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抑郁症患者前脑岛亚区连接异常与躯体症状的关系

2020/08/25 浏览次数:42



研究背景




近些年,抑郁症等心理疾病逐渐成为影响国民身心健康的重大障碍。据WHO统计,抑郁症在全球约有3 亿患者,且患病率逐年增加,预计到2030 年将跃居所有疾病负担第二位。除了情绪低落、快感缺失等情绪症状外,躯体化症状也是抑郁症重要临床表现。躯体化症状与难治性抑郁症密切相关,是抑郁症常见的残留症状,造成沉重的经济负担。目前抑郁症躯体化症状的神经机制尚不明确,前脑岛在抑郁症及躯体症状中扮演重要角色,本研究采用前脑岛亚区为种子点进行功能连接分析,探索其在躯体化症状中的作用,并在电休克模型中进行了验证。



研究方法




本研究纳入45例抑郁症患者和35例年龄、性别、教育年限匹配的正常被试,进行静息态磁共振扫描和临床症状评估(汉密尔顿抑郁量表、患者健康问卷躯体化症状量表),抑郁组被试进行电休克治疗后再进行一次扫描和评估。以前脑岛亚区(图一)为种子点进行功能连接分析,并将该指标在电休克之后予以验证。

图一 Regions of interest (ROIs) used as seeds for resting-resting state functional connectivity analyses with the ventral and dorsal anterior insula.

Sagittal, coronal, and axial views of bilateral ROIs are shown. Anterior insula (AI) subregions were derived from a recent study that revealed regional subspecialization using clustering of resting-state functional connectivity (RSFC) patterns. The bilateral AI was segmented into two subregions, ventral (vAI, blue) and dorsal (dAI, red) based on Deen et al. (2011)



研究结果




与正常对照组相比,抑郁症患者左侧腹侧前脑岛与右侧眶额叶,右侧腹侧前脑岛与右侧眶额叶之间的连接减弱(图二),且与躯体症状的严重程度成负相关(图三)。在电休克之后,抑郁症患者以上减弱的功能连接明显增强(图四),且增强程度与躯体化症状的改善程度明显相关(图五)。

图二 Differences in resting-state functional connectivity (RSFC) of the ventral anterior insula between depressive patients and controls.

(a) The left (L)vAI was used as the ROI for comparison of RSFC strength between depressive patients (DPs) and healthy controls (HCs). Depressive patients exhibited significantly weaker RSFC from LvAI to right orbitofrontal cortex (rOFC). 

(b) The right (R)vAI was used as the ROI for comparison of RSFC strength between depressive patients (DPs) and healthy controls (HCs). Depressive patients exhibited significantly weaker RvAI–rOFC RSFC (correction with family-wise error, voxel p < 0.05, two-tailed). *** p<0.001


图三 Associations between vAI–OFC RSFC and clinical symptoms.

(a)There was a significant negative correlation between the left ventral anterior insula to right orbitofrontal cortex (LvAI–rOFC) RSFC and PHQ-15 score in depressive patients. 

(b) There was a negative correlation between RvAI–rOFC RSFC and PHQ-15 score in depressive patients at the trend level. 

(c) There was a significant negative correlation between LvAI–rOFC RSFC and HDRS score in depressive patients.

图四 The effect of ECT on RSFC in the vAI and somatic symptoms.

(a) Changes in PHQ-15 scores after ECT.

(b) Changes in LvAI–rOFC RSFC induced by electroconvulsive therapy (ECT). 

(c)Change in RvAI–rOFC RSFC after ECT.


图五 Increased RSFC following ECT is associated with somatic symptom improvement. 

(a) There was a significant correlation between increased LvAI–rOFC connectivity and reduced PHQ-15 score (two-tailed). 

(b) There was a trend-level relationship between increased RvAI–rOFC connectivity and reduced PHQ-15 at the trend level (two-tailed, no significant correlation).



结论




本研究表明腹侧前脑岛-右侧眶额叶功能连接的减弱与抑郁症躯体症状相关,且功能连接的增强与躯体症状的改善相关,为抑郁症躯体化症状的干预治疗提供可能的靶点。


相关研究结果发表在《Brain Imaging and Behavior》(IF:3.4),题为:Abnormal connectivity of anterior-insular subdivisions and relationship with somatic symptom in depressive patients,中心成员张婷、柏同健、谢雯为第一作者,田仰华和中心主任汪凯为共同通讯作者。


原文链接:

https://doi.org/10.1007/s11682-020-00371-x



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