抑郁症患者前脑岛亚区连接异常与躯体症状的关系
发布时间：2020-08-25 浏览次数：0
近些年，抑郁症等心理疾病逐渐成为影响国民身心健康的重大障碍。据WHO统计，抑郁症在全球约有3 亿患者，且患病率逐年增加，预计到2030 年将跃居所有疾病负担第二位。除了情绪低落、快感缺失等情绪症状外，躯体化症状也是抑郁症重要临床表现。躯体化症状与难治性抑郁症密切相关，是抑郁症常见的残留症状，造成沉重的经济负担。目前抑郁症躯体化症状的神经机制尚不明确，前脑岛在抑郁症及躯体症状中扮演重要角色，本研究采用前脑岛亚区为种子点进行功能连接分析，探索其在躯体化症状中的作用，并在电休克模型中进行了验证。
本研究纳入45例抑郁症患者和35例年龄、性别、教育年限匹配的正常被试，进行静息态磁共振扫描和临床症状评估（汉密尔顿抑郁量表、患者健康问卷躯体化症状量表），抑郁组被试进行电休克治疗后再进行一次扫描和评估。以前脑岛亚区（图一）为种子点进行功能连接分析，并将该指标在电休克之后予以验证。
与正常对照组相比，抑郁症患者左侧腹侧前脑岛与右侧眶额叶，右侧腹侧前脑岛与右侧眶额叶之间的连接减弱(图二)，且与躯体症状的严重程度成负相关（图三）。在电休克之后，抑郁症患者以上减弱的功能连接明显增强（图四），且增强程度与躯体化症状的改善程度明显相关（图五）。
图三 Associations between vAI–OFC RSFC and clinical symptoms.
(a)There was a significant negative correlation between the left ventral anterior insula to right orbitofrontal cortex (LvAI–rOFC) RSFC and PHQ-15 score in depressive patients.
(b) There was a negative correlation between RvAI–rOFC RSFC and PHQ-15 score in depressive patients at the trend level.
(c) There was a significant negative correlation between LvAI–rOFC RSFC and HDRS score in depressive patients.
图五 Increased RSFC following ECT is associated with somatic symptom improvement.
(a) There was a significant correlation between increased LvAI–rOFC connectivity and reduced PHQ-15 score (two-tailed).
(b) There was a trend-level relationship between increased RvAI–rOFC connectivity and reduced PHQ-15 at the trend level (two-tailed, no significant correlation).
结论
