双相抑郁患者全脑皮层厚度和皮层表面积的异常变化

Changes of cortical thickness and cortical surface area in patients with bipolar depression

目的 探讨处于抑郁症状期的双相障碍（bipolar disorder,BD）患者脑灰质皮层厚度和皮层表面积的异常变化,以及灰质皮层的异常改变与临床症状的关系.方法 对28例双相障碍重性抑郁发作期患者、28例健康对照进行3.0 T磁共振扫描,采集得到的3DT1数据采用freesurfer软件进行自动化处理,计算并比较全脑66个区域（左右半球各33个）的灰质皮层厚度和表面积数值,并与临床资料进行相关分析.结果 患者组左眶额叶内侧[（2.40±0.12） mm]、左背侧前扣带回[（2.66±0.21） mm]皮层厚度较正常对照组[（2.55±0.18） mm;（2.88±0.27） mm]显著下降（P=1.2× 10^-3;P=3.1×10^-4）.患者组左楔叶[（1 443.13± 131.00） mm^2]、右额上回[（6 634.70±600.16） mm2]皮层表面积较正常对照组[（1 596.93± 126.58）mm^2;（7 300.50±653.39）mm2]显著减小（P=2.7×10^-4;p=1.3×10^-3）.进一步与临床资料的相关分析发现患者组左楔叶皮层表面积与有效病程显著负相关（r=-0.494,P=0.027）,背侧前扣带回皮层厚度和汉密尔顿17项量表总分显著负相关（r=-0.513,P=0.016）.结论 双相障碍重性抑郁发作期患者情绪环路主要脑区的皮层厚度和表面积均发生异常变化,但区域并不完全重叠,相关分析提示皮层厚度与表面积分别与不同的临床特征相关.

Objective To investigate the changes of cortical thickness and surface area in patients with bipolar depression（BD）,and to explore the relationship between abnormal changes in gray matter and clinical symptoms.Methods 28 BD patients and 28 healthy controls underwent T1-weighted MRI.The Freesurfer software was used to process the T1 images,which used a set of automated sequences to analyze cortical thickness and surface area on 66 regions （33 regions of each hemisphere）,and the correlation with clinical features was also calculated.Results Compared with controls,BD patients showed thinner cortical thickness in left medial orbitofrontal cortex（（2.40±0.12） mm vs （2.55 ±0.18） mm,P=1.2× 10^-3） and left rostral anterior cingulate（（2.66±0.21） mm vs （2.88±0.27） mm,P=3.1 ×10^-4）,and smaller area of left cuneus（（1 443.13± 131.00） mm2vs （6 634.70±600.16） mm2,P=2.7×10^-4） and right superior frontal gyrus （（6 634.70±600.16） mm2vs （7 300.50±653.39） mm2,P=1.3× 10^-3）.In addition,the negatively correlation was found between the cortical area of left cuneus and effective illness duration （r=-0.471,P=0.018）,and the cortical thickness in left rostral anterior cingulate and total score of HAMD-17（17-item Hamilton Rating Scale for Depression） （r=-0.508,P=0.009）.Conclusion There are abnormal altertion of cortical thickness and cortical areas of emotional circuit in bipolar depression,but the brain areas are not completely overlapping.Correlation analysis suggests that cortical thickness and area is related to different clinical features.