【摘要】 目的 探讨重性抑郁障碍患者默认网络内功能连接(FC)变化及其与反刍思维症状的相关性。方法 选取78例重性抑郁障碍患者和与之相匹配的80名健康对照行静息态功能磁共振扫描，采用24项汉密尔顿抑郁量表(HAMD-24)和反刍思维反应量表(RRS)进行评估。比较两组间默认网络内FC差异及其与临床量表评分的相关性。其中，25例重性抑郁障碍患者经抗抑郁药治疗8周后再次进行扫描与评估，比较治疗前后默认网络内FC的变化及其与临床量表评分差值的相关性。结果 治疗后研究组HAMD-24、RRS总分均低于各自治疗前(P<0.01)。与对照组相比，研究组左侧背外侧前额叶皮层(DLPFC)与顶下小叶、后扣带皮层、左侧额中回、左侧颞顶联合区、左侧外颞叶皮层FC增高；右侧后躯皮层与左侧后躯皮层FC增高(P<0.01)。其中，25例研究组患者经过8周治疗后，左侧DLPFC与左侧外颞叶皮层FC降低(P<0.05)。左侧DLPFC与左侧后扣带皮层FC与HAMD-24中激越因子分、胃肠道症状因子分均呈正相关(P<0.01);左侧DLPFC与右侧顶下小叶FC、左侧DLPFC与左侧颞顶联合区FC与HAMD-24中偏执症状因子分均呈正相关(P<0.05);左侧DLPFC与右侧后扣带皮层FC与RRS中非适应性沉思因子分呈正相关(P<0.01);左侧DLPFC与左侧颞顶联合区FC与RRS中症状反刍因子分呈正相关(P<0.01);左侧DLPFC与左侧额中回FC与RRS中适应性反思因子分呈正相关(P<0.01)。治疗前后左侧DLPFC与左侧外颞叶皮层FC的变化与HAMD-24中全身症状因子分减分值、强迫症状因子分减分值均呈正相关(P<0.05)。结论 默认网络内脑功能活动的增高可能是重性抑郁障碍重要的神经病理基础，且这可能是其反刍思维症状的特质性异常。更多还原

【Abstract】 Objective To explore the changes of functional connectivity(FC) in default mode network(DMN) in patients with major depressive disorder(MDD) and its correlation with rumination.Methods A total of 78 MDD patients(study group) and 80 matched healthy controls(control group) were selected and underwent resting-state functional magnetic resonance imaging(fMRI) scans. All of them were assessed with 24-item Hamilton Depression Scale(HAMD-24) and Ruminative Responses Scale(RRS). The differences in DMN between the two groups, and its correlations with clinical features were compared. Finally, 25 MDD patients underwent a second scan and assessment after 8 weeks of antidepressant treatment to evaluate changes of FC in DMN and their correlation with changes in clinical features. Results After treatment, the total scores of HAMD-24 and RRS in study group decreased significantly compared with those before treatment(P<0.01). Compared to control group, study group exhibited increased FCs between the left dorsolateral prefrontal cortex(DLPFC) and regions including the inferior parietal lobule, posterior cingulate cortex, left middle frontal gyrus, temporal-parietal junction, and left lateral temporal cortex, as well as increased connectivity in the bilateral posterior parietal cortex(P<0.01). After treatment, 25 MDD patients in study group showed decreased FC between the left DLPFC and left lateral temporal cortex(P<0.05). FC between left DLPFC and left posterior cingulate cortex was positively correlated with factor scores of agitation and gastro-intestinal symptoms of HAMD-24(P<0.01). FCs between left DLPFC and right inferior parietal lobule, between left DLPFC and left temporal-parietal junction were positively correlated with paranoid symptoms score of HAMD-24(P<0.05). FC between left DLPFC and right posterior cingulate cortex was positively correlated with non-adaptive rumination score of RRS(P<0.01). FC between left DLPFC and left temporal-parietal junction was positively correlated with symptom rumination score of RRS(P<0.05). FC between left DLPFC and left middle frontal gyrus was positively correlated with adaptive rumination score of RRS(P<0.01). Notably, change in FC between left DLPFC and left lateral temporal cortex before and after treatment was positively correlated with reductions in somatic symptoms and obsessional symptoms scores of HAMD-24(P<0.05). Conclusion The increased functional activity within the DMN may represent a critical neuropathological basis for MDD, potentially underlying the specific abnormalities in rumination symptoms.更多还原