米氮平对抑郁症患者认知功能的影响及MRI脑结构成像的关系研究

Influence of mirtazapine on cognitive function in patients with depression:test of a Neuropsychological Training System and a MRI study

目的采用神经心理检测评估抗抑郁药对患者认知功能的影响,同时通过核磁共振(MRI)研究实验前后患者脑结构的变化。方法药物治疗为开放性设计,抑郁症患者29例给予可变剂量的米氮平(瑞美隆)治疗,剂量范围为15～30mg/d,治疗时间12周。对照组共30例,为正常人群,不予任何干预。通过MRI检测,监控和对比抑郁症患者治疗前后脑结构的变化;同时分别在治疗前后对患者进行HAMD、WCST、WSM评定。以HAMD的减分率评定疗效:痊愈>75%,显著进步74%～50%,进步49%～25%,无效<24%。结果HAMD量表减分率稍大于50%,根据标准判定为显著进步。患者组治疗12周后WCST的分类数、持续错误数、随机错误数均明显少于治疗前,正确数和分类数也明显高于治疗前,以上差异均有统计学意义(P<0.01)。治疗前后治疗组和对照组除了长时记忆,WSM所有指标都有显著性差异,且治疗前后的组间差异也具有统计学意义。而通过观察治疗前后的脑核磁共振图,发现抑郁症患者治疗前后及对照组均显示两侧的海马容积不对称(左侧小于右侧P<0.01);抑郁症患者治疗前的两侧海马容积对比治疗后及对照组有明显减小(P<0.01);右侧杏仁核明显小于治疗后及对照组(P<0.01);结论海马及杏仁核容积异常可能是构成抑郁症的神经生物学基础,边缘系统在抑郁症的发病机理中起着重要作用。

Objective This study used magenetic resonance imaging and neuropsychological assessment techniques to compare the cognitive function before and after drug treatment for depressed patient. We aim to understand the physical variation of depressed patients＇s brain. Methods The use of the drug mirtazapine, dose ： 15 - 30 mg/d, the treatment time of 12 weeks in the control group without any intervention, as a control group of 30 normal people, through MRI testing, monitoring and comparing the morphological variation of patients＇s brain before and after the treatment of antidepressant Remeron. Before and after treatment, the patients were asked to take the WMS and WCST psycholgical assessment, The extent and property of the depressed patients＇ neuropsychological dysfunction were observed. Comprehensive assessment of relevance between the activation of brain and cognitive and the clinical situational change were made before and after antidepressant treatment. The assessment of efficacy was accorded to HAMD： recovery 〉 75%, a significant improvement 74% - 50%, Improvement 49% - 25%, invalid 〈 24%. The assessments were taken before and after treatment respectively. Results After treatment, the group of depressed patient showed a significant improvement in HAMD, WSM, WCST. More specifically, for WCST the number of categories, contiued mistakes, random errors were significantly less than before treatment, the correct number and the number of classificaition are also significantly higher than that before treatment, the differences were significant （P 〈 0. 01 ） . In addition to long-term memory, all the factors in WSM were significantly different before and after Remeron treatment, including the difference between the control group and treatment group. The rate of decrease of HAMD was slightly larger than 50 percent, which indicated that an improvement of the treatment was gained. Through MRI, we found that hippocampal volume is asymmetrical on both sides in every group of the research. （ left smaller than the right side of P 〈 0. 01 ; before the treatment the depressed patients have significantly decreased hippocampal volume on both sides when compared with after treatment group as well as the control group （P 〈 0. 01 ） ; the right amygdala is smaller than that after treatment and the control group （P 〈 0. 01 ） ; Conclusion It prove that the hippocampus and amygdala volume abnormalities of depression may constitute the basis of neurobiolgy. The limbic system plays an important role in the pathogenesis of depression.