膝下前扣带回-边缘相关脑区功能连接对抗抑郁疗效的早期预测作用

Study on functional connectivity between the subgenual anterior cingulate cortes and limbic cortices in predicting the efficacy of early antidepressant treatment outcome

目的以膝下前扣带回到边缘系统相关脑区的功能连接为基础，寻找早期抗抑郁治疗疗效预测的生物学指标。方法随机入组32例抑郁症患者及20例健康对照，利用脑磁图数据计算基线膝下前扣带回到杏仁核、海马的theta波功能连接，以抗抑郁治疗2周后17项汉密尔顿抑郁量表（HAMD17）总分减分率是否50％为标准划分患者为早期疗效有效组和无效组。比较各组功能连接，分析其与治疗2周后HAMD17，减分率的相关性。结果与对照组相比，抑郁症组膝下前扣带回与右侧杏仁核（MNI坐标：z=22，y=-2，Z=-15；F=6．90，P=0．012）、左侧杏仁核（MNI坐标：x=-24，y=-6，z=-16；F=5．75，P=0．020）、右侧海马（MNI坐标：x=30，y=-3，Z=-24；F=5．11，P=0．028）功能连接减弱。与治疗无效组相比，有效组膝下前扣带回与右侧杏仁核（F=12．417，P=0．0016）、右侧海马（F=8．74，P=0．0065）的功能连接较小。膝下前扣带回-右侧杏仁核（r=-0．56，P=0．0018）、膝下前扣带回-右侧海马（r=-0．50，P=0．0066）的功能连接与2周后HAMD17减分率呈负相关。ROC分析提示膝下前扣带回与右侧杏仁核[曲线下面积（area under cuwe，AUC）=0．73，JP=0．029]、右侧海马（AUC=0．71，P=0．042）可区分2周治疗效果。结论膝下前扣带回与右侧海马、右侧杏仁核基线时较高功能连接预示着较差的早期疗效，提示可能是抑郁症早期疗效预测的生物学指标。

Objective To explore the role of functional connectivity （FC） between the subgenual anterior cingulate cortes （sgACC） and limbie cortices in predicting the efficacy of early antidepressant treatment. Methods Resting state magnetoencephalography （MEG） data were collected from 32 patients with major depressive disorder（MDD） and 20 matched healthy control subjects at baseline.According to whether the HAMDI7 total score reduction rate reached 50% after 2 weeks, the patients were divided into responder group and non-responder group.The difference of the FC, the relationship between the FC and the change rate of HAMD17 were explored. Results Compared with controls, MDD patients showed decreased connectivity of the sgACC with the right hippocampus （ MNI coordinate ： x = 30, y = - 3, z = - 24 ; F= 5.11, P= 0.028 ）, the right amygdala （ MNI coordinate ： x = 22, y = - 2, z = - 15 ; F= 6.90, P = 0.012 ） and the left amygdala （ MNI coordi-nate： x = -24, y = - 6, z =- 16 ; F= 5.75, P = 0.020 ）. Compared with non-responders, the connectivity of the sgACC with the right hippocampus （ MNI coordinate ： x = 30, y = - 3, z = - 24 ; F= 8.74, P= 0.0065 ）, the right a- mygdala（ MNI coordinate ：x= 22 ,y= -2 ,z= - 15 ; F= 12.417 ,P- 0.0016） were higher in responders.Pretreatment connectivity of the sgACC with the right hippocampus （ r = - 0.50, P= 0.0066 ）, the right amygdala （ r = -0.56, P= 0.0018） were negatively correlated with clinical improvement.ROC analyses confirmed the value of the connectivity of sgACC with the right hippocampus （ area under curve （ AUC ） = 0.71, P= 0.042 ） , the right amygdala（ AU C = 0.73, P= 0.029） in classifying responders versus non-responders in 2 weeks of treatment. Conclusion The decreased FC of the sgACC with the right hippocampus and the right amygdala at baseline is associated with a better improvement ,which can potentially serve as a treatment outcome biomarker in early curative effect of depression.