首发重性抑郁障碍患者默认网络功能连接与临床症状的关系

Relationship between default mode network functional connectivity and clinical symptoms in patients with first-episode major depressive disorder

中文关键词:  首发重性抑郁障碍  磁共振成像  默认网络  功能连接

英文关键词:First-episode major depressive disorder  Magnetic resonance imaging  Default mode network  Functional connectivity

中文摘要:

      背景 默认网络的功能改变与抑郁障碍的发病密切相关。然而，默认网络子系统（核心子系统、背内侧前额叶子系统、内侧颞叶子系统）与首发重性抑郁障碍临床症状的关系仍不清楚。目的 探讨静息状态下首发重性抑郁障碍患者默认网络各子系统与全脑的功能连接，并分析这些功能连接与临床症状的关系，从默认网络子系统层面揭示首发重性抑郁障碍的潜在神经机制。方法 于2020年9月—2023年9月，在内蒙古自治区精神卫生中心纳入符合《精神障碍诊断与统计手册（第4版）》（DSM-Ⅳ）重性抑郁障碍诊断标准的首发门诊及住院患者64例（研究组），同期在社区招募与研究组年龄、性别、受教育年限相匹配的健康志愿者54名（对照组）。两组均接受汉密尔顿抑郁量表24项版（HAMD-24）评定。采用西门子3.0 T磁共振采集两组静息态功能磁共振图像，并比较两组默认网络子系统（核心子系统、背内侧前额叶子系统、内侧颞叶子系统）各脑区与全脑功能连接的差异。提取研究组与对照组差异有统计学意义的脑区功能连接值，采用Spearman秩相关系数分析这些功能连接值与研究组HAMD-24评分的相关性。结果 最终完成研究者，研究组46人、对照组43人。研究组默认网络核心子系统的右侧顶上小叶与右侧小脑第8叶的功能连接（t=3.954，P<0.05，GRF校正），背内侧前额叶子系统的右外颞叶皮层与右侧小脑第8叶、右侧海马、左侧海马、右侧内侧和旁扣带回的功能连接（t=4.595、4.208、5.200、4.038，P均<0.05，GRF校正），背内侧前额叶子系统的颞顶联合区与左侧舌回、右侧小脑第8叶的功能连接（t=3.557、4.274，P<0.05，GRF校正）均强于对照组，研究组右侧额下回与左侧直回的功能连接弱于对照组（t=-3.824，P<0.05，GRF校正）。研究组右外颞叶皮层与右侧海马、颞顶联合区与右侧小脑第8叶的功能连接值与HAMD-24认知障碍因子评分均呈负相关（r=-0.306、-0.318，P均<0.05）。结论 默认网络（核心子系统、背内侧前额叶子系统）与小脑、边缘系统部分脑区及舌回的功能连接增强可能与首发重性抑郁障碍的神经机制有关。首发重性抑郁障碍患者背内侧前额叶子系统与小脑及海马功能连接的改变可能与患者的认知功能有关。

英文摘要:

      Background The functional changes of the default mode network （DMN） are closely related to the onset of major depressive disorders. However， the relationship between the DMN subsystem （core subsystem， dorsomedial prefrontal cortex subsystem， medial temporal lobe subsystem） and symptoms of first-episode major depressive disorder remains unclear.Objective To investigate abnormal functional connectivity between DMN subsystems and the whole brain in first-episode major depressive disorder patients during the resting-state， and to analyse the correlations between these functional connectivity patterns and clinical symptoms， so as to reveal the potential neural mechanisms from the perspective of DMN subsystem.Methods From September 2020 to September 2023， a total of 64 first-episode outpatients and inpatients meeting the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders， fourth edition （DSM-IV） were enrolled at the Inner Mongolia Autonomous Region Mental Health Center as the study group. During the same period， 54 healthy volunteers matched for age， gender， and years of education were recruited from the community as the control group. Both groups were assessed using the Hamilton Depression Scale-24 item （HAMD-24）. Resting-state functional magnetic resonance images （rs-fMRI） of the two groups were acquired using a Siemens 3.0 T scanner， and differences in functional connectivity between DMN subsystems （core subsystem， dorsomedial prefrontal cortex subsystem， medial temporal lobe subsystem） and the whole brain were compared. The functional connectivity values of brain regions with statistically significant differences between the two groups were extracted. Spearman's rank correlation coefficient analysis was used to investigate the correlation between these functional connectivity values and HAMD-24 scores of the study group.Results Ultimately， 46 patients and 43 controls completed the study. Compared with the control group， the study group exhibited significantly stronger functional connectivity in the following pathways： between the right superior parietal lobule （core subsystem） and right cerebellar lobule VIII （t=3.954， P<0.05， GRF-corrected）， between the right lateral temporal cortex （dorsomedial prefrontal cortex subsystem） and right cerebellar lobule VIII， right and left hippocampi， right medial， and paracingulate gyrus （t=4.595， 4.208， 5.200， 4.038， P<0.05， GRF-corrected）， and between the temporoparietal junction （dorsomedial prefrontal cortex subsystem） and left lingual gyrus and right cerebellar lobule VIII （t=3.557， 4.274， P<0.05， GRF-corrected）. Conversely， weaker functional connectivity was observed between the right inferior frontal gyrus and left gyrus rectus （t=-3.824， P<0.05， GRF-corrected）. Furthermore， within the study group， the functional connectivity values between the right lateral temporal cortex and right hippocampus， as well as between the temporoparietal junction and right cerebellar lobule VIII， were both negatively correlated with the HAMD-24 cognitive impairment factor score （r=-0.306， -0.318， P<0.05）.Conclusion Increased functional connectivity between the DMN （specifically its core and dorsomedial prefrontal cortex subsystems） and cerebellum， partial limbic system， and lingual gyrus may be associated with the neuropathology of first-episode major depressive disorder. Furthermore， alterations in functional connectivity between the dorsomedial prefrontal cortex subsystem and both the cerebellum and hippocampus in these patients may be related to cognitive function. ［Funded by 2019 Annual Inner Mongolia Autonomous Region Natural Science Foundation Project （number， 2019MS03038）； 2023 Annual Inner Mongolia Autonomous Region Natural Science Foundation Project （number， 2023MS08028）］