【摘要】 目的采用脑结构磁共振成像技术,探究抑郁障碍患者治疗前后大脑皮层的变化。方法选取28例首发抑郁障碍患者(研究组)及28名来自社区的健康对照者(对照组)。评定研究组在经草酸艾司西酞普兰片治疗前后及对照组在基线时的汉密尔顿抑郁量表(HAMD-24)、汉密尔顿焦虑量表(HAMA),并计算研究组量表的减分率。采集研究组药物治疗前后及对照组基线时的T1像磁共振成像数据,使用基于表面的形态学测量分析方法(SBM)比较研究组治疗前后的大脑皮层变化的差异及研究组与对照组在基线期的大脑皮层变化的差异。结果治疗前研究组HAMD-24、HAMA总分均高于对照组(P<0.05)。研究组治疗后HAMD-24、HAMA均较治疗前降低(P<0.05)。治疗前研究组右侧大脑的喙侧额中回的皮层厚度较对照组降低(经顶点水平的FWE校正后P<0.05)。研究组治疗后左侧大脑的梭状回区、枕外侧区、舌回区、内侧眶额皮层、后扣带回、颞上回、缘上回、额上回的局部皮层折叠系数较治疗前降低(经顶点水平的FWE校正后P<0.05);左侧大脑的旁中央区、中央前区、顶上区、颞上沟两侧的局部皮层折叠系数较治疗前增加(经顶点水平的FWE校正后P<0.05)。结论首发抑郁障碍患者在未经药物治疗下有部分脑区出现大脑皮层厚度的降低,经过草酸艾司西酞普兰治疗8周后存在多个脑区局部皮层折叠系数的改变。更多还原

【Abstract】 Objective To explore the changes of cerebral cortex in patients with depression before and after treatment using structural magnetic resonance imaging(sMRI). Methods 28 patients with first-episode depression(study group) treated with escitalopram oxalate and 28 healthy controls from the community(control group) were selected and assessed with Hamilton Depression Scale(HAMD-24), Hamilton Anxiety Scale(HAMA), and the score reduction rates of the scales in study group were calculated. T1 MRI data of study group before and after treatment and control group at baseline were collected, and surface-based morphological measurement analysis(SBM) was used to compare the differences of cerebral cortex changes in study group before and after treatment as well as the differences of cerebral cortex changes between study group and control group at baseline. Results At baseline, the total scores of HAMD-24 and HAMA in study group were all significantly higher than those in control group(P<0.05). After the treatment, the total scores of HAMD-24 and HAMA in study group all decreased significantly compared with those before treatment(P<0.05). At baseline, the thickness of the cortex in rostral middle frontal of right hemisphere in study group was significantly smaller than that in control group(P<0.05 after FWE correction at the vertex level). In study group, the gyrifications of local cortex in fusiform gyrus, lateral occipital region, lingual gyrus, medial orbitofrontal cortex, posterior cingulate gyrus, superior temporal gyrus, superior limbic gyrus and superior frontal gyrus of left hemisphere after treatment all decreased significantly compared with those before treatment(P<0.05 after FWE correction at the vertex level); and the gyrifications of local cortex in paracentral, precentral, superiorparietal and both sides of superior temporal sulcus of left hemisphere increased significantly compared with those before treatment(P<0.05 after FWE correction at the vertex level). Conclusion In patients with first episode depressive disorder, the thickness of cerebral cortex decreases in some brain regions without drug treatment. After 8 weeks of treatment with escitalopram oxalate, the gyrification of multiple brain regions changes.更多还原