【摘要】：目的:利用磁共振彌散張量成像(diffusion tensor imaging，DTI)技術(shù)，研究首發(fā)重性抑郁障礙(major depressive disorder，MDD)患者腦白質(zhì)微結(jié)構(gòu)的改變，探討重性抑郁障礙患者的病程、疾病嚴(yán)重程度和發(fā)病年齡與彌散張量各向異性的關(guān)系。 方法:收集了71例首發(fā)重性抑郁障礙患者以及45例同地區(qū)正常人群的DTI數(shù)據(jù)分為兩組進(jìn)行比較，控制性別和年齡因素后，MDD患者和正常對(duì)照進(jìn)行一一配對(duì)，共41對(duì)(22對(duì)男性，19對(duì)女性)，用DSM--IV--TR軸I障礙定式臨床檢查（the struetured cliniealinterview for DSM—IV axis1disorders for patient，SCID—I/P)對(duì)MDD進(jìn)行篩查診斷，用漢密爾頓抑郁量表(Hamilton Depression scale,HAMD)（17項(xiàng)）、漢密爾頓焦慮量表(Hamilton Anxiety scale,HAMA)（14項(xiàng)）、抑郁自評(píng)量表(Self-Rating Depression Scale,SDS)評(píng)定臨床癥狀。要求MDD組符合HAMD評(píng)分大于17分，，HAMA評(píng)分小于14分;正常對(duì)照組符合HAMD評(píng)分低于7分，SDS評(píng)分標(biāo)準(zhǔn)分小于30分,HAMA評(píng)分小于7分.對(duì)兩組被試進(jìn)行磁共振彌散張量成像掃描，用部分各向異性(fractionalanisotropy，F(xiàn)A)作為組織擴(kuò)散特征的指標(biāo)。用FSL(FMRIB Software Library，http://www.fmrib.ox.ac.uk/fsl)軟件包中基于纖維的空間統(tǒng)計(jì)方法（Tract-Based Spatial Statistics，TBSS）對(duì)彌散張量圖像進(jìn)行分析，首先對(duì)圖像進(jìn)行頭動(dòng)校正和渦流校正、全腦mask后,形成個(gè)體FA圖像，通過(guò)非線性變換方法將個(gè)體FA圖配準(zhǔn)到MNI152標(biāo)準(zhǔn)空間，得到一個(gè)平均的FA像，該圖像被濃縮產(chǎn)生一個(gè)模板骨架（mean FA skeleton image），界定FA的閾值≥0.2以排除周圍組織的干擾，最后，采用TFCE（Threshold-Free Cluster Enhancement）方法進(jìn)行多重校正比較，以校正后p值小于0.01作為顯著性標(biāo)準(zhǔn)，把每個(gè)抑郁障礙患者的平均FA值與患者的病程、癥狀嚴(yán)重程度、首次發(fā)病年齡進(jìn)行相關(guān)分析。 結(jié)果:l)與正常對(duì)照比較，MDD患者平均FA值升高，升高的位點(diǎn)位于左上縱束（校正后p0.01）；2)MDD患者平均FA值與HAMD評(píng)分、病程、首次發(fā)病年齡無(wú)顯著相關(guān)； 結(jié)論:1）首發(fā)青中年重性抑郁障礙患者存在腦白質(zhì)微結(jié)構(gòu)的改變。 2）首發(fā)青中年重性抑郁障礙患者可能存在神經(jīng)纖維代償性再生。 3）首發(fā)青中年重性抑郁障礙患者腦白質(zhì)微結(jié)構(gòu)的改變和疾病的嚴(yán)重程度、病程及發(fā)病年齡無(wú)關(guān)。
[Abstract]:Objective: to study the changes of white matter microstructure in patients with first-episode depressive disorder (major depressive disorder,MDD) by using magnetic resonance diffusion Zhang Liang (diffusion tensor imaging,DTI) technique, and to explore the course of disease in patients with severe depressive disorder. Relationship between severity and age of disease and anisotropy of dispersive Zhang Liang. Methods: the DTI data of 71 patients with first-onset depression disorder and 45 normal controls were divided into two groups. After sex and age factors were controlled, 41 pairs (22 male) of MDD patients and normal controls were matched. In 19 women, MDD was screened and diagnosed with DSM--IV--TR axis I disorder (the struetured cliniealinterview for DSM-IV axis1disorders for patient,SCID-I/P) and Hamilton Depression scale (Hamilton Depression scale,HAMD) (17 items). Hamilton anxiety scale (Hamilton Anxiety scale,HAMA) (14 items) and self-rating Depression scale (Self-Rating Depression Scale,SDS) were used to assess clinical symptoms. The compliance score of MDD group was more than 17 points and HAMA score was less than 14 points, while that of normal control group was less than 7 points, SDS score was less than 30 points, HAMA score was less than 7 points. Diffusion Zhang Liang imaging was performed in two groups, and partial anisotropy (fractionalanisotropy,FA) was used as the index of tissue diffusion characteristics. The dispersion Zhang Liang image is analyzed by using the fiber based spatial statistical method (Tract-Based Spatial Statistics,TBSS) in the FSL (FMRIB Software Library, http://www.fmrib.ox.ac.uk/fsl) software package. First, the head moving correction and eddy current correction of the image are carried out. After the whole brain mask, the individual FA image is formed. The individual FA image is registered into the MNI152 standard space by nonlinear transformation method, and an average FA image is obtained. The image is condensed to produce a template skeleton (mean FA skeleton image),. The threshold value of FA was defined as 鈮

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