摘要： 目的 应用功能磁共振(fMRI)低频振幅(ALFF)技术对首发抑郁症患者治疗前后脑功能活动变化进行研究,探讨认知行为治疗(CBT)对抑郁症患者的神经作用机制。方法 对首发抑郁症者(患者组,18例)及与其性别、年龄、教育年限相匹配的健康人(对照组,40例)进行静息态fMRI扫描,患者组在完成8周CBT治疗后再次进行fMRI扫描,并对患者组治疗前后和健康对照组进行量表评估,运用基于Matlab平台的DPARSF软件对影像学数据进行处理,计算被试全脑的ALFF值并进行比较分析。结果 与治疗前相比,抑郁症患者治疗后在17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、患者健康问卷抑郁症状群量表(PHQ-9)和广泛性焦虑量表(GAD-7)总分均显著降低,差异有统计学意义(P<0.05)。与治疗前相比,治疗后患者额中回ALFF值升高,枕中回ALFF值降低。方差分析结果显示,经过CBT治疗后该脑区与对照组的差异无统计学意义,提示该脑区治疗后趋于正常化。结论 CBT可以增强额中回和降低枕中回的脑活动强度,对抑郁症患者脑功能有双向动态平衡调节作用。

首发抑郁症患者认知行为治疗前后静息态脑功能磁共振低频振幅的变化

王洋¹, 王菲^1,2, 汤艳清¹, 魏胜男², 姜晓薇², 张然¹

1. 中国医科大学附属第一医院 精神医学科, 沈阳 110001;
2. 中国医科大学附属第一医院 放射科, 沈阳 110001

收稿日期:2019-12-24出版日期:2020-06-30发布日期:2020-06-15
通讯作者:王菲E-mail:fei.wang@cmu.edu.cn
作者简介:王洋(1995-),女,硕士研究生.
基金资助:国家自然科学基金（81725005）


关键词: 抑郁症, 认知行为治疗, 静息态功能磁共振成像, 低频振幅
Abstract: Objective To further explore the neurobiological mechanisms,underlying the effect of cognitive behavioral therapy (CBT) in the treatment of first-episode patients with major depressive disorder (MDD),using amplitude of low-frequency fluctuations (ALFF) of functional magnetic resonance imaging (fMRI) in resting-state. Methods Eighteen first-episode patients with MDD and 40 healthy controls (HC),matched by gender,age,and years of education,were evaluated using fMRI scan. MDD subjects were treated only with an 8-week course of CBT and were re-evaluated afterwards using fMRI scan. MDD subjects (before and after treatment) and HC were assessed,using various scales. Every subject's ALFF was calculated by MATLAB-based Data Processing Assistant for Resting-State fMRI (DPARSF) software and then compared and analyzed. Results Compared with the results before CBT,the total scores of Hamilton Depression Scale-17 (HAMD-17),Hamilton Anxiety Scale (HAMA),patient health questionnaire-9(PHQ-9),and generalized anxiety disorder-7 (GAD-7) of patients with depression after CBT were significantly reduced,thus establishing statistically significant differences (P<0.05). After treatment,patients' ALFF value increased in the left middle frontal gyrus and decreased in the left middle occipital gyrus. ANOVA analysis showed that the difference between post-CBT and HC results was not statistically significant,suggesting that the brain area tended to normalize after treatment. Conclusion CBT can activate the activity intensity of the middle frontal gyrus and reduce the activity intensity of the middle occipital gyrus,thus exercising a two-way dynamic balance regulation effect on the brain function of patients with depression.
Key words: major depressive disorder, cognitive behavior therapy, resting-state functional magnetic resonance imaging, amplitude of low-frequency fluctuation
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