抑郁症患者前扣带回代谢特征与下丘脑-垂体-肾上腺轴活性水平的氢质子波谱研究

Relation of anterior cingulate cortex metabolic characteristics to hypothalamic-pituitary-adrenal axis functional in depressive patients:A 1H-magnetic resonance spectroscope study

目的:用磁共振氢质子波谱的方法探讨抑郁症患者前扣带回(ACC)代谢特征与下丘脑-垂体-肾上腺轴(HPA轴)功能活性的关系。方法:选取68例符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的抑郁症患者及30例正常对照,采用磁共振扫描检测前扣带回氢质子波谱N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、谷氨酸复合物(Glx)及肌醇(mI)等5种代谢物的含量,计算NAA/Cr、Glx/Cr、Cho/Cr、mI/Cr比值。用皮质醇醒觉反应(CAR)检测HPA轴活性,定义为连续2天醒后30 min觉醒时皮质醇浓度差值的均值。根据抑郁症组HPA轴活性均值将抑郁症组分为HPA轴高活性组35例(>6.6 nmol/L)及HPA轴低活性组33例(≤6.6nmol/L)。结果:与正常对照相比,抑郁症患者两侧ACC的NAA/Cr[左侧(1.6±0.5)vs.(2.0±0.5),右侧(1.7±0.4)vs.(2.2±0.5)]和Glx/Cr[左侧(0.1±0.03)vs.(0.1±0.03),右侧(0.1±0.01)vs.(0.2±0.04)]较低(均P<0.05),右侧Cho/Cr较高[(1.5±0.9)vs.(0.9±0.3),P<0.01];与低HPA轴活性组相比,高HPA轴活性组左侧NAA/Cr较低[(1.6±0.4)vs.(1.7±0.4),P<0.05],右侧Cho/Cr较高[(1.7±0.2)vs.(1.2±0.1),P<0.01]。结论:抑郁症患者可能存在双侧前扣带回N-乙酰天门冬氨酸、谷氨酸及胆碱等代谢紊乱,高HPA轴活性可能与部分代谢物质存在相关。

Objective： To investigate the relationship between metabolic characteristics and hypothalamic-pituitary-adrenal axis （HPA） in anterior cingulate lobes （ACC） in depressive patients with 1H-magnetic resonance spectroscope （1H-MRS）. Methods： Totally 68 patients with major depression disorder meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition （DSM-IV） and 30 healthy controls were scanned by magnetic resonance and 1H-MRS data were collected.The bilateral anterior cingulate lobes were selected as region of interest.The levels of N-acetyl aspartic acid （NAA）,choline （Cho）,creatine （Cr）,glutamic acid complexes （Glx） and inositol （mI） were detected.The NAA/Cr,Glx/Cr,Cho/Cr,mI/Cr ratios were calculated.Cortisol awakening response （CAR） method was used to detect the activity of the HPA axis.The depressive patients were divided into high activity group （n=35） and low activity group （n=33） according to the mean HPA activity level （6.56 nmol/L）. Results： Compared with the healthy group,depressive group showed lower NAA/Cr[left （1.6±0.5） vs.（2.0±0.5）,right （1.7±0.4） vs.（2.2±0.5）] and Glx/Cr ratios[left （0.1±0.03） vs.（0.1±0.03）,right （0.1±0.01） vs.（0.2±0.04）] in bilateral ACC lobes and higher Cho/Cr ratios[（1.5±0.9） vs.（0.9±0.3）] in right ACC lobe （Ps〈0.05）.Compared with the low HPA activity group,the high HPA activity group had lower NAA/Cr[（1.6±0.4） vs.（1.7±0.4）] in left ACC and higher Cho/Cr[（1.7±0.2） vs.（1.2±0.1）] in right ACC （Ps〈0.05）. Conclusion： Depressive patients show metabolic abnormalities in bilateral ACC,involving NAA,Glx and Cho metabolism;HPA axis function levels are possibly related to some substance metabolic abnormalities in ACC.