摘要目的 探讨抑郁症和双相抑郁患者情绪图片任务下脑功能激活的特异性.方法 采用任务态功能磁共振成像研究方法,对30例双相Ⅰ型抑郁、30例抑郁症(major depressive disorder)及30名健康对照者进行负性和中性情绪图片任务态脑fMRI(functional magnetic resonance imaging,fMRI)扫描,最后纳入分析的双相Ⅰ型抑郁症患者17例(双相Ⅰ型组)、抑郁症18例(抑郁症组)及对照组21名(对照组).采用SPM及REST软件对3组图像进行预处理及统计学分析,对单因素方差分析结果脑功能激活有差异的脑区进行post-hoc两两检验,并采用Pearson相关分析对HAMD17与差异脑区体素值进行相关分析.结果 (1)与对照组比较:双相Ⅰ型组在负性和中性情绪图片任务下,均表现为右侧海马旁回[负性图片MNI坐标(x、y、z):27、-21、-18,t=4.84;中性图片MNI坐标(x、y、z):21、-33、-12,t=5.33]激活降低(P＜0.05),未见激活增强的脑区;抑郁症组在负性情绪图片任务下,表现为右侧额中回[MNI坐标(x、y、z):9、9、69,t=4.96]激活增强(P＜0.05),未见激活降低的脑区;在中性情绪图片任务下,表现为双侧额中回[左侧额中回MNI坐标(x、y、z):-24、9、63,t=5.39;右侧额中回MNI坐标(x、y、z):15、12、69,t=5.95]、右侧前扣带回[MNI坐标(x、y、z):9、12、42,t=4.91]、右侧额下回[MNI坐标(x、y、z):48、21、-15,t=4.94]激活增强(P＜0.05),未见激活降低的脑区.(2)与抑郁症组比较:在负性情绪图片任务下,双相Ⅰ型组未见激活有差异的脑区;在中性情绪图片任务下,双相Ⅰ型组表现为左侧楔前叶[MNI坐标(x、y、z):-3、-66、39,t=4.65]激活降低(P＜0.05),未见激活增强的脑区.(3) Pearson相关分析显示,在负性和中性情绪图片任务中均未发现2个患者组各激活降低或增强脑区体素值与HAMD17评分之间具有相关性(r=0.349、0.163、0.256、-0.200、-0.379、-0.147、-0.284、-0.076、-0.165,均P＞0.05).结论 抑郁症和双相Ⅰ型抑郁对于负性和中性情绪图片任务脑激活有差异.双相Ⅰ型抑郁患者表现脑功能激活降低,而抑郁症患者表现为脑功能激活增强;这些特点或许可以作为区分双相Ⅰ型抑郁与抑郁症的生物学标记.

abstractsObjective To investigate the characteristics of brain function activity in patients with bipolar depressive disorder and major depressive disorder (MDD) facing affective pictures.Methods Thirty bipolar Ⅰ depressive disorder patients,30 MDD patients and 30 healthy controls were included in the study.All subjects were scanned with 3.0T MRI scanner in negative and neutral affective pictures task state.After eliminating those taking medicines and head moving,and matching the factors such as gender,age and education level et al,there were 17 patients with bipolar Ⅰ depressive disorder,18 patients with MDD and 21 healthy controls in the final analysis.Using SPM and REST software to complete the image preprocessing and statistical analysis of the three groups and one-way analysis of variance (ANOVA) with least significant difference (LSD) post-hoc tests were used to compare different brain regions.Meanwhile,Pearson correlation analysis was performed to further assess the relationship between the clusters of these different regions and HAMD17 score.Results Facing negative and neutral affective pictures tasks,subjects with bipolar Ⅰ depressive disorder showed lower activation in right parahippocampus (negative affective pictures MNI(x,y,z):27,-21,-18;t=4.84;neutral affective pictures MNI (x,y,z):21,-33,-12;t=5.33) than the healthy controls (P＜0.05).There was no greater activation in subjects with bipolar Ⅰ depressive disorder rather than the healthy controls.Facing negative affective pictures tasks,subjects with MDD showed greater activation in right middle frontal gyrus(MNI (x,y,z):9,9,69;t=4.96) than the healthy controls (P＜0.05).There was no lower activation in subjects with MDD rather than the healthy controls.Facing neutral affective pictures tasks,subjects with MDD showed greater activation in bilateral middle frontal gyrus(left middle frontal gyrus MNI(x,y,z):-24,9,63;t=5.39;right middle frontal gyrus MNI(x,y,z):15,12,69;t=5.95),right cingulated gyrus(MNI(x,y,z):9,12,42;t=4.91),right inferior frontal gyrus(MNI (x,y,z):48,21,-15;t=4.94),than the healthy controls(all P＜0.05).There was no lower activation in subjects with MDD rather than the healthy controls.Facing negative affective picture tasks,there was no significant differences between bipolar Ⅰ depressive disorder and MDD.Facing neutral affective pictures tasks,subjects with bipolar Ⅰ depressive disorder showed lower activation in the left precuneus (MNI (x,y,z):-3,-66,39;t=4.65)than MDD.There was no greater activation in subjects with bipolar Ⅰ depressive disorder rather than MDD.There were no significant correlations between the cluster values of lower or greater activation regions and HAMD scores of bipolar Ⅰ depressive disorder and MDD.(r=0.349,0.163,0.256,-0.2,-0.379,-0.147,-0.284,-0.076,-0.165,all P＞0.05).Conclusion The results suggest that there are differences of brain function activity between bipolar Ⅰ depressive disorder and MDD in negative and neutral affective pictures task.Patients with bipolar Ⅰ depressive disorder showed reduced activities and MDD showed enhanced activities.These feature may be regarded as the biomarker to distinguish the bipolar Ⅰ depressive disorder from MDD.