaa Depression Study (VDS, 153 psychiatric out-and 41 inpatients), suicidal ideation was assessed with the Scale for Suicidal Ideation (SSI), Hamilton Depression Scale (HAM-D) item 3 and Beck Depression Inventory (BDI) item 9, and by asking whether patients had seriously considered suicide during the episode. The positive and negative predictive values (PPV, NPV) for suicide attempts during a six-month follow-up were investigated.ResultsDepending on the setting, 56–88% of patients had suicidal ideation in some of the assessments, but only 8–44% in all of them. Agreement ranged from negligible to moderate (kappa 0.06–0.64), being lowest among primary care patients. The correlates of suicidal ideation overlapped. No assessment had optimal sensitivity, specificity, PPV and NPV. Nevertheless, PPVs ranged up to 43%.ConclusionsWhich MDD patient is classified as having suicidal ideation depends strongly on the method of assessment, with the greatest variation likely in primary care. Differences in assessments may cause inconsistency in risk factors. Predicting suicide attempts is difficult, but not futile.     

急性缺血性脑卒中伴发抑郁障碍的静息态脑功能磁共振成像研究

目的利用静息态脑功能磁共振成像(rsfMRI)技术探讨急性缺血性脑卒中伴发抑郁障碍患者的脑功能情况。方法对13例急性缺血性脑卒中伴发抑郁障碍患者(病例组)及13名性别、年龄、优势手与之相匹配的健康对照(对照组),进行常规MRI、rsfMRI扫描并采集图像,包括矢状位T1WI和轴位T1WI、T2WI、FLAIR、DWI像,以及rsfMRI图像,分析比较两组的局部一致性(regional homogeneity,ReHo)。结果病例组与对照组相比,双额上回内侧、左颞下回、左顶下小叶、右角回、右扣带回中部及右小脑的ReHo降低(P<0.01);右枕叶中部、双楔叶及距状沟的ReHo增高(P<0.01)。结论急性缺血性脑卒中伴发抑郁障碍患者在静息状态下存在多个脑区功能异常。     

抑郁症患者静息状态的功能磁共振成像研究

目的 了解在静息状态下抑郁症患者脑区的局部一致性特点.方法 采用功能磁共振成像(fMRI)技术,检测静息状态下27例抑郁症患者(患者组)和性别、年龄、受教育程度均与患者相匹配的27名正常人(对照组)的脑功能活动,并对两组进行比较.利用局部一致性方法 分析fMRI数据,用SPM2软件进行配对t检验(P＜0.005).结果 与对照组相比,患者组双侧额中回、右额下回、右颞上回、左前扣带回、右后扣带回、右岛叶、双侧豆状核、双侧屏状核、左尾状核局部一致性显著增高(P＜0.005,未校正,体素值＞10);未显示脑区有明显的局部一致性减低.结论 抑郁症患者神经环路脑区局部在静息状态下具有很高的一致性,其局部一致性的增高可能参与了抑郁症的代偿机制.     

Local synchronization and amplitude of the fluctuation of spontaneous brain activity in attention-deficit/hyperactivity disorder: a resting-state fMRI study

Regional homogeneity（ReHo）and the amplitude of low-frequency fluctuation（ALFF）are two approaches to depicting different regional characteristics of resting-state functional magnetic resonance imaging（RS-fMRI）data.Whether they can complementarily reveal brain regional functional abnormalities in attention-deficit/hyperactivity disorder（ADHD）remains unknown.In this study,we applied ReHo and ALFF to 23 medication-na ve boys diagnosed with ADHD and 25 age-matched healthy male controls using whole-brain voxel-wise analysis.Correlation analyses were conducted in the ADHD group to investigate the relationship between the regional spontaneous brain activity measured by the two approaches and the clinical symptoms of ADHD.We found that the ReHo method showed widely-distributed differences between the two groups in the fronto-cingulo-occipitocerebellar circuitry,while the ALFF method showed a difference only in the right occipital area.When a larger smoothing kernel and a more lenient threshold were used for ALFF,more overlapped regions were found between ALFF and ReHo,and ALFF even found some new regions with group differences.The ADHD symptom scores were correlated with the ReHo values in the right cerebellum,dorsal anterior cingulate cortex and left lingual gyrus in the ADHD group,while no correlation was detected between ALFF and ADHD symptoms.In conclusion,ReHo may be more sensitive to regional abnormalities,at least in boys with ADHD,than ALFF.And ALFF may be complementary to ReHo in measuring local spontaneous activity.Combination of the two may yield a more comprehensive pathophy-siological framework for ADHD.     

首发未用药精神分裂症与精神分裂症患者健康子女静息态脑功能低频振幅研究

目的探讨首发未用药精神分裂症患者和精神分裂症患者健康子女脑功能磁共振低频振幅(amplitude of low frequency fluctuation,ALFF)的共性与差异。方法应用静息态功能磁共振ALFF的方法对年龄30岁的23例首发未用药精神分裂症患者、25名精神分裂症患者健康子女以及29名健康对照进行大脑范围内ALFF值比较。结果与对照组相比,患者组和患者子女组在左侧颞下回后部、左侧海马旁回、左侧海马、右侧中央后回、双侧楔前叶的ALFF值有统计学差异(P0.05),而患者组和患者子女组间在以上脑区的ALFF值无统计学差异(P0.05);与患者子女组和对照组相比,患者组在左侧颞下回前部、左侧颞上极、双侧距状裂周围皮层的ALFF值有统计学差异(P0.05),患者子女组和对照组间在以上脑区的ALFF值无统计学差异(P0.05)。结论首发未用药精神分裂症患者以及精神分裂症患者健康子女都存在脑功能异常;左侧颞下回后部、左侧海马旁回、左侧海马、右侧中央后回、双侧楔前叶可能是与精神分裂症遗传素质性相关的脑区;左侧颞下回前部、左侧颞上极、双侧距状裂周围皮层可能是与疾病状态性相关的脑区。     

Hyperactive putamen in patients with paroxysmal kinesigenic choreoathetosis: A resting‐state functional magnetic resonance imaging study

Paroxysmal kinesigenic choreoathetosis (PKC) is a rare neurologic disorder characterized by sudden attacks of brief involuntary dyskinetic movement, which are precipitated by voluntary movement. The pathophysiology of PKC remains unclear. The purpose of this study is to localize cerebral functional abnormalities in idiopathic PKC with resting‐state functional magnetic resonance imaging (fMRI). From May 2007 to August 2008, seven patients with idiopathic PKC were included. The mean age of onset was 11.7 ± 3.1 (range, 8–17) years and the mean disease duration was 6.9 ± 5.1 (range, 1–14) years. Seven subjects of an age‐ and sex‐matched control group were recruited. Interictal brain fMRI was performed in the PKC patients and in the normal controls. Voxel‐based analysis was used to characterize the alteration of amplitude of low frequency fluctuation (ALFF) in patients with PKC. Difference between the patient patterns and the control was analyzed with Student t‐test. The whole brain analysis indicated that the patient group had significantly increased ALFF in the bilateral putamen (P < 0.005) than normal control. fMRI could be useful to evaluate PKC with negative conventional imaging. It was suggested that abnormal cortico‐striato‐pallido‐thalamic loop might be associated with the pathophysiology of idiopathic PKC. © 2010 Movement Disorder Society     

基于低频振幅算法的血氧水平依赖功能磁共振成像在无灶性癫痫中的应用

目的 采用基于低频振幅算法的血氧水平依赖功能磁共振成像技术,探讨无灶性癫痫脑活动的神经机制及其意义. 方法 运用功能性磁共振成像技术观察安徽医科大学附属省立医院自2010年9月至2011年3月收治的16例无灶性癫痫患者和同期招募的15名健康对照者脑血氧水平依赖信号的改变;收集其静息态数据,然后运用低频振幅算法对数据进行分析,得到每个受试者的低频振幅统计图,观察无灶性癫痫患者相对于健康对照者低频振荡幅度(ALFF)增高和减弱的区域. 结果 无灶性癫痫组和健康对照组相比ALFF增强的脑区分布在右侧颞叶(MNI坐标分别为15,-90,-21)、内侧额叶(0,24,-24)、腹侧前扣带回(-12,30,27)及右侧小脑半球(-51,-57,-4);而ALFF减弱的脑区分布在左侧小脑半球及相邻后缘枕叶(-48,-15,39)、后扣带回(60,-21,33)及楔前叶(-6,-54,66). 结论 无灶性癫痫患者静息状态下表现出异常的脑功能活动方式,ALFF升高的脑区反映了大脑对癫痫活动的产生、传播等易化作用,表明了癫痫的高活动:而ALFF减低的脑区则反映了大脑对癫痫活动的抑制.