复发性与首发性抑郁症的静息态脑功能MRI低频振幅初步研究

目的 基于低频振幅（ALFF）方法研究复发性抑郁症（RDE）和首发性抑郁症（FDE）脑功能活动改变特征。 方法 前瞻性纳入2家医院确诊的20例RDE病人、18例FDE病人,同期纳入性别、年龄相匹配的20例健康志愿者作为对照组（HC组）。3组受试者均行静息态功能MRI（rs-fMRI）检查,并完成汉密顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA-14）、焦虑自评量表（SAS）、抑郁自评量表（SDS）、中文版冗思量表（RRS）评定。采用Matlab平台上的DPARSF 5.0工具包进行rs-fMRI数据预处理,采用单因素方差分析比较3组间ALFF差异,并对结果进行高斯随机场（GRF）校正。提取3组间ALFF有差异脑区的时间序列均值（ALFF值）,对ALFF值的事后两两比较采用LSD-t检验,所得结果进行Bonferroni校正（P<0.016）。最后对3组间有统计学差异脑区的ALFF值与临床量表评分进行Pearson相关分析。 结果 RDE组与FDE组的HAMD-17、HAMA-14、SDS、SAS、RRS评分均高于HC组（均P<0.05）,RDE组的SDS、SAS评分高于FDE组（均P<0.05）。与FDE组相比,RDE组左侧杏仁核、右侧海马的ALFF值增高,而右侧额中回、左侧三角部额下回的ALFF值减低（均P<0.016）。与HC组相比,RDE组左侧楔前叶、右侧舌回的ALFF值减低（均P<0.016）,FDE组右侧额中回、左侧三角部额下回的ALFF值增高,而FDE组在左侧楔前叶、左侧杏仁核、右侧海马、右侧舌回的ALFF值减低（均P<0.016）。相关性分析显示,RDE组右侧海马ALFF值与HAMA-14量表评分呈负相关（r=-0.53,P=0.014）。 结论 RDE与FDE病人的ALFF值差异脑区与前额叶-边缘神经环路密切相关,尤其在右侧额中回、左侧三角部额下回、左侧杏仁核、右侧海马表现明显,这有助于区别RDE组和FDE组的神经病理机制差异。

Amplitude of low-frequency fluctuations of resting-state functional MRI in recurrent and first-episode depression

Objective Using amplitude of low-frequency fluctuations(ALFF) based method to study the characteristics of altered functional brain activity in recurrent depressive episodes (RDE) and first-episode depression (FDE). Methods Twenty patients with RDE and 18 patients with FDE diagnosed from two hospitals were prospectively included, and 20 age- and sex-matched healthy volunteers were included as healthy controls (HC) during the same period, and subjects in all 3 groups underwent resting-state functional magnetic resonance imaging (rs-MRI) and completed the 17-item Hamilton rating scale for depression (HAMD-17), 14-item Hamilton anxiety scale (HAMA-14), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Rumination response scale (RSS) were completed. The DPARSF 5.0 toolkit on Matlab platform was used for rs-fMRI data preprocessing, and one-way ANOVA was used to compare the differences in ALFF among the 3 groups, and Gaussian random field (GRF) correction was applied to ALFF. The mean values of the time series of brain regions with differences in ALFF between the 3 groups, ALFF values were extracted, and the two-way comparison of ALFF values was performed by LSD-t test, and the results obtained were Bonferroni corrected (P<0.016). Finally, Pearson correlation analysis was performed between the ALFF values of statistically different brain areas and clinical scale scores among the 3 groups. Results The HAMD-17, HAMA-14, SDS, SAS, and RRS scores were higher in the RDE and FDE groups than in the HC group (all P<0.05), and the SDS and SAS scores were higher in the RDE group than in the FDE group (all P<0.05). Compared with the FDE group, the ALFF values in the left amygdala and right hippocampus were increased in the RDE group, while the ALFF values in the right middle frontal gyrus and left inferior frontal triangular gyrus were decreased (all P<0.016). Compared with the HC group, the RDE group had reduced ALFF values in the left precuneus and right lingual gyrus (all P<0.016), and the FDE group had increased ALFF values in the right middle frontal gyrus and left inferior frontal triangular gyrus, and the FDE group had reduced ALFF values in the left precuneus, left amygdala, right hippocampus, and right lingual gyrus (all P<0.016). Correlation analysis showed that the right hippocampal ALFF values in the RDE group were negatively correlated with HAMA-14 scale scores (r=-0.53, P=0.014). Conclusions The brain areas with differential ALFF values between RDE and FDE patients are closely related to the prefrontal-limbic loop, especially in the right middle frontal gyrus, left inferior frontal triangular gyrus, left amygdala, and right hippocampus, which has some significance for differentiating the differences in neuropathological mechanisms between the RDE and FDE groups.