【作者】 陈涛；

【导师】 朱道民；

【作者基本信息】 安徽医科大学 ， 精神病与精神卫生学（专业学位）， 2023， 硕士

【摘要】 背景:在重度抑郁障碍(Major depressive disorder,MDD)中,睡眠障碍作为一种常见伴随症状,对MDD的发生、发展、转归以及复发都具有重要的临床意义。本研究的目的是调查接受常规抗抑郁药物治疗的MDD患者睡眠和临床症状的内在神经机制。方法:48位MDD患者均进行急性期以及缓解期(首次就诊后平均7个月)的磁共振成像和多导睡眠图(Polysomnography,PSG)的检查,并使用临床量表对症状进行评估。采用偏相关分析探索脑功能、睡眠以及临床症状改善程度之间的相关关系,并在此基础上进行三者间的中介分析。结果:我们发现,基线时的右侧顶上小叶(superior parietal gyrus,SPG)和右侧额中回的分数低频振幅(fractional amplitude of low-frequency fluctuations,f ALFF)可以分别预测重度抑郁症患者抑郁和焦虑症状的改善情况。此外,我们发现MDD患者右侧SPG的f ALFF与基线睡眠效率(sleep efficiency,SE)显著正相关。进一步的中介分析显示,右侧SPG的f ALFF在基线SE与抑郁症状改善之间起中介作用。结论:本研究除了强调f ALFF可作为预测和跟踪MDD患者疾病进展的潜在预后生物标志物外,还可能为改善MDD患者的睡眠质量从而促进临床症状的恢复提供神经机制基础,并为MDD伴睡眠障碍患者的临床干预提供现实依据。更多还原

【Abstract】 Background and purpose:Antidepressant medications represent the most common treatment option for major depressive disorder(MDD).The objective of this study was to investigate status-related changes(acute vs.remitted status)in brain function in MDD patients.Methods:Forty-eight MDD patients were receiving regular antidepressant medications(an average of 7 months after the initial visit,remitted status).At each visit,all the patients underwent MRI and polysomnography examinations and clinical assessment.Results:We found that baseline fractional amplitude of low-frequency fluctuations(f ALFF)of right superior parietal gyrus(SPG)and right middle frontal gyrus could predict improvement in depression and anxiety symptoms acute to remitted status in MDD patients,respectively.Moreover,we found that f ALFF of the right SPG in MDD patients was significantly positively correlated with baseline sleep efficiency(SE).Further mediation analysis revealed that the f ALFF of right SPG mediated the relationship between baseline SE and depressive symptom improvement.Conclusions:Apart from highlighting the f ALFF as a potential prognostic biomarker to predict and track disease progression in MDD patients,these findings might provide a neural mechanism basis for improving sleep quality of MDD patients and thus promoting the recovery of clinical symptoms,as well as provide a practical basis for clinical interventions in MDD patients with sleep disorders.更多还原