摘要
目的探讨重性抑郁症患者治疗前后生化物质改变及其与执行功能之间的关系。方法对15例重性抑郁患者（MDD）给予五羟色胺再摄取抑制剂（SSRIs）治疗，共8周。于治疗基线及治疗末利用质子磁共振波谱技术（^1H—MRS）测量患者组前扣带回皮质（ACC）的N一乙酰天门冬氨酸（NAA）、谷氨酸复合物（Glx）、胆碱复合物（Cho）及肌醇（MI）的浓度，并与15例正常对照者（对照组）作比较。此外，分别对患者组在治疗前后和正常组进行执行功能测试及比较。结果1）治疗前患者组双侧ACC三种代谢物的绝对浓度[NAA（7．36±1．67）mmol／L、Glx（11．68±1．65）mmol／L、MI（5．28±0．66）rnmol／L]明显低于正常组[NAA（9．27±1．37）mmol／L、Glx（15．20±1．91）mmol／L、MI（7．80±2．73）mmol／L]（P〈0．01），治疗后患者组ACCNAA及Glx的绝对浓度[NAA（9．34±2．45）mmol／L、Glx（16．79±3．96）mmol／L]较治疗前[NAA（7．36±1．67）mmol／L，Glx（11．68±1．65）mmol／L]明显升高（P〈0．05）。2）治疗前患者组的WCST成绩及SCWT成绩均差于正常对照组（P〈0．05或者P〈0．01）；治疗后患者组的WCST和SCWT的成绩均较治疗前明显提高沪〈0．05或P〈0．01）。3）治疗后患者组ACCGlx的绝对浓度与WCST中的完成分类数正相关（r=0．739，P=0．009）且分别与完成第一个分类所需应答数（r=-0．699，P=0．017）及SCWT中的甲表完成时间成负相关（r=-0．651，P=0．030）；治疗后MDD患者ACC提高的MI（r=-0．705，P=0．023）及NAA（r=-0．735，P=0．010）的浓度均与WCST中的完成第一个分类所需应答数负相关。结论ACC可能是对抗抑郁治疗起反应的关键脑区。治疗后重性抑郁症患者ACC提高的NAA，Glx及MI浓度可能与其执行功能的改善有关。
Objective To investigate neuro-biochemical changes of bilateral anterior cingulate cortex （ACC） in the patients with major depressive disorder （MDD） and the correlation between abnormal metabolism and the cognitive function before and after treatment. Methods Fifteen patients with major depression and 15 age-,sex- and education-matched healthy controls （HC） were involved. The neurochemical abnormalities inclu- ding the levels of N-acetylaspartate （ NAA）, choline-containing compounds, glutamate/glutamine and myoinostol were measured by single-voxel proton magnetic resonance spectroscopic （1H-MRS）. The subjects were then as- sessed with executive function with neuropsychological tests including Wisconsin cards sorting test （WCST） ,verbal fluency Task （vF）, StrooP Color and Word Test （SCWT）. After this, the patients took selectivity serotonin re- uptake inhibitors （SSRIs） for eight weeks. Then,we examined the changes in NAA, Cho, Glx and MI in ACC of patients and assessed their executive function with the neuropsychological tests again. Results 1 ） In ACC,base- line NAA （ （ 7.36 ± 1.67 ） mmol/L）, GLx （ （ 11.68 ± 1.65 ） mmol/L） and MI levels （ （ 5.28 ± 0.66 ） mmol/L） were significantly lower in MDD compared to those of HC （ NAA （ 9.27 ± 1.37 ） mmol/L, Glx （ 15.20 ± 1.91 ） mmol/L, MI （7.80 ± 2.73 ）mmol/L） （P 〈 0.01 ） ; After treatment, the NAA （ （9.34 ± 2.45 ） mmol/L） and Glx （ （ 16.79 ± 3.96 ）mmol/L）increased significantly after treatment compared to those prior to pretreatment（ NAA（ 7.36 ± 1.67 ） mmol/L,Glx（ 11.68 ± 1.65 ）mmol/L, P 〈 0.05 ）. 2 ） The normal controls exhibited better in Performance of WCST and Performance of completion time of SCWT than our MDD patients （P 〈 0.05 or P 〈 0.01 ）. The patients made significant improvements in Performance of WCST and completion time of SCWT（ C form） after treatment （P 〈 0.05 or P〈 0.01 ）. 3 ） In post-treatment MDD ,the ACC Glx level was significantly positively correlated with the categories completes of WCST （ r = 0. 739, P = 0. 009） and inversely related with the numbers to complete the first categories of WCST （ r = - 0.699, P = 0.017 ） and the completion time of SCWT（ C form） （ r = - 0. 651, P = 0.030） ;elevated MI（ r = -0.705, P= 0.023 ）and NAA（ r = -0. 735, P= 0.010）levels in ACC of post-treatment MDD were both negatively correlated with the numbers to complete the first categories of WCST. Conclusion The ACC may be a key region involved in antidepressant treatment in MDD. The increased ACC NAA,Glx and MI in MDD after treatment may be significantly correlated with the improve of executive function.
出处
《中华行为医学与脑科学杂志》
CAS
CSCD
北大核心
2013年第9期803-806,共4页
Chinese Journal of Behavioral Medicine and Brain Science
基金
国家自然科学基金项目（413417）
关键词
重性抑郁症
前扣带回
磁共振波谱成像
执行功能
Major depressive disorder
Anterior cingutate
Magnetic resonance spectroscopy
Exec- utive dysfunctiotl
