【摘要】 目的　观察抑郁症患者基础和认知激活脑血流灌注显像异常类型 ,以了解不同发病年龄对抑郁症脑血流灌注的影响。方法　研究对象分 4组 :非老年期抑郁症组、非老年期对照组、老年期抑郁症组和老年期对照组。非老年期和老年期抑郁症组均为初发抑郁 ,未经抗抑郁治疗 ,经精神疾病CCMD 2 R、ICD 10分类 ,诊断为中度抑郁发作伴躯体症状 ,Hamilton抑郁量表评分 (2 4项 )为 2 4～49分。抑郁症组和对照组均无脑血管病危险因素 ,均为右利手。老年期抑郁症组及老年期对照组CT检查结果均正常。 39例非老年期患者中 2 5例行双日法基础与Wisconsin卡片分类试验 (WCST)认知激活脑SPECT显像 ,另 14例仅行基础脑SPECT显像。 17例非老年期对照者均行双日法基础与WCST认知激活脑SPECT显像。 18例老年期抑郁症患者中 12例行双日法基础与WCST认知激活脑SPECT显像 ,另 6例仅行基础脑SPECT显像。 2 1例老年期正常对照者中 18例行双日法基础与WCST认知激活脑SPECT显像 ,另 3例仅行基础脑SPECT显像。结果　①非老年期抑郁症患者的基础局部脑血流 (rCBF)灌注显像示额叶、颞叶低灌注 ;激活显像时 ,额叶和颞叶的低灌注更加明显 ,并且顶叶也有明显的血流灌注减低。与对照组相比 ,差异有显著性。②老年期抑郁症患者的基础rCBF脑显像示?更多还原

【Abstract】 Objective To evaluate the rCBF abnormalities of the baseline and cognitively activated rCBF imaging in unmedicated adult and elderly patients with depression Methods The subjects were divided into four groups: depressed adults, normal adult controls, depressed elders and normal elderly controls All depressed patients were unmedicated and the diagnoses (depression of moderate degree with accompanying somatization) were confirmed by the ICD 10 criteria Age range of the 39 depressed adult patients was 17～55 years 17 age matched normal adult controls (age range 21～50 years) were studied under identical conditions The age range of 18 depressed elderly patients was 62～76 years 21 age matched normal elderly controls (age range 60～72 years) were studied under identical conditions Baseline and cognitively activated 99 Tc m ECD SPECT were performed on 25 of the 39 adult patients with depression and 17 normal adult controls Baseline 99 Tc m ECD SPECT only was performed on the remaining 14 patients with depression Baseline and cognitively activated 99 Tc m ECD SPECT were performed on 12 of the 18 elderly patients with depression and 18 of the 21 normal elderly controls Baseline 99 Tc m ECD SPECT only was performed on the remaining elderly patients and 3 normal elderly controls Results ①The characteristic abnormalities of baseline and cognitively activated brain SPECT imaging of depression in adults: the baseline rCBF values of frontal and temporal lobe decreased significantly and the activated rCBF values of frontal, temporal lobe decreased more evidently than that in the baseline imaging and additionally decreased activated rCBF values in parietal lobe were found ②The characteristic abnormalities of baseline and cognitively activated brain SPECT imaging of elderly patients with depression: the baseline rCBF values of frontal, temporal lobe and right basal ganglia decreased significantly and the activated rCBF values of frontal , temporal, right parietal lobe and left basal ganglia aslo decreased Conclusions ①Hypoperfusion of frontal and temporal cortex was identified in adult and elderly patients with depression ②The hypoperfusion of frontal and temporal cortex may be the cause of cognitive disorder and the depressed mood in patients with depression ③Compared with the depressed adult patients, there is additional hypoperfusion of basal ganglia in the depressed elderly patients ④Cognitively activated brain perfusion imaging is useful to diagnose depression more accurately更多还原