双相抑郁患者前额叶及海马磁共振质子波谱成像研究

A 1H magnetic resonance spectroscopy imaging study on the prefrontal lobe and hippocampus in patients with bipolar depressive disorder

目的探讨双相抑郁患者前额叶及海马磁共振质子波谱(proton magnetic resonance spectroscopy,1H-MRS)的代谢物变化特点,为其神经生物学研究提供线索。方法应用磁共振质子波谱成像技术检测26例双相抑郁患者(患者组)和26例单相抑郁患者及13例健康志愿者(对照组)双侧前额叶白质、前扣带回皮质、海马N-乙酰天门冬氨酸(N-Acetylaspartate,NAA)、胆碱(choline,Cho)、肌酸(creatine,Cr)3种代谢物,以Cr为参照物,分别计算双侧NAA/Cr和Cho/Cr比值。采用SPSS 13.0进行统计处理。结果患者组左侧前额叶白质NAA/Cr(1.65±0.31)低于对照组(2.37±0.36),左侧前额叶白质Cho/Cr(1.35±0.27)低于对照组(1.65±0.21),差异有统计学意义(P<0.05);右侧前额叶白质NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组双侧前扣带回NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组双侧海马NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组与单相抑郁组的双侧额叶白质、双侧前扣带回皮质、双侧海马NAA/Cr、Cho/Cr值差异均无统计学意义。结论双相抑郁患者可能存在左侧前额叶神经元功能下降和膜磷脂代谢异常,其代谢物特点存在偏侧化。

Objective To investigate the changes of proton magnetic resonance spectroscopy （^1H-MRS） in the prefrontal lobe and hippocampus in patients with bipolar depressive disorder, and to provide some clues to neurobiology process of bipolar depressive disorder. Methods The N-aeetylaspartate （NAA）, choline-containing compounds （Cho） and creatine （Cr） of the prefrontal white matter, anterior cingulated cortex and hippocampus were studied in 26 patients with bipolar depressive disorder, 26 patients with unipolar disorder and 13 healthy controls. The ratios of NAA/Cr and Cho/Cr were calculated. Results The NAA/Cr and Cho/Cr in the left prefrontal white matter were significantly lower in patients than in normal controls （1.65±0.31 vs 2.37±0.36 and 1.35±0.27 vs 1.65±0.21; P〈 0.01 and P〈 0.05, respectively）. There were no significant difference in NAA/Cr and Cho/Cr in the right prefrontal white matter, anterior cingulated cortex and hippocampus between patients and controls （P 〉 0.05）. There was no significant difference in the ratios of NAA/Cr and Cho/Cr in the prefrontal white matter, anterior eingulated cortex and hippocampus between patients with bipolar depressive disorder and those with unipolar disorder （P 〉 0.05）. Conclusions Patients with bipolar depressive disorder may have neuronal dysfunction and abnormal membrane phospholipid metabolism in the left prefrontal white matter, which is primarily lateralized to the left side.