抑郁症患者脑血流改变的SPECT及乙酰唑胺SPECT研究
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摘要
目的：用SPECT测定抑郁症患者局部脑血流(rCBF)改变，比较乙酰唑胺脑负荷试验后脑血流灌注变化，观察抑郁症患者脑血流下降区域的脑血管的调节能力，以及是否存在潜在缺血灶，并探讨脑血流量变化与抑郁严重程度之间的关系。
方法：
收集18例未经抗抑郁治疗的符合(CCMD-3)抑郁症诊断标准的抑郁症患者，以19例正常人作为对照组，行单光子发射计算机断层扫描(SPECT)检查，观察其脑血流灌注情况。以Hamilton抑郁量表和焦虑量表作为反映抑郁严重程度的指标，观察脑血流改变和抑郁严重程度之间的关系。抑郁症患者48h后口服乙酰唑胺2g，再行SPECT检查(乙酰唑胺脑SPECT)。观察服用乙酰唑胺前后脑内缺血的变化。
结果：
与对照组比较，抑郁组患者双侧额叶、颞叶的rCBF显著下降(p＜0.01～0.05)，左顶叶、右基底节rCBF也明显降低(p＜0.05)；同时，抑郁症患者局部脑血流低灌注存在不对称性，以左侧更加明显。服用乙酰唑胺后，原脑内各血流灌注下降部位恢复正常血供，未发现潜在缺血病灶。抑郁症患者rCBF与HAMD量表总分无明显相关，而与其某些亚相因子显著相关，双侧额叶rCBF与HAMA量表总分呈负相关。
结论：
抑郁症患者存在某些特定部位脑血流灌注下降；乙酰唑胺脑负荷SPECT实验未发现抑郁症患者存在潜在缺血部位，而且使其局部脑血流低灌注状态恢复正常。提示抑郁症患者脑rCBF改变区域的血管调节能力良好，其血流下降的原因并非血管本身器质性病变所致。
Objective:
To observe regional cerebral blood flow (rCBF) changes using SPECT, cerebral vasoreactivity and possible potential cerebral hypoperfusion using acetazolamide SPECT stress test in patients with depressive disorder; as well as to determine the correlation of cerebral hypoperfusion with the severity of depression. Method:
Eighteen unmedicated patients fulfilling the CCMD-3 criteria for depressive disorder and nineteen healthy control subjects were included. Baseline SPECT was performed in both patients and control subjects, and acetazolamide SPECT stress test was performed 2 days later in patients after orally administration of 2 g acetazolamide. Hamilton Depression (HAMD) score and Hamilton Anxiety (HAMA) score was determined to represent the severity of depression. Result:
Compared with the control subjects, obvious decrease of rCBF in both sides of frontal and temporal lobes, as well as in left parietal lobe and right basal ganglia with smaller extent, was found (P<0.05~0.01). Meanwhile, the cerebral hypoperfusion in both sides was asymmetric-lower in the left. After administration of acetazolamide, the decreased rCBF of all regions in patients was significantly improved, recovered to normal levels, and no potential cerebral ischemic region was found. Furthermore, the rCBF was correlated with certain subtype factors, but not the total score, of the HAMD score, while the decrease of rCBF in both frontal lobes was correlated with total score of HAMA. Conclusion:
Cerebral hypoperfusion exists in patients with depressive disorder; acetazolamide SPECT stress test failed to evoke potential cerebral hypoperfusion, and by contrast, made the decreased rCBF recover to normal level. That suggests the cerebral vasoreactivity is intact in patients with depressive disorder, the decrease of rCBF is not due to the organic reasons of vessels.
方法：
收集18例未经抗抑郁治疗的符合(CCMD-3)抑郁症诊断标准的抑郁症患者，以19例正常人作为对照组，行单光子发射计算机断层扫描(SPECT)检查，观察其脑血流灌注情况。以Hamilton抑郁量表和焦虑量表作为反映抑郁严重程度的指标，观察脑血流改变和抑郁严重程度之间的关系。抑郁症患者48h后口服乙酰唑胺2g，再行SPECT检查(乙酰唑胺脑SPECT)。观察服用乙酰唑胺前后脑内缺血的变化。
结果：
与对照组比较，抑郁组患者双侧额叶、颞叶的rCBF显著下降(p＜0.01～0.05)，左顶叶、右基底节rCBF也明显降低(p＜0.05)；同时，抑郁症患者局部脑血流低灌注存在不对称性，以左侧更加明显。服用乙酰唑胺后，原脑内各血流灌注下降部位恢复正常血供，未发现潜在缺血病灶。抑郁症患者rCBF与HAMD量表总分无明显相关，而与其某些亚相因子显著相关，双侧额叶rCBF与HAMA量表总分呈负相关。
结论：
抑郁症患者存在某些特定部位脑血流灌注下降；乙酰唑胺脑负荷SPECT实验未发现抑郁症患者存在潜在缺血部位，而且使其局部脑血流低灌注状态恢复正常。提示抑郁症患者脑rCBF改变区域的血管调节能力良好，其血流下降的原因并非血管本身器质性病变所致。
Objective:
To observe regional cerebral blood flow (rCBF) changes using SPECT, cerebral vasoreactivity and possible potential cerebral hypoperfusion using acetazolamide SPECT stress test in patients with depressive disorder; as well as to determine the correlation of cerebral hypoperfusion with the severity of depression. Method:
Eighteen unmedicated patients fulfilling the CCMD-3 criteria for depressive disorder and nineteen healthy control subjects were included. Baseline SPECT was performed in both patients and control subjects, and acetazolamide SPECT stress test was performed 2 days later in patients after orally administration of 2 g acetazolamide. Hamilton Depression (HAMD) score and Hamilton Anxiety (HAMA) score was determined to represent the severity of depression. Result:
Compared with the control subjects, obvious decrease of rCBF in both sides of frontal and temporal lobes, as well as in left parietal lobe and right basal ganglia with smaller extent, was found (P<0.05~0.01). Meanwhile, the cerebral hypoperfusion in both sides was asymmetric-lower in the left. After administration of acetazolamide, the decreased rCBF of all regions in patients was significantly improved, recovered to normal levels, and no potential cerebral ischemic region was found. Furthermore, the rCBF was correlated with certain subtype factors, but not the total score, of the HAMD score, while the decrease of rCBF in both frontal lobes was correlated with total score of HAMA. Conclusion:
Cerebral hypoperfusion exists in patients with depressive disorder; acetazolamide SPECT stress test failed to evoke potential cerebral hypoperfusion, and by contrast, made the decreased rCBF recover to normal level. That suggests the cerebral vasoreactivity is intact in patients with depressive disorder, the decrease of rCBF is not due to the organic reasons of vessels.
引文
1．翁晖亮．抑郁症病人自杀的预防与干预．中国社区医师，2003；23：46．
2．沈渔村，张维熙．精神病学(第三版)．人民卫生出版社，1998；408-427．
3．中华医学会精神科分会主编．中国精神障碍分类与诊断标准(第三版)．济南；山东科学技术出版社，2001；32．
4. Eihwuegi AS. Central monoamines and their role in major depression. Progress in neuro-psychopharmacology & biological psychiatry,2004;28(3):435-451.
5. Owens MJ. Selectivity of antidepressants: from the monoamine hypothesis of depression to the SSRI revolution and beyond. Journal of clinical psychiatry,2004;65(4):5-10.
6. Slattery DA, Hudson AL, Nutt DJ. Invite review: the evolution of antidepressant mechanisms. Fundamental & clinical pharmacology,2004; 18(1): 1-21.
7. Tran PV, Bymaster FP, McNamara RK, Potter WZ. Dual monoamine modulation for improved treatment of major depressive disorder. Journal of clinical psychophannacology,2003;23(1):78-86.
8. Berman RM, Sanacora G, Anand A, Roach LM, Fasula MK, Finkelstein CO, Wachen RM, Oren DA, Heninger GR, Charney DS. Monoamine depletion in unmedicated depressed subjects. Biological psychiatry,2002;51 (6):469-473.
9. Inoue T, Tsuchiya K, Miura J, Sakakibara S, Denda K, Kasahara T, Koyama T. Bromocriptine treatment of tricyclic and heterocyclic antidepressant-resistant depression. Biological psychiatry, 1996;40(2): 151-153.
10．江开达．精神医学新概念．上海；上海医科大学出版社，2001；103-109．
11. Bremner JD, Narayan M, Anderson ER, Staib LH, Miller HL, Charney DS. Hippocampal volume reduction in major depression. Amercian journal of psychiatry,2000; 157(1):115-118.
12. Frodi T, Meisenzahi EM, Zetzsche T, Born C, Groll C, Jager M, Leinsinger G, Bottlender R, Hahn K, Moller HJ. Hippocampal changes in patients with a first episode of major depression. American journal of
psychiatry,2002; 159(7): 1112-1118.
13. Posener JA, Wang L, Price JL, Gado MH, Province MA, Miller MI, Babb CM, Csernansky JG. High-dimensional mapping of the hippocampus in depression. American journal of psychiatry,2003; 160(1):83-89.
14. Vakili K, Srinivasan S, Pillay, Beny Lafer, Maurizio Fava, Perry F, Renshaw, Christina M, Bonello-Cintron, Deborah A, Yurgelun-Todd. Hippocampal volume in primary unipolar major depression: a magnetic resonance imaging study. Biological Psychiatry, 2000;47(12): 1087-1110.
15. Pizzagalli DA, Oakes TR, Fox AS, Chung MK, Larson CL, Abercrombie HC, Schaefer SM, Benca RM, Davidson RJ. Functional but not structural subgenual prefrontal cortex abnormalities in melancholia. Molecular psychiatry,2004;9(4):393-405.
16．赵晋华，林祥通，江开达，刘永昌，徐莲琴．抑郁症的基础与认知激活脑SPECT显像．中华核医学杂志，1998；18(2)：70-72．
17．高成阁，张芬如，曹亚敏，陈策，李强，马现仓，亢万虎，趁佩璋．精神分裂症和抑郁症局部脑血流的变化．西安交通大学学报(医学版)，2002,23(5)：499-501．
18. Navarro V, Gasto C, Lomena F, Mateos JJ, Marcos T. Frontal cerebral perfusion dysfunction in elderly late-onset major depression assessed by ~(99m)TC-HAMPO SPECT. Neuroimage,2001; 14:202-205.
19. Cho MJ, Lvoo Ik, Lee DW, Kwon JS, Lee JS, Jung JK, Lee MC. Brain single photon emission computed tomograpy findings in depressive pseudodementia patients. Journal of affective disorders,2002;69(1-3): 159-166.
20. Austin MP, Dougall N, Ross M, Murray C, O.carroll RE, Moffoot A, Ebmeier KP, Goodwin GM. SPECT with 99mTc-exametazime in major depression and the pattern of brain activity underlying the psychotic/neurotic continuum. Journal of affective disorders, 1992;26(1):31-43.
21. Vangu MD, Esser JD, Boyd IH, Berk M. Effects of electroconvulsive therapy on regional cerebral blood flow measured by 99mtechnetium HMPAO SPECT.
Progress in neuro-psychopharmacology & biological psychiatry, 2003;27(1):15-19.
22. Mayberg HS, Lewis PJ, Regenold W, Wagner HN JR. Paralimbic hypoperfusion in unipolar depression. Journal of nuclear medicine,1994;35:929-934.
23. Ito H, Kawashima R, Awata S, Ono S, Sato K, Goto R, Koyama M, Sato M, Fukuda H. Hypoperfusion in the limbic system and prefrontal cortex in depression: SPECT with anatomic standardization technique. Journal of nuclear medicine, 1996;37(3):410-414.
24. Skaf CR, Yamada A, Garride GE, Buchpiguel CA, Akamine S, Castro CC, Busatto GE Psychotic symptoms in major depressive disorder are associated with reduced regional cerebral blood flow in the subgenual anterior cingulated cortex: a voxel-based single photon emission computed tomography (SPECT) study. Journal of affective disorders,2002;68(2-3):295-305.
25. Awata S, Ito H, Konno M, Ono S, Kawashima R, Fukuda H, Sato M. Regional cerebral blood flow abnormalities in late-life depression: relation to refractoriness and chronification. Psychiatry and clinical neurosciences, 1998;52(1):97-105.
26．邓红，白培深，李险峰，张承刚，马锦堂，付文嫒．抑郁症患者的脑单光子发射计算机断层摄影研究．中华精神病学杂志，1997；30(4)：196-199．
27. Oda K, Okubo Y, Ishida R, Murata Y, Ohta K, Matsuda T, Matsushima E, Ichimiya T, Suhara T, Shibuya H, Nishikawa T. Regional cerebral blood flow in depressed patients with white matter magnetic resonance hyperintensity. Biological psychiatry, 2003;53(2): 150-156.
28. Kawakatsu S, Komatani A. Xe-133 inhalation SPECT in manic-depressive illness. Nippon Rinsho, 1994;52:1180.
29. Holthoff VA, Beuthien Baumann B, Pietrzyk U, Pinkert J, Oehme L, Franke WG, Bach O. Changes in regional cerebral perfusion in depression. SPECT monitoring of response to treatment. Der Nervenarzt, 1999;70(7):620-626.
30. Martin S, Martin E, Santoch, Mark A Richardson, Robert Royall. Brain blood changes in depressed patients treated with interpersonal psychotherapy or
venlafaxine hydrochloride: preliminary findings. Archives of general psychiatry,2001,58(7):641-648.
31. Mervaala E, Kononen M, Fohr J, Husso-Saastamoinen M, Valkonen-Korhonen M, Kuikka JT, Viinamaki H, Tammi AK, Tiihonen J. SPECT and neuropsychological performance in severe depression treated with ECT. Journal of affective disorders,2001,66(1):47-58.
32. Nadeau SE, McCoy KJ, Crucian GP, Greer RA, Rossi F, Bowers D, Goodman WK, Heilman KM, Triggs WJ. Cerebral blood flow changes in depressed patients after treatment with repetitive transcranial magnetic stimulation: evidence of individual variability. Neuropsychiatry, neuropsychology, and behavioral neurology,2002; 15(3): 159-175.
33. Maes M, Dierckx R, Meltzer HY, Ingels M, Schotte C, Vandewoude M, Calabrese J, Cosyns P. Regional cerebral blood flow in unipolar depression measured with Tc-99m-HMPAO single photon emission computed tomography: negative findings. Psychiatry research,1993;50(2):77-88.
34. Tutus A, Simsek A, Sofuoglu S, Nardali M, Kugu N, Karaasian F, Gonul AS. Changes in regional cerebral blood flow demonstrated by single photon emission computed tomography in depressive disorders: comparison of unipolar vs. bipolar subtypes. Psychiatry research, 1998;83(3): 169-177.
35. Delvenne V, Delecluse F, Hubain PP, Schoutens A, De Maertelaer V, Mendlewicz J. Regional cerebral blood flow in patients with affective disorders. British journal of psychiatry; the journal of mental science, 1990; 157:359-365.
36. Jose M, Emily Stem, George S, Hong P. Hippocampal and anterior cingulated activation deficits in patients with geriatric depression. The American Journal of Psychiatry,2001; 158(8): 1321-1323.
37. Baxter LR Jr, Schwaiz JM, Phelps ME, Mazziotta JC, Guze BH, Selin CE, Gemer RH, Sumida RM. Reduction of prefrontal cortex glucose metabolism common to three types of depression. Archives of general psychiatry,1989;46(3):243-250.
38. Bench CJ, Friston KJ, Brown RG, Scott LC, Frackowiak RS, Dolan RJ. The
anatomy of melancholia-focal abnormalities of cerebral blood flow in major depression. Psychological medicine,1992;22(3):607-615.
39. George MS, Ketter TA, Post RM. SPECT and PET imaging in mood disorder. Journal of clinical psychiatry, 1993;54:6-13.
40. Videbech P, Ravnkilde B, Pedersen TH, Hartvig H, Egander A, Clemmensen K, Rasmussen NA, Andersen F, Gjedde A, Rosenberg R. The Danish PET/depression project: clinical symptoms and cerebral blood flow. A regions-of-interest analysis. Acta psychiatrica Scandinavica,2002; 106(1):35-44.
41. Fernandez-Arguelles P, Castro J, Castro Montano J, Garcia Lopez O, Cambil Molina T. SPECT study of a group of patients with severe recurrent depression. Actas Iuso-espanolas de neurologia, psuquiatria y ciencias afines, 1998;26(4):223-232.
42. Abou Saleh MT, A1 Suhaili AR, Karim L, Prais V, Hamdi E. Single photon emission tomography with 99mTc-HMPAO in Arab patients with depression. Journal of affective disorders, 1999;55(2-3): 115-123.
43. Jaracz J, Rajewski A, Junik R, Sowinski J, Gembicki M. The assessment of regional cerebral blood flow using HMPAO-SPECT during depressive episode and in remission. Psychiatria polska, 1996;30(5):757-769.
44. Indaka T, Nakajima T, Suzuki Y, Okazaki A, Maehara T, Shiraishi H. Quantitative regional cerebral blood flow measured by Tc-~(99m)HMPAO SPECT in mood disorders. Psychiatry Res Neuroimaging, 1997;68:143-154.
45. Hickie I, Ward P, Scott E, Haindi W, Walker B, Dixon J, Turner K. Neo-striatal rCBF correlates of psychomotor slowing in patients with major depression. Psychiatry research, 1999;92(2-3):75-81.
46. Silverskiold P, Risberg J. Regional cerebral blood flow in depression and mania. Archives of general psychiatry,1989;46:253-259.
47. Murata T, Suzuki R, Higuchi T, Oshima A. Regional cerebral blood flow in the patients with depressive disorders. Keio journal of medicine,2000;49 (1): 112-113.
48. Michael D, Devors SR. Dual isotop imaging speeds stroke assement. Diagnostic
imaging, 1991;6:112-115.
49. Sogabe I. Regional cerebral blood flow measurements at pre-and post-Diamox test using split dose ~(99m)TC-ECD SPECT: comparison with 133Xe inhalation method and linearization correction. Kaku Igaku, 1997;34(1):35-44.
50．修雁，陈绍亮，孙晓光，牛敬忠，朱文炳，崔尧元，陈可靖，谢瑞满．乙酰唑胺脑血流负荷试验在缺血性脑血管病中的应用．中华核医学杂志，1998；18(1)：11-13．
51．刘新通，郑芷萍，乔穗宪，唐安戊．口服乙酰唑胺负荷实验SPECT脑灌注显像早期诊断TIA的价值．中华核医学杂志，2001；21(4)：236-237．
52．黄舜韶，黄立安，徐浩，费建林．SPECT、MRA、TCD、颈部血管彩超对椎基底动脉供血不足的诊断价值．中风与神经疾病杂志,2001；18(2)：102-104．
53．汪向东，王希林，马弘等．心理卫生评定量表手册．北京：心理卫生杂志社，1999：222
54. Sokoloff L, Reivich M, Kennedy C, Des Rozsiers MH, Patlak CS, Pettigrew KD, Sakurad O, Shinohara M. The(C-14) deoxyglucose method for measurement of local cerebral glucose utilization: therapy, procedure and normal values in conscious and anesthetized albino rat. J Neurochem, 1977;28:897-916.
55. Vasile RG, Schwartz RB, Garada B, Holman BL, Alpert M, Davidson PB, Schildkraut JJ. Focal cerebral perfusion defects demonstrated by ~(99m)TC-hexamethylpropylenamine oxime SPECT in elderly depressed patients. Psychiatry Res Neuroimaging,1996;67:59-70.
56．王晓明，龙存国，付红梅，郑霞清，游金辉，谢建平．抑郁症患者脑单光子发射计算机断层扫描显像的初步研究．现代康复，2001；5(2)：27-35．
57．喻东山．抑郁症的神经解剖基础．国外医学精神病学分册，1995；2：107-109．
58. Amsterdam JD, Mozley PD. Temporal lobe asymmetry with lofetamine(IMP) SPECT imaging in patients with major depression. Journal of affective disorders, 1992;24(1):43-53.
59. Krausz Y, Bonne O, Gorfine M, Karger H, Lerer B, Chisin R. Age-related changes in brain perfusion of normal subjects detected by ~(99m)Tc-HMPAO SPECT.
Neuroradiology, 1998;40:428-434.
60. Rodriguez G, Warkentin S, Risberg J. Sex differences in regional cerebral blood flow. J Cereb Blood Flow Metab,1988;8:783-789.
61. Videbech P. PET measurements of brain glucose metabolism and blood flow in major depressive disorder: a critical review. Acta Psychiatric Scandinavica,2000; 101 (1):11-20.
62. Sacheim HA, Prohovnik I, Moeller J, Brown RP, Apter S, Prudic J, Devanand DP, Mukherjee S. Regional cerebral blood flow in mood disorders. I. Comparison of major depressives and normal controls at rest. Archives of general psychiatry, 1990;47(1):60-70.
63. Fountoulakis, Kostas N, Iacovides, Apostolos, Gerasimou, George, Fotiou, Fotis, Ioannidou, Christina. The relationship of regional cerebral blood flow with subtypes of major depression. Progress in Neuro-Psychophamacology and Biological Psychiatry,2004;28(3):537-546.
64. Bonne Omer, Louzoun Yoram, Aharon Itzhak, Krausz Yodphat, Karger Haim, Lerer Bernard, Bocher Moshe. Cerebral blood flow in depressed patients: a methodological comparism of statistical parametric and region of interest analyses. Psychiatry Research: Neuroimaging,2003; 122(1):49-57.
65. Rogg J, Rutigliano M, Yonas H. The acetazolamide challenge imaging techniques designed to evaluate cerebral blood flow reserve. Am J Neuroradiology, 1989;10:803-810.
66. Sullivan H, Kingsbury TB,Morgan ME. The rCBF response to Diamox in normal subjects and cerebrovascular disease patients. J Neurosurgery, 1987;67:525-534.
67. Vorstrup S, Brun B, Lassen NA. Evaluation of the cerebral vasodilatory capacity by the Acetazolamide test before EC/IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke, 1986; 17:1291-1298.
68. Ehrewreich DL, Bums RA, Alman KW. Influence of acetazolamide on cerebral blood flow. Arch Neurol,1961;11:46-65.
69. Oishi M, Mochizuki Y, Takasu T. Cerebral blood flow and cerebrovascular response
to acetazolamide in patients with chronic alcoholism. Journal of Neurology, Neurosurgery and Psychiatry, 1997;63(1): 100-102.
70. Bonne O, Krausz Y. Pathophysiological significance of cerebral perfusin abnormalities in major depression-trait or state marker? European Neuropsychopharmacology,1997;7:225-233.
71. Igor I Galynker, Jun Cai, Fukiat Ongseng, Howard Finestone. Hypofrontality and negative symptoms in major depressive disorder. The Journal of Nuclear Medicine, 1998;39(4):608-612.
72．袁勇贵，吴爱勤，张心保．焦虑和抑郁障碍共病的生物学研究进展．国外医学精神病学分册，2000；27(3)：143-148．
73. Byrum, Chrislopher E, Ahearn, Eileen P, Ranga K, Krishnan R. A neuroanatomic model for depression. Biological Psychiatry,1999;23(2): 175-193.
2．沈渔村，张维熙．精神病学(第三版)．人民卫生出版社，1998；408-427．
3．中华医学会精神科分会主编．中国精神障碍分类与诊断标准(第三版)．济南；山东科学技术出版社，2001；32．
4. Eihwuegi AS. Central monoamines and their role in major depression. Progress in neuro-psychopharmacology & biological psychiatry,2004;28(3):435-451.
5. Owens MJ. Selectivity of antidepressants: from the monoamine hypothesis of depression to the SSRI revolution and beyond. Journal of clinical psychiatry,2004;65(4):5-10.
6. Slattery DA, Hudson AL, Nutt DJ. Invite review: the evolution of antidepressant mechanisms. Fundamental & clinical pharmacology,2004; 18(1): 1-21.
7. Tran PV, Bymaster FP, McNamara RK, Potter WZ. Dual monoamine modulation for improved treatment of major depressive disorder. Journal of clinical psychophannacology,2003;23(1):78-86.
8. Berman RM, Sanacora G, Anand A, Roach LM, Fasula MK, Finkelstein CO, Wachen RM, Oren DA, Heninger GR, Charney DS. Monoamine depletion in unmedicated depressed subjects. Biological psychiatry,2002;51 (6):469-473.
9. Inoue T, Tsuchiya K, Miura J, Sakakibara S, Denda K, Kasahara T, Koyama T. Bromocriptine treatment of tricyclic and heterocyclic antidepressant-resistant depression. Biological psychiatry, 1996;40(2): 151-153.
10．江开达．精神医学新概念．上海；上海医科大学出版社，2001；103-109．
11. Bremner JD, Narayan M, Anderson ER, Staib LH, Miller HL, Charney DS. Hippocampal volume reduction in major depression. Amercian journal of psychiatry,2000; 157(1):115-118.
12. Frodi T, Meisenzahi EM, Zetzsche T, Born C, Groll C, Jager M, Leinsinger G, Bottlender R, Hahn K, Moller HJ. Hippocampal changes in patients with a first episode of major depression. American journal of
psychiatry,2002; 159(7): 1112-1118.
13. Posener JA, Wang L, Price JL, Gado MH, Province MA, Miller MI, Babb CM, Csernansky JG. High-dimensional mapping of the hippocampus in depression. American journal of psychiatry,2003; 160(1):83-89.
14. Vakili K, Srinivasan S, Pillay, Beny Lafer, Maurizio Fava, Perry F, Renshaw, Christina M, Bonello-Cintron, Deborah A, Yurgelun-Todd. Hippocampal volume in primary unipolar major depression: a magnetic resonance imaging study. Biological Psychiatry, 2000;47(12): 1087-1110.
15. Pizzagalli DA, Oakes TR, Fox AS, Chung MK, Larson CL, Abercrombie HC, Schaefer SM, Benca RM, Davidson RJ. Functional but not structural subgenual prefrontal cortex abnormalities in melancholia. Molecular psychiatry,2004;9(4):393-405.
16．赵晋华，林祥通，江开达，刘永昌，徐莲琴．抑郁症的基础与认知激活脑SPECT显像．中华核医学杂志，1998；18(2)：70-72．
17．高成阁，张芬如，曹亚敏，陈策，李强，马现仓，亢万虎，趁佩璋．精神分裂症和抑郁症局部脑血流的变化．西安交通大学学报(医学版)，2002,23(5)：499-501．
18. Navarro V, Gasto C, Lomena F, Mateos JJ, Marcos T. Frontal cerebral perfusion dysfunction in elderly late-onset major depression assessed by ~(99m)TC-HAMPO SPECT. Neuroimage,2001; 14:202-205.
19. Cho MJ, Lvoo Ik, Lee DW, Kwon JS, Lee JS, Jung JK, Lee MC. Brain single photon emission computed tomograpy findings in depressive pseudodementia patients. Journal of affective disorders,2002;69(1-3): 159-166.
20. Austin MP, Dougall N, Ross M, Murray C, O.carroll RE, Moffoot A, Ebmeier KP, Goodwin GM. SPECT with 99mTc-exametazime in major depression and the pattern of brain activity underlying the psychotic/neurotic continuum. Journal of affective disorders, 1992;26(1):31-43.
21. Vangu MD, Esser JD, Boyd IH, Berk M. Effects of electroconvulsive therapy on regional cerebral blood flow measured by 99mtechnetium HMPAO SPECT.
Progress in neuro-psychopharmacology & biological psychiatry, 2003;27(1):15-19.
22. Mayberg HS, Lewis PJ, Regenold W, Wagner HN JR. Paralimbic hypoperfusion in unipolar depression. Journal of nuclear medicine,1994;35:929-934.
23. Ito H, Kawashima R, Awata S, Ono S, Sato K, Goto R, Koyama M, Sato M, Fukuda H. Hypoperfusion in the limbic system and prefrontal cortex in depression: SPECT with anatomic standardization technique. Journal of nuclear medicine, 1996;37(3):410-414.
24. Skaf CR, Yamada A, Garride GE, Buchpiguel CA, Akamine S, Castro CC, Busatto GE Psychotic symptoms in major depressive disorder are associated with reduced regional cerebral blood flow in the subgenual anterior cingulated cortex: a voxel-based single photon emission computed tomography (SPECT) study. Journal of affective disorders,2002;68(2-3):295-305.
25. Awata S, Ito H, Konno M, Ono S, Kawashima R, Fukuda H, Sato M. Regional cerebral blood flow abnormalities in late-life depression: relation to refractoriness and chronification. Psychiatry and clinical neurosciences, 1998;52(1):97-105.
26．邓红，白培深，李险峰，张承刚，马锦堂，付文嫒．抑郁症患者的脑单光子发射计算机断层摄影研究．中华精神病学杂志，1997；30(4)：196-199．
27. Oda K, Okubo Y, Ishida R, Murata Y, Ohta K, Matsuda T, Matsushima E, Ichimiya T, Suhara T, Shibuya H, Nishikawa T. Regional cerebral blood flow in depressed patients with white matter magnetic resonance hyperintensity. Biological psychiatry, 2003;53(2): 150-156.
28. Kawakatsu S, Komatani A. Xe-133 inhalation SPECT in manic-depressive illness. Nippon Rinsho, 1994;52:1180.
29. Holthoff VA, Beuthien Baumann B, Pietrzyk U, Pinkert J, Oehme L, Franke WG, Bach O. Changes in regional cerebral perfusion in depression. SPECT monitoring of response to treatment. Der Nervenarzt, 1999;70(7):620-626.
30. Martin S, Martin E, Santoch, Mark A Richardson, Robert Royall. Brain blood changes in depressed patients treated with interpersonal psychotherapy or
venlafaxine hydrochloride: preliminary findings. Archives of general psychiatry,2001,58(7):641-648.
31. Mervaala E, Kononen M, Fohr J, Husso-Saastamoinen M, Valkonen-Korhonen M, Kuikka JT, Viinamaki H, Tammi AK, Tiihonen J. SPECT and neuropsychological performance in severe depression treated with ECT. Journal of affective disorders,2001,66(1):47-58.
32. Nadeau SE, McCoy KJ, Crucian GP, Greer RA, Rossi F, Bowers D, Goodman WK, Heilman KM, Triggs WJ. Cerebral blood flow changes in depressed patients after treatment with repetitive transcranial magnetic stimulation: evidence of individual variability. Neuropsychiatry, neuropsychology, and behavioral neurology,2002; 15(3): 159-175.
33. Maes M, Dierckx R, Meltzer HY, Ingels M, Schotte C, Vandewoude M, Calabrese J, Cosyns P. Regional cerebral blood flow in unipolar depression measured with Tc-99m-HMPAO single photon emission computed tomography: negative findings. Psychiatry research,1993;50(2):77-88.
34. Tutus A, Simsek A, Sofuoglu S, Nardali M, Kugu N, Karaasian F, Gonul AS. Changes in regional cerebral blood flow demonstrated by single photon emission computed tomography in depressive disorders: comparison of unipolar vs. bipolar subtypes. Psychiatry research, 1998;83(3): 169-177.
35. Delvenne V, Delecluse F, Hubain PP, Schoutens A, De Maertelaer V, Mendlewicz J. Regional cerebral blood flow in patients with affective disorders. British journal of psychiatry; the journal of mental science, 1990; 157:359-365.
36. Jose M, Emily Stem, George S, Hong P. Hippocampal and anterior cingulated activation deficits in patients with geriatric depression. The American Journal of Psychiatry,2001; 158(8): 1321-1323.
37. Baxter LR Jr, Schwaiz JM, Phelps ME, Mazziotta JC, Guze BH, Selin CE, Gemer RH, Sumida RM. Reduction of prefrontal cortex glucose metabolism common to three types of depression. Archives of general psychiatry,1989;46(3):243-250.
38. Bench CJ, Friston KJ, Brown RG, Scott LC, Frackowiak RS, Dolan RJ. The
anatomy of melancholia-focal abnormalities of cerebral blood flow in major depression. Psychological medicine,1992;22(3):607-615.
39. George MS, Ketter TA, Post RM. SPECT and PET imaging in mood disorder. Journal of clinical psychiatry, 1993;54:6-13.
40. Videbech P, Ravnkilde B, Pedersen TH, Hartvig H, Egander A, Clemmensen K, Rasmussen NA, Andersen F, Gjedde A, Rosenberg R. The Danish PET/depression project: clinical symptoms and cerebral blood flow. A regions-of-interest analysis. Acta psychiatrica Scandinavica,2002; 106(1):35-44.
41. Fernandez-Arguelles P, Castro J, Castro Montano J, Garcia Lopez O, Cambil Molina T. SPECT study of a group of patients with severe recurrent depression. Actas Iuso-espanolas de neurologia, psuquiatria y ciencias afines, 1998;26(4):223-232.
42. Abou Saleh MT, A1 Suhaili AR, Karim L, Prais V, Hamdi E. Single photon emission tomography with 99mTc-HMPAO in Arab patients with depression. Journal of affective disorders, 1999;55(2-3): 115-123.
43. Jaracz J, Rajewski A, Junik R, Sowinski J, Gembicki M. The assessment of regional cerebral blood flow using HMPAO-SPECT during depressive episode and in remission. Psychiatria polska, 1996;30(5):757-769.
44. Indaka T, Nakajima T, Suzuki Y, Okazaki A, Maehara T, Shiraishi H. Quantitative regional cerebral blood flow measured by Tc-~(99m)HMPAO SPECT in mood disorders. Psychiatry Res Neuroimaging, 1997;68:143-154.
45. Hickie I, Ward P, Scott E, Haindi W, Walker B, Dixon J, Turner K. Neo-striatal rCBF correlates of psychomotor slowing in patients with major depression. Psychiatry research, 1999;92(2-3):75-81.
46. Silverskiold P, Risberg J. Regional cerebral blood flow in depression and mania. Archives of general psychiatry,1989;46:253-259.
47. Murata T, Suzuki R, Higuchi T, Oshima A. Regional cerebral blood flow in the patients with depressive disorders. Keio journal of medicine,2000;49 (1): 112-113.
48. Michael D, Devors SR. Dual isotop imaging speeds stroke assement. Diagnostic
imaging, 1991;6:112-115.
49. Sogabe I. Regional cerebral blood flow measurements at pre-and post-Diamox test using split dose ~(99m)TC-ECD SPECT: comparison with 133Xe inhalation method and linearization correction. Kaku Igaku, 1997;34(1):35-44.
50．修雁，陈绍亮，孙晓光，牛敬忠，朱文炳，崔尧元，陈可靖，谢瑞满．乙酰唑胺脑血流负荷试验在缺血性脑血管病中的应用．中华核医学杂志，1998；18(1)：11-13．
51．刘新通，郑芷萍，乔穗宪，唐安戊．口服乙酰唑胺负荷实验SPECT脑灌注显像早期诊断TIA的价值．中华核医学杂志，2001；21(4)：236-237．
52．黄舜韶，黄立安，徐浩，费建林．SPECT、MRA、TCD、颈部血管彩超对椎基底动脉供血不足的诊断价值．中风与神经疾病杂志,2001；18(2)：102-104．
53．汪向东，王希林，马弘等．心理卫生评定量表手册．北京：心理卫生杂志社，1999：222
54. Sokoloff L, Reivich M, Kennedy C, Des Rozsiers MH, Patlak CS, Pettigrew KD, Sakurad O, Shinohara M. The(C-14) deoxyglucose method for measurement of local cerebral glucose utilization: therapy, procedure and normal values in conscious and anesthetized albino rat. J Neurochem, 1977;28:897-916.
55. Vasile RG, Schwartz RB, Garada B, Holman BL, Alpert M, Davidson PB, Schildkraut JJ. Focal cerebral perfusion defects demonstrated by ~(99m)TC-hexamethylpropylenamine oxime SPECT in elderly depressed patients. Psychiatry Res Neuroimaging,1996;67:59-70.
56．王晓明，龙存国，付红梅，郑霞清，游金辉，谢建平．抑郁症患者脑单光子发射计算机断层扫描显像的初步研究．现代康复，2001；5(2)：27-35．
57．喻东山．抑郁症的神经解剖基础．国外医学精神病学分册，1995；2：107-109．
58. Amsterdam JD, Mozley PD. Temporal lobe asymmetry with lofetamine(IMP) SPECT imaging in patients with major depression. Journal of affective disorders, 1992;24(1):43-53.
59. Krausz Y, Bonne O, Gorfine M, Karger H, Lerer B, Chisin R. Age-related changes in brain perfusion of normal subjects detected by ~(99m)Tc-HMPAO SPECT.
Neuroradiology, 1998;40:428-434.
60. Rodriguez G, Warkentin S, Risberg J. Sex differences in regional cerebral blood flow. J Cereb Blood Flow Metab,1988;8:783-789.
61. Videbech P. PET measurements of brain glucose metabolism and blood flow in major depressive disorder: a critical review. Acta Psychiatric Scandinavica,2000; 101 (1):11-20.
62. Sacheim HA, Prohovnik I, Moeller J, Brown RP, Apter S, Prudic J, Devanand DP, Mukherjee S. Regional cerebral blood flow in mood disorders. I. Comparison of major depressives and normal controls at rest. Archives of general psychiatry, 1990;47(1):60-70.
63. Fountoulakis, Kostas N, Iacovides, Apostolos, Gerasimou, George, Fotiou, Fotis, Ioannidou, Christina. The relationship of regional cerebral blood flow with subtypes of major depression. Progress in Neuro-Psychophamacology and Biological Psychiatry,2004;28(3):537-546.
64. Bonne Omer, Louzoun Yoram, Aharon Itzhak, Krausz Yodphat, Karger Haim, Lerer Bernard, Bocher Moshe. Cerebral blood flow in depressed patients: a methodological comparism of statistical parametric and region of interest analyses. Psychiatry Research: Neuroimaging,2003; 122(1):49-57.
65. Rogg J, Rutigliano M, Yonas H. The acetazolamide challenge imaging techniques designed to evaluate cerebral blood flow reserve. Am J Neuroradiology, 1989;10:803-810.
66. Sullivan H, Kingsbury TB,Morgan ME. The rCBF response to Diamox in normal subjects and cerebrovascular disease patients. J Neurosurgery, 1987;67:525-534.
67. Vorstrup S, Brun B, Lassen NA. Evaluation of the cerebral vasodilatory capacity by the Acetazolamide test before EC/IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke, 1986; 17:1291-1298.
68. Ehrewreich DL, Bums RA, Alman KW. Influence of acetazolamide on cerebral blood flow. Arch Neurol,1961;11:46-65.
69. Oishi M, Mochizuki Y, Takasu T. Cerebral blood flow and cerebrovascular response
to acetazolamide in patients with chronic alcoholism. Journal of Neurology, Neurosurgery and Psychiatry, 1997;63(1): 100-102.
70. Bonne O, Krausz Y. Pathophysiological significance of cerebral perfusin abnormalities in major depression-trait or state marker? European Neuropsychopharmacology,1997;7:225-233.
71. Igor I Galynker, Jun Cai, Fukiat Ongseng, Howard Finestone. Hypofrontality and negative symptoms in major depressive disorder. The Journal of Nuclear Medicine, 1998;39(4):608-612.
72．袁勇贵，吴爱勤，张心保．焦虑和抑郁障碍共病的生物学研究进展．国外医学精神病学分册，2000；27(3)：143-148．
73. Byrum, Chrislopher E, Ahearn, Eileen P, Ranga K, Krishnan R. A neuroanatomic model for depression. Biological Psychiatry,1999;23(2): 175-193.
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