首发未经治疗的抑郁症患者皮层下灰质结构的形态学研究
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摘要
目的探讨首发未经治疗抑郁症(MDD)早期患者大脑皮层下灰质体积及形状改变。方法选取30例首发未经治疗的抑郁症患者和26名健康对照组(HC组)进行功能磁共振检查。采用基于体素形态学分析(VBM)、基于Vertex的表面形态学分析技术获得两组的大脑皮层下灰质体积和形状,并进行组间比较。结果VBM显示MDD组双侧壳核和左侧丘脑体积明显缩小(Bonferroni校正,P<0.05)。基于Vertex的表面形态学分析技术显示MDD组双侧壳核的后外侧和腹内侧、左侧丘脑的背侧和腹侧较对照组存在局限性萎缩(FWE校正,P<0.05),致使其表面形状改变。左侧丘脑背侧局限性萎缩程度与MDD患者临床严重程度呈负相关。结论本研究表明MDD患者发病的早期阶段大脑壳核和丘脑的形态学可能发生改变。
Objective To investigate whether focal subcortical grey matter changes may be present from the early stages of major depression.Methods We recruited 30 first-episode,untreated patients with major depressive disorder and 26healthy control subjects.Voxel-based morphometry was used to evaluate cortical grey matter changes,and automated volumetric and shape analyses were used to assess volume changes and shape deformation of the subcortical grey matter structures,respectively.Probabilistic tractography was then subsequently used to demonstrated the relationships between the subcortical and the cortical GM.Results Voxel-based morphometry showed increases in subcortical grey matter volume in patients compared to controls.Compared to controls,MDD patients had significant volume reductions in adjusted bilater-al putamen and left thalamus(P<0.05).Meanwhile,Vertex-based shape analysis showed a regionally contracted area on the posterolateral and ventromedial aspects of the bilateral putamen and on the dorsal and ventral aspects of left thalamus in MDD patients(P<0.05).Additionally,a negative correlation was found between the local atrophy in the dorsal aspects of left thalamus and clinical variables representing severity.Conclusion Our results suggest that structural abnormalities in the putamen and thalamus may be present in the early stages of MDD.
Objective To investigate whether focal subcortical grey matter changes may be present from the early stages of major depression.Methods We recruited 30 first-episode,untreated patients with major depressive disorder and 26healthy control subjects.Voxel-based morphometry was used to evaluate cortical grey matter changes,and automated volumetric and shape analyses were used to assess volume changes and shape deformation of the subcortical grey matter structures,respectively.Probabilistic tractography was then subsequently used to demonstrated the relationships between the subcortical and the cortical GM.Results Voxel-based morphometry showed increases in subcortical grey matter volume in patients compared to controls.Compared to controls,MDD patients had significant volume reductions in adjusted bilater-al putamen and left thalamus(P<0.05).Meanwhile,Vertex-based shape analysis showed a regionally contracted area on the posterolateral and ventromedial aspects of the bilateral putamen and on the dorsal and ventral aspects of left thalamus in MDD patients(P<0.05).Additionally,a negative correlation was found between the local atrophy in the dorsal aspects of left thalamus and clinical variables representing severity.Conclusion Our results suggest that structural abnormalities in the putamen and thalamus may be present in the early stages of MDD.
引文
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13 Haber SN,Knutson B.The reward circuit:linking primate anatomy and human imaging[J].Neuropsychopharmacology,2010,35:4-26.
14 Lacerda ALT,Keshavan MS,Hardan AY,et al.Anatomic evaluation of the orbitofrontal cortex in major depressive disorder[J].Biological psychiatry,2004,55:353-358.
15 Kumar P,Waiter G,Ahearn T,et al.Abnormal temporal difference reward-learning signals in major depression[J].Brain,2008,131:2084-2093.
16 Redgrave P,Coizet V,Comoli E,et al.Interactions between the midbrain superior colliculus and the basal ganglia[J].Frontiers in neuroanatomy,2010,4:1-8.
17 Culpepper L.Impact of Untreated Major Depressive Disorder on Cognition and Daily Function[J].The Journal of clinical psychiatry,2015,76:901-901.
18 Peng J,Liu J,Nie B,et al.Cerebral and cerebellar gray matter reduction in first-episode patients with major depressive disorder:a voxel-based morphometry study[J].European journal of radiology,2011,80:395-399.
19 Zhang J,Wang J,Wu Q,et al.Disrupted brain connectivity networks in drug-naive,first-episode major depressive disorder[J].Biological psychiatry,2011,70:334-342.
20 Bora E,Fornito A,Pantelis C,et al.Gray matter abnormalities in major depressive disorder:a meta-analysis of voxel based morphometry studies[J].Journal of affective disorders,2012,138:9-18.
21 Alexander GE,DeL ong MR,Strick PL.Parallel organization of functionally segregated circuits linking basal ganglia and cortex[J].Annual review of neuroscience,1986,9:357-381.
22 Middleton FA,Strick PL.Basal-ganglia‘projections’to the prefrontal cortex of the primate[J].Cerebral Cortex,2002,12:926-935.
23 Lacerda AL,Keshavan MS,Hardan AY,et al.Anatomic evaluation of the orbitofrontal cortex in major depressive disorder[J].Biological psychiatry,2004,55:353-358.
24刘晨.皮层下缺血性血管性痴呆的多模态磁共振研究[D].第三军医大学,2015:1-104.
2 Kaymaz N,van Os J,Loonen AJM,et al.Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation:a meta-analysis of placebo-controlled randomized trials[J].The Journal of Clinical Psychiatry,2008,69:1423-1436.
3 Zou K,Deng W,Li T,et al.Changes of brain morphometry in firstepisode,drug-na?ve,non-late-life adult patients with major depression:an optimized voxel-based morphometry study[J].Biological psychiatry,2010,67:186-188.
4 Malykhin NV,Carter R,Hegadoren KM,et al.Fronto-limbic volumetric changes in major depressive disorder[J].Journal of affective disorders,2012,136:1104-1113.
5 Heller AS,Johnstone T,Shackman AJ,et al.Reduced capacity to sustain positive emotion in major depression reflects diminished maintenance of fronto-striatal brain activation[J].Proceedings of the National Academy of Sciences,2009,106:22445-22450.
6 Webb CA,Weber M,Mundy EA,et al.Reduced gray matter volume in the anterior cingulate,orbitofrontal cortex and thalamus as a function of mild depressive symptoms:a voxel-based morphometric analysis[J].Psychological medicine,2014,44:2833-2843.
7 Menke RAL,Szewczyk-Krolikowski K,Jbabdi S,et al.Comprehensive morphometry of subcortical grey matter structures in early‐stage Parkinson's disease[J].Human brain mapping,2014,35:1681-1690.
8tepán-Buksakowska I,SzabóN,Horínek D,et al.Cortical and subcortical atrophy in Alzheimer disease:parallel atrophy of thalamus and hippocampus[J].Alzheimer Disease&Associated Disorders,2014,28:65-72.
9 Michel TM,Camara S,Tatschner T,et al.Increased xanthine oxidase in the thalamus and putamen in depression[J].The World Journal of Biological Psychiatry,2010,11:314-320.
10 Meyer JH,Krüger S,Wilson AA,et al.Lower dopamine transporter binding potential in striatum during depression[J].Neuroreport,2001,12:4121-4125.
11 Pan CC,McQ uoid DR,Taylor WD,et al.Association analysis of the COMT/MTHFR genes and geriatric depression:an MRI study of the putamen[J].International journal of geriatric psychiatry,2009,24:847-855.
12 Di Martino A,Scheres A,Margulies DS,et al.Functional connectivity of human striatum:a resting state FMRI study[J].Cerebral cortex,2008,18:2735-2747.
13 Haber SN,Knutson B.The reward circuit:linking primate anatomy and human imaging[J].Neuropsychopharmacology,2010,35:4-26.
14 Lacerda ALT,Keshavan MS,Hardan AY,et al.Anatomic evaluation of the orbitofrontal cortex in major depressive disorder[J].Biological psychiatry,2004,55:353-358.
15 Kumar P,Waiter G,Ahearn T,et al.Abnormal temporal difference reward-learning signals in major depression[J].Brain,2008,131:2084-2093.
16 Redgrave P,Coizet V,Comoli E,et al.Interactions between the midbrain superior colliculus and the basal ganglia[J].Frontiers in neuroanatomy,2010,4:1-8.
17 Culpepper L.Impact of Untreated Major Depressive Disorder on Cognition and Daily Function[J].The Journal of clinical psychiatry,2015,76:901-901.
18 Peng J,Liu J,Nie B,et al.Cerebral and cerebellar gray matter reduction in first-episode patients with major depressive disorder:a voxel-based morphometry study[J].European journal of radiology,2011,80:395-399.
19 Zhang J,Wang J,Wu Q,et al.Disrupted brain connectivity networks in drug-naive,first-episode major depressive disorder[J].Biological psychiatry,2011,70:334-342.
20 Bora E,Fornito A,Pantelis C,et al.Gray matter abnormalities in major depressive disorder:a meta-analysis of voxel based morphometry studies[J].Journal of affective disorders,2012,138:9-18.
21 Alexander GE,DeL ong MR,Strick PL.Parallel organization of functionally segregated circuits linking basal ganglia and cortex[J].Annual review of neuroscience,1986,9:357-381.
22 Middleton FA,Strick PL.Basal-ganglia‘projections’to the prefrontal cortex of the primate[J].Cerebral Cortex,2002,12:926-935.
23 Lacerda AL,Keshavan MS,Hardan AY,et al.Anatomic evaluation of the orbitofrontal cortex in major depressive disorder[J].Biological psychiatry,2004,55:353-358.
24刘晨.皮层下缺血性血管性痴呆的多模态磁共振研究[D].第三军医大学,2015:1-104.