摘要
目的:探讨难治性抑郁症患者与正常对照之间神经生化代谢分布的差异,探索rTMS治疗前后难治性抑郁症局部脑代谢物的特异性。方法:应用1H-MRS检测34例难治性抑郁症患者双侧前额叶N-乙酰天门冬氨酸(NAA)、谷氨酸(Glx)、胆碱复合物(cho)、肌醇(ml)及肌酸(cr)5种代谢物,分别计算NAA、Glx、Cho、mI与Cr的比值,并与28名健康对照者比较。对34例难治性抑郁症患者进行4周共20次高频rTMS治疗。治疗前后分别评定汉密尔顿抑郁量表(HAMD)。治疗后再次应用1H-MRS检测34例难治性抑郁症患者双侧前额叶代谢物分布特征。结果:①rTMS治疗前难治性抑郁症组患者左侧前额叶皮质mI/Cr比值明显低于健康对照组(P<0.001)。rTMS治疗组治疗有效患者mI/Cr比值增高,与健康对照比较无显著性差异。②在控制年龄、病程的影响后,rTMS治疗组左侧前额叶mI/Cr改变与HAMD减分率成正相关(r=0.86,P=0.000)。结论:难治性抑郁症患者可能存在前额叶胶质细胞代谢异常,有效的rTMS治疗可改善神经胶质细胞功能。
Objective： In this study neurochemical changes within prefrontal cortex（PFC） of severely depressed patients before and after repetitive transcranial magnetic stimulation （rTMS） were evaluated by proton magnetic resonance spectroscopy （1H-MRS）. Methods： Thirty-four young depressed patients with treatment resistant unipolar depression were enrolled in a double-blind, randomized study[active（n=19） vs. sham（n=15）], and the PFC was investigated before and after high-frequency （15Hz） rTMS using 3-tesla proton magnetic resonance spectroscopy. The N-acetylaspartate （NAA）, glutamine＋glutamate（Glx）, choline（Cho）, myo-Inositol（mI） and creatine（Cr） were measured and their ratios of metabolite to Cr levels were determined in bilateral frontal lobe. The result of metabolites were compared with 28 age- and gendermatched healthy controls. Results： （1）In depressive patients a significant reduction in mI/Cr was observed pre-rTMS （P〈 0.001）. After successful treatment, mI/Cr increased significantly in left PFC and the levels no longer differed from those of age-matched controls. （2）A positive correlation between clinical improvement and an increment in m-Ino ratio was observed（r=-0.86,P=0.000）. Conclusion： There might exist abnormal metabolism of glual ceils in prefrontal cortex of young patients with treatment-resistant depression, which can be partly reversed by successful rTMS.
出处
《中国临床心理学杂志》
CSSCI
CSCD
北大核心
2012年第6期802-804,808,共4页
Chinese Journal of Clinical Psychology
关键词
难治性抑郁症
磁共振波谱
重复经颅磁刺激
前额叶
Treatment-resistant depression
Proton magnetic resonance spectroscopy
Repetitive transcranial magnetic stimulation
Prefrontal cortex
