中国临床心理学杂志

难治性抑郁症患者rTMS治疗前后双侧前额叶质子磁共振波谱定量研究

单位：1. 广东省医学科学院广东省人民医院广东省精神卫生中心广东广州 510080
2. 中南大学湘雅二医院精神卫生研究所湖南长沙 410011
3. 湖南省人民医院放射科湖南长沙 410011

分类号：R395.2

出版年,卷(期):页码：2012,20(6):802-804

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 gender-matched healthy controls.Results: ①In 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.②A 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 cells in prefrontal cortex of young patients with treatment-resistant depression,which can be partly reversed by successful rTMS.

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