局部脑血流灌注评价抑郁症患者治疗疗效的临床研究

The clinical study on antidepressant response in patients with depressive disorder by regional cerebral blood flow

目的观察抑郁症患者治疗前、后局部大脑皮质血流灌注(rCBF)特点,以评价治疗效果。方法选择未经治疗的按CCMD-2-R诊断标准诊断,汉密尔顿(HAMD-24)抑郁量表评分≥20分的抑郁症患者20例,行脑99m锝-双半胱乙酯(99Tcm-ECD)显像并与19名年龄匹配的健康人作比较,显像后抑郁症患者接受选择性5-羟色胺再摄取抑制剂(SSRI)治疗,14例有效者于治疗后4周、10周再次行脑血流灌注显像。采用大脑皮质各区域与小脑皮质的放射性比值对局部脑血流进行半定量分析,并对抑郁症患者与对照组的局部脑血流以及抑郁症患者治疗前后脑血流进行对比分析。结果①抑郁症患者血流灌注减低区主要表现在前额叶(80%)、扣带回(65%)与正常对照组比差异有统计学意义(P<0.01),右颞叶、枕叶、及右顶叶血流灌注亦减低(P<0.05)。②治疗后有效者减低区血流灌注有改善,但局部脑血流在治疗后4周与治疗前比较差异无统计学意义,治疗10周后扣带回、右颞叶与治疗前比较差异有统计学意义(P<0.05)。结论①抑郁症患者前额叶、扣带回血流灌注减低。②治疗后有效的抑郁症患者随治疗时间的延长脑血流灌注明显改善。

Objective To assess antidepressant theraputic effect with the characteristic of regional cerebral blow flow （rCBF） in untreated and treated patients with depressive disorder. Methods ^99 Tc^m ECD brain single photon emission computed tomography （SPECT） imaging was performed in 20 untreated depressive disorder patients, all the patients were enrolled by HAMD （24） and treated with selective serotonin reuptake inhibitor（SSRI）. Fourteen of which were classified as remitters after treatment, brain perfusion imaging was performed at fourth week and tenth week,and compared with 19 agematched normal controls. Results ①The regional of interest （ROI） were drawn and analyzed., the depressive patients were demonstrated decreased rCBF in prefrontal lobe, cingulate gyrus and right temporal lobe, parietal lobe and occipital lobe before treatment.②The increase of rCBF of the prefrontal and the cingulated were found in remitters after treatment of four weeks, but there was not statistic difference compared with the rCBF of untreated depressive patients, there was significant difference of rCBF at cingulated and right temporal lobe at tenth week. Conclusion ①There are low rCBF in the prefrontal and the cingulated in the depressive patients. ②The rCBF of the depressive patients with remitter can increase after treatment, we can evaluate the effects of treatment by brain SPECT imaging.