沈宗霖,程宇琪,鲁毅,刘芳,卢瑾,许秀峰.首次发病且未用药的成年早发和晚发抑郁症患者脑功能连接差异研究[J].四川精神卫生杂志,2019,32(5):406-412.
首次发病且未用药的成年早发和晚发抑郁症患者脑功能连接差异研究
Study of differences in brain functional connectivity between early and later onset depression among first-episode drug-naive adult patients
投稿时间:2019-03-21  
DOI:10.11886/j.issn.1007-3256.2019.05.005
中文关键词:  抑郁症  磁共振  楔前叶  功能连接  发病年龄
英文关键词:Major depressive disorder  Magnetic resonance imaging  Precuneus  Functional connectivity  Age at onset
基金项目:国家自然科学基金(81660237);云南省卫生内设研究机构项目(2018NS0109);云南省应用基础研究2017FE468(-176)
作者单位邮编
沈宗霖 昆明医科大学第一附属医院 650032
程宇琪 昆明医科大学第一附属医院 650032
鲁毅 昆明医科大学第一附属医院 650032
刘芳 昆明医科大学第一附属医院 650032
卢瑾 昆明医科大学第一附属医院 650032
许秀峰 昆明医科大学第一附属医院 650032
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中文摘要:
      目的 比较成年早发抑郁症(EOD)和成年晚发抑郁症(LOD)患者默认网络(DMN)内部功能连接的差异,探究不同发病年龄的抑郁症患者是否有不同的发病机制。方法 选取在昆明医科大学第一附属医院精神科门诊或住院的EOD患者(n=58)和LOD患者(n=62)为研究对象,同期招募年轻健康对照组(n=60)和年老健康对照组(n=52)。对受试者进行静息态功能磁共振扫描,选择左侧楔前叶为种子点,计算该种子点与全脑的功能连接,并比较各组间该种子点的功能连接差异。结果 四组之间功能连接具有差异的脑区涉及双侧额叶、颞叶、基底节、枕叶、顶叶及小脑等脑区。EOD组左侧楔前叶与左侧小脑Crus1区、左侧小脑IX区、左侧颞中回、右侧楔前叶、右侧前扣带回、右侧额中回、右侧角回、右侧脑岛、右侧内侧额上回、右侧颞中回的功能连接均高于年轻健康对照组(Z=3.752 4~5.867 8,P均<0.05);而左侧楔前叶与左侧额中回、左侧中央旁小叶、右侧缘上回、右侧额上回、右侧颞下回、右侧中央后回、右侧中央前回、右侧枕上回的功能连接均低于年轻健康对照组(Z=-5.007 6~-3.797 7,P均<0.05)。LOD组左侧楔前叶与左侧小脑Crus2区、左侧尾状核、左侧颞下回、左侧小脑Crus1区、左侧角回、左侧额中回、右侧额中回、右侧角回、右侧眶额部额中回的功能连接均高于年老健康对照组(Z=4.122 8~6.579 4,P均<0.05);与左侧海马旁回、左侧额上回、右侧枕中回、右侧中央前回、右侧内侧额上回、右侧锯状回、右侧颞下回、右侧中央旁小叶、右侧梭状回、右侧后扣带回的功能连接均低于年老健康对照组(Z=-5.884 0~-3.617 2,P均<0.05)。EOD组左侧楔前叶与左侧锯状回、左侧小脑IV-VI区、左侧小脑Crus2区的功能连接比LOD组高(Z=4.087 7、3.937 4、3.672 1,P均<0.05);EOD组左侧楔前叶与右侧额中回、右侧眶额部额下回、右侧额上回的功能连接比LOD组低(Z=-4.274 8、-3.956 8、-4.724 3、-3.663 2,P均<0.05)。结论 DMN内部功能连接增高及额顶网络功能连接降低可能与EOD的发病机制相关,而DMN前部功能连接增高和后部功能连接降低可能与LOD的发病机制相关,不同发病年龄的成年抑郁症患者可能有不同的发病机制。
英文摘要:
      Objective To compare the differences of functional connectivity (FC) of default mode network (DMN) between early onset depression (EOD) and later onset depression (LOD) adult patients, and to explore whether depression patients with different age of onset have different pathogenesis.Methods EOD patients (n=58) and LOD patients (n=62) from First Affiliated Hospital of Kunming Medical University were enrolled. Meanwhile, young healthy control group (n=60) and old healthy control group (n=52) were set as controls. Resting-state fMRI scan was performed on all selected subjects, and the left precuneus (PCu) was selected as the seed point to calculate the functional connectivity of whole brain, then the results among four groups were compared.Results Brain regions with different functional connectivity among four groups involved bilateral frontal lobe, temporal lobe, basal ganglia, occipital lobe, parietal lobe and cerebellum. Compared with the young healthy control group, the functional connectivity between the left precuneus and the Crus1 region of the left cerebellum, left cerebellum IX, left middle temporal gyrus, right precuneus, right anterior cingulate gyrus, right middle frontal gyrus, right angular gyrus, right insula, right medial superior frontal gyrus and the right middle temporal gyrus in the EOD group were all higher (Z=3.752 4~5.867 8, P<0.05), the functional connectivity between the left precuneus and the left middle frontal gyrus, left paracentral lobule, right superior marginal gyrus, right superior frontal gyrus, right inferior temporal gyrus, right posterior central gyrus, right anterior central gyrus and right superior occipital gyrus were all lower in the EOD group (Z=-5.007 6~-3.797 7, P<0.05). Compared with the old healthy control group, the left precuneus in LOD group had higher functional connectivity with the left cerebellum Crus2 area, left caudatus nucleus, left inferior temporal gyrus, left cerebellum Crus1 area, left angular gyrus, left middle frontal gyrus, right medial frontal gyrus, right angular gyrus and right orbitofrontal gyrus (Z=4.122 8~6.579 4, P<0.05), and lower functional connectivity was also found between left precuneus and the left parhippocampal gyrus, left superior frontal gyrus, right middle occipital gyrus, right anterior central gyrus, right medial superior frontal gyrus, right sawed gyrus, right inferior temporal gyrus, right paracentral lobule, right fusiform gyrus, and right posterior cingulate gyrus in LOD group (Z=-5.884 0~-3.617 2, P<0.05). Compared with the LOD group, the functional connectivity between the left precuneus and left saw-like gyrus, left cerebellar IV-VI region and the left cerebellar Crus2 region in the EOD group were higher (Z=4.087 7, 3.937 4, 3.672 1, P<0.05), and the functional connectivity between the left precuneus and right middle frontal gyrus, right orbital inferior frontal gyrus and right superior frontal gyrus were lower (Z=-4.274 8, -3.956 8, -4.724 3, -3.663 2, P<0.05).Conclusion Increased FC within DMN and decreased FC in frontoparietal network (FPN) may associated with the pathological mechanism of EOD, while increased FC in anterior of DMN and decreased FC in posterior of DMN may associated with the pathological mechanism of LOD, suggesting depressed adult patients with different age at onset might have different pathological mechanism.
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