摘要目的:探讨焦虑性抑郁症(anxious depression，AD)患者与非焦虑性抑郁症(non anxious depression，NAD)患者大脑灰质体积(gray matter volume，GMV)的差异，及差异脑区灰质体积与临床特征的相关性。方法:2014年9月至2018年10月招募抑郁症患者150例，同时招募性别、年龄与之匹配的健康对照者62例。使用17项汉密尔顿抑郁量表(Hamilton depression scale-17，HAMD-17)评估抑郁症患者的严重程度，按照HAMD-17的焦虑/躯体化因子分是否≥7分，将抑郁症患者分为AD组( n＝80)与NAD组( n＝70)。对所有被试进行3.0 T静息态结构磁共振扫描。通过基于体素的形态学测量分析(voxel-based morphometry，VBM)对结构磁共振数据进行预处理，使用rest工具包计算三组被试脑灰质体积的差异，在SPSS 19.0软件中使用post-hoc t test进行组间事后比较。对AD组与NAD组相比具有显著性差异脑区的脑灰质体积与焦虑/躯体化因子分进行Pearson相关分析。 结果:与NAD组比较，AD组右侧额中回(MNI：x＝28.5，y＝21.0，z＝48.0， t＝-4.83，Bonferroni多重比较校正， P<0.05/3)、左背外侧额上回(MNI：x＝-18.0，y＝27.0，z＝43.5， t＝-6.08，Bonferroni多重比较校正， P<0.05/3)灰质体积下降，差异有统计学意义。相关分析发现AD患者右侧额中回体积与焦虑/躯体化因子分的自知力评分呈负相关( r＝-0.36， P＝0.001，Bonferroni多重比较校正)。 结论:与NAD相比，AD患者的前额叶体积下降，与AD患者临床症状严重程度有关，其中右侧额中回体积减小可以作为自知力受损严重程度的潜在生物学标记。

abstractsObjective:To explore the difference of gray matter volume between anxious depression(AD)and non anxious depression(NAD) patients, and its correlation with clinical characteristics.Methods:One hundred and fifty patients with depression were included from September 2014 to October 2018, meanwhile 62 healthy controls with matching demographic characteristic were recruited. The severity of the patients was assessed by Hamilton depression scale-17(HAMD-17). Patients were divided into anxious depression group(AD group, n=80)and non-anxious depression group (NAD group, n=70) according to whether anxiety/somatization factor scored 7. All subjects were scanned with 3.0 T underwent structural MRI scan. The structural magnetic resonance data were preprocessed by voxel-based morphometry (VBM). The rest toolkit was used to calculate the difference of gray matter volume among the three groups. By SPSS 19.0, post-hoc t test was used for pairwise comparison and Pearson correlation analysis was performed between gray matter volume and clinical factors in patients with anxious depression. Results:Compared to the NAD group, the gray matter volume of the right middle frontal gyrus(MNI: x=28.5, y=21.0, z=48.0, t=-4.83, Bonferroni multiple comparison adjustment, P<0.05/3) and left dorsolateral superior frontal gyrus(MNI: x=-18.0, y=27.0, z=43.5, t=-6.08, Bonferroni multiple comparison correction, P<0.05/3)were significantly decreased in AD group. Correlation analysis found that the gray matter volume of the right middle frontal gyrus in patients with anxious depression was negatively correlated with the insight of anxiety/somatization factor score ( r=-0.36, P=0.001). Conclusion:The volume of prefrontal lobe in patients with anxiety depression is lower than that in patients with non anxiety depression, which may be related to the serious clinical symptoms in patients with anxiety depression.The decrease of right middle frontal gyrus volume can be used as a potential biological marker for the severity of impaired insight.