SSRIs抗抑郁药治疗首发重性抑郁症患者前后双侧额叶和海马^1H-MRS的分析

^1H-MRS in bilaterlis frontal lobe and hippocampus of patients with first episode major depression after SSRIs antidepressant treatment

目的利用质子磁共振波谱分析(1H-MRS)探讨首发重性抑郁症患者脑部神经生化物质的变化。方法利用1H-MRS测量21例首发重性抑郁症患者双侧额叶、海马N-乙酰天门冬氨酸(NAA)、谷氨酸复合物(Glx)、胆碱复合物(Cho)、肌酸(Cr)和肌醇(mI)水平,计算NAA/Cr、Glx/Cr、Cho/Cr、mI/Cr,并与21例正常对照者(对照组)进行比较。选择性5羟色胺再摄取抑制剂(SSRIs)抗抑郁治疗3个月后再次比较病例组治疗前后NAA/Cr、Glx/Cr、Cho/Cr、mI/Cr的变化。结果治疗前病例组左侧额叶NAA/Cr、右侧额叶Glx/Cr、NAA/Cr及左侧海马Glx/Cr、NAA/Cr较对照组降低;右侧额叶和海马mI/Cr较对照组升高;SSRI抗抑郁药治疗后病例组左侧额叶及海马NAA/Cr较治疗前升高,右侧额叶mI/Cr较治疗前降低。结论重性抑郁症的病理机制可能与神经功能障碍、谷氨酸系统及第二信使系统异常有关,抗抑郁剂的疗效可能与改善神经功能及调整第二信使系统功能失调有关。

Objective To measure neuro-biochemical changes in brain of first episode major depression （MD） patients. Methods Single-voxel proton magnetic resonance spectroscopic （1H-MRS） examination of bilateralis frontal lobe and hippocampus was conducted in 21 first episode major depression patients and 21 age-, sex- and education-matched healthy controls. After this, major depression patients took selectivity serotonin reuptake inhibitors （SSRIs） for three months. Then, we examined the changes in NAA, Cho, Cr, Glx and mI in bilaterlis frontal lobe and hippocampus of patients. Finally, we compared the metabolism of the subjects with that of the controls. Results （1） Bilateralis frontal lobe NAA/Cr, right frontal lobe Glx/Cr and left hippocampus NAA/Cr and Glx/Cr were ＇significantly lower in MD patients than in the controls, but right frontal lobe and right hippocampus ml/Cr significantly were higher than those in controls. （2） After treatment left frontal lobe and left hippocampus NAA/Cr significantly increased compared with pretherapy. Right frontal lobe mI/Cr significantly decreased. Conclusion Nerve cell activity disorder, abnormal second messenger and glutamicacid and glutamine may be involved in the pathogenesis of MD. Antidepressant can regulate abnormal metabolism and improve nerve cell activity.