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| 首发重性抑郁障碍患者默认网络功能连接变化与临床症状的关系 |
| Relationship between changes in default network functional connectivity and clinical symptoms in patients with first-episode major depressive disorder |
| 投稿时间：2025-06-26 修订日期：2025-11-06 |
| DOI： |
| 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:Primary major depressive disorder Magnetic resonance imaging Default network Functional connectivity |
| 基金项目:内蒙古自治区自然科学(项目名称:首发抑郁症患者全病程管理模式的疗效研究,项目编号:2019MS03038) |
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| 中文摘要: |
| 【摘要】背景 默认网络的功能改变在抑郁障碍中发挥重要作用。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子系统内及各子系统与全脑功能连接变化与临床症状的相关性。方法 于2020年9月—2023年9月纳入内蒙古自治区精神卫生中心符合《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46例（研究组）以及社区招募的与之年龄、性别、受教育年限相匹配的对照者43名（对照组），两组均接受汉密尔顿抑郁量表24项版（HAMD-24）评定。利用西门子3.0 T磁共振采集两组被试的静息态功能磁共振图像，采用功能连接分析法，计算并比较两组被试的默认网络子系统(核心子系统、内侧颞叶子系统、背内侧前额叶子系统) 内及各子系统与全脑功能连接的差异。分析差异脑区功能连接值与量表评分的关系。结果 研究组与对照组默认网络子系统内部节点之间的功能连接比较，差异无统计学意义（P?0.05）。研究组核心子系统右侧顶上小叶与右侧小脑的功能连接高于对照组（t=3.954，P<0.01，GRF校正）。研究组背内侧前额叶子系统右外颞叶皮层与右侧小脑、双侧海马、右侧内侧和旁扣带回的功能连接高于对照组（t=4.595、4.208、5.200、4.038，P均<0.01，GRF校正），颞顶联合区与左侧舌回、右侧小脑的功能连接高于对照组（t=3.557、4.274，P<0.01，GRF校正），右额下回与左侧直肌的功能连接低于对照组（t=-3.824，P<0.01，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的功能连接值与24项汉密尔顿抑郁量表认知障碍因子分呈负相关（r=-0.306、-0.318，P<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加可能与首发重性抑郁障碍的病理机制有关。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与认知功能受损有关。 |
| 英文摘要: |
| 【Abstract】Background Functional alterations in the default network play an important role in depressive disorders. However, the relationship between default network subsystems (core subsystem, dorsomedial prefrontal system, medial temporal lobe subsystem) and first-episode major depressive disorder remains unclear. Objective To investigate the correlation between changes in functional connectivity within the default network subsystems and between each subsystem and the whole brain and clinical symptoms in patients with first-episode major depressive disorder in the resting state.Methods Forty-six first-ever outpatients and inpatients who met the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV) diagnostic criteria for major depressive disorder at the Inner Mongolia Autonomous Region Mental Health Center (the study group) and 43 community-recruited age-, gender-, and years of education-matched controls were enrolled from September 2020 to September 2023 ( control group), both groups were assessed by the 24-item version of the Hamilton Depression Scale (HAMD-24). Resting-state functional magnetic resonance images of the two groups were acquired using Siemens 3.0 T magnetic resonance, and functional connectivity analysis was used to calculate and compare the differences in functional connectivity within and between subsystems of the default network (core subsystems, medial temporal lobe subsystems, and dorsal medial prefrontal lobe systems) and the whole brain in the two groups. Differential brain region functional connectivity values were analyzed in relation to scale scores.Results Functional connectivity between nodes within the default network subsystem was not statistically significant when comparing the study group with the control group (P?0.05). The functional connectivity between the right supraparietal lobule and the right cerebellum of the core subsystem was higher in the study group than in the control group (t=3.954, P<0.01, GRF corrected).Functional connectivity of the right outer temporal lobe cortex of the dorsomedial prefrontal lobe system with the right cerebellum, bilateral hippocampus, and right medial and paracentral cingulate gyrus was higher in the study group than in the control group (t=4.595, 4.208, 5.200, 4.038, P<0.01, GRF-corrected), and functional connectivity of the temporoparietal joint area with the left lingual gyrus and right cerebellum was higher than in the control group (t=3.557, 4.274, P<0.01, GRF corrected), and the functional connectivity of the right inferior frontal gyrus with the left rectus muscle was lower than that of the control group (t=-3.824, P<0.01, GRF corrected).Functional connectivity values between the right outer temporal cortex and the right hippocampus, and the temporoparietal joint area and the right cerebellum were negatively correlated with the 24-item Hamilton Depression Inventory Cognitive Impairment Factor Score in the study group (r=-0.306, -0.318, P<0.05).Conclusion Increased functional connectivity of the default network (core subsystem, dorsomedial prefrontal system) with the cerebellum, some brain regions of the limbic system, and the lingual gyrus may be related to the pathomechanism of first-episode major depressive disorder. Altered functional connectivity of the dorsomedial prefrontal system with the cerebellum and hippocampus in patients with first-episode major depressive disorder is associated with impaired cognitive function. |
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