目的 分析伴焦虑痛苦特征的重性抑郁障碍(MDD)青少年静息态脑影像学特征,进一步了解其神经机制。方法 采取方便抽样纳入2022年1—12月期间就诊于山西医科大学第一医院精神卫生科门诊的27例MDD伴焦虑痛苦特征青少年和社区招募的36名健康对照。采用3.0T西门子磁共振扫描仪采集静息态脑影像学数据。比较两组青少年一般人口学资料、脑影像学数据的差异,分析差异脑区与临床症状的相关。结果 MDD伴焦虑痛苦特征组和对照组年龄、性别差异无统计学意义(P>0.05)。将年龄、性别、受教育年限作为协变量,MDD组左侧枕中回的Bc值(节点介数)高于健康对照组(P<0.05,FDR校正),双侧枕下回的NCp(节点聚类系数)、NLe(节点局部效率)、以及左侧楔叶的NLe(节点局部效率)低于健康对照组(P<0.05,FDR校正)。差异脑区与汉密尔顿抑郁量表(HAMD)和焦虑量表(HAMA)得分无显著相关性(P＞0.05,FDR校正)。结论 伴有焦虑痛苦特征的重性抑郁障碍青少年局部节点的拓扑属性存在异常,表现为双侧枕下回,左侧楔叶以及枕中回,本研究为进一步了解MDD伴有焦虑痛苦特征亚型青少年的神经机制提供脑影像学的证据支持。
Abstract
Objective To assess the neuroimaging characteristics of adolescents with major depressive disorder (MDD) comorbid anxious distress, in order to understand the underlying neuro-mechanism. Methods A convenient sample of 27 adolescents with MDD with anxious distress who visited the outpatient clinic of the Department of Psychiatry of the First Hospital of Shanxi Medical University from January to December 2022, and 36 healthy controls were included in this study. All participants completed a case report form and underwent fMRI data collection.Difference in general demographic data and fMRI data between the two groups were compared,and the correlation between the differentiated brain areas and clinial symptoms was analyzed. Results No significant difference was observed in age and gender between the two groups(P>0.05). However, after adjusting for age, gender and educational level, the Bc value in the left middle occipital gyri (MOG) was significantly higher in MDD with anxious distress group (P<0.05, FDR correction). Additionally, the NCp/NLe value of the bilateral inferior occipital gyri (IOG) and NLe of the left cuneus were significantly lower compared to the healthy control group (P<0.05, FDR correction).However, the Bc/NCp/NLe value of the differentiated brain areas did not show any correlation with the scores on the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) (P＞0.05, FDR correction). Conclusions The topology properties of adolescents with MDD and anxious distress differ from those of healthy controls, particularly in the bilateral IOG, left cuneus, and MOG. These findings further the understanding of MDD with anxious distress.
关键词
重性抑郁障碍 /
焦虑痛苦特征 /
青少年
Key words
major depressive disorder /
anxious distress /
adolescent
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Drysdale AT, Grosenick L,Downar J, et al. Resting-state connectivity biomarkers define neurophysiological subtypes of depression[J]. Nat Med,2017,23(1):28-38.
[2] Gaspersz R, Nawijn L, Lamers F, et al. Patients with anxious depression: Overview of prevalence, pathophysiology and impact on course and treatment outcome[J]. Curr Opin Psychiatry,2018,31(1):17-25.
[3] Thase ME, Weisler RH, Manning JS, et al. Utilizing the DSM-5 anxious distress specifier to develop treatment strategies for patients with major depressive disorder[J]. J Clin Psychiatry,2017,78(9):22046.
[4] Braund TA, Palmer DM, Williams LM, et al. Characterising anxiety in major depressive disorder and its use in predicting antidepressant treatment outcome: An iSPOT-D report[J]. Aust N Z J Psychiatry,2019,53(8):782-793.
[5] Tsai J, Thase ME, Mao Y, et al. Lurasidone for major depressive disorder with mixed features and anxiety: A post-hoc analysis of a randomized, placebo-controlled study[J]. CNS Spectr,2017,22(2):236-245.
[6] McIntyre RS, Weiller E, Zhang P, et al. Brexpiprazole as adjunctive treatment of major depressive disorder with anxious distress: Results from a post-hoc analysis of two randomised controlledtrials[J].J Affect Disord,2016,201:116-123.
[7] Nelson JC. Anxious depression and response to treatment[J]. Am J Psychiatry,2008,165(3):297-299.
[8] Ma X, Liu J, Liu T, et al. Altered resting-state functional activity in medication-naive patients with first-episode major depression disorder vs. healthy control: A quantitative meta-analysis[J]. Front Behav Neurosci,2019,13:89.
[9] Zhang L, Cui X, Ou Y, et al. Abnormal long- and short-range functional connectivity in patients with first-episode drug-naive melancholic and non-melancholic major depressive disorder[J]. J Affect Disord, 2023,320:360-369.
[10] Gong L, Hou Z, Wang Z, et al. Disrupted topology of hippocampal connectivity is associated with short-term antidepressant response in major depressive disorder[J]. J Affect Disord, 2018,225:539-544.
[11] American Psychiatric Association. Diagnostic and statistical manual of mental disorders:DSM-5[M]. American Psychiatric Pub, 2013.
[12] Hamilton M.A Rating scale for depression[J].J Neurol Neurosurg Psychiatry,1960,23:56-62.
[13] Hamilton M.The assessment of anxiety states by rating[J].Br J Med Psychol,1959,32(1):50-55.
[14] Guo H, Cheng C, Cao X, et al. Resting-state functional connectivity abnormalities in first-onset unmedicated depression[J]. NeuralRegen Res,2014, 9(2):153-163.
[15] Chen CJ, Liu ZJ, Xi C, et al. Multimetric structural covariance in first-episode major depressive disorder:A graph theoretical analysis[J]. J Psychiatry Neurosci, 2022, 47(3):e176-e185.
[16] Dong Q, Liu J, Zeng L, et al. State-independent microstructural white matter abnormalities in major depressive disorder[J]. Front Psychiatry, 2020,11:431.
[17] Zhang J, Wang J, Wu Q, et al. Disrupted brain connectivity networks in drug-naive, first-episode major depressive disorder[J]. Biol Psychiatry,2011,70(4):334-342.
[18] Wang X, Tan H, Li X, et al. Resting-state functional magnetic resonance imaging-based identification of altered brain the fractional amplitude of low frequency fluctuation in adolescent major depressive disorder patients undergoing electroconvulsive therapy[J]. Front Psychiatry, 2022,13:972968.
[19] Guo Z, Chen L, Tang LR, et al. Association between decreased interhemispheric functional connectivity of the insula and duration of illness in recurrent depression[J]. J Affect Disord, 2023,329:88-95.
[20] Hou Z, Kong Y, He X, et al. Increased temporal variability of striatum region facilitating the early antidepressant response in patients with major depressive disorder[J].Prog Neuropsychopharmacol Biol Psychiatry, 2018,85:39-45.
[21] Desseilles M, Balteau E, Sterpenich V, et al. Abnormal neural filtering of irrelevant visual information in depression[J]. J Neurosci,2009,29(5):1395-1403.
[22] Veer IM, Beckmann CF, van Tol MJ, et al. Whole brain resting-state analysis reveals decreased functional connectivity in major depression[J]. Front Syst Neurosci,2010,4:41.
[23] Parker JG, Zalusky EJ, Kirbas C. Functional MRI mapping of visual function and selective attention for performance assessment and presurgical planning using conjunctive visual search[J]. Brain and Behav,2014,4(2):227-237.
[24] Štillová K, Jurák P, Chládek J, et al. The posterior medial cortex is involved in visual but not in verbal memory encoding processing: An intracerebral recording study[J]. J Neural Transm, 2013,120(3):391-397.
[25] Yuan J, Yu H, Yu M, et al. Altered spontaneous brain activity in major depressive disorder: An activation likelihood estimation Meta-analysis[J]. J Affect Disord,2022,314:19-26.
[26] Li G, Rossbach K, Zhang A, et al. Resting-state functional changes in the precuneus within first-episode drug-naive patients with MDD[J].Neuropsychiatr Dis Treat,2018,14:1991-1998.
[27] Marwood L, Wise T, Perkins AM, Cleare AJ. Meta-analyses of the neural mechanisms and predictors of response to psychotherapy in depression and anxiety[J].Neurosci Biobehav Rev,2018,95:61-72.
基金
国家自然科学基金面上项目(82371551);山西省医学科技创新人才强医计划(2023RC010);山西省“136”兴医工程项目(Y2022136008);山西省科技创新人才团队(202204051001027)
PDF(1067 KB)
