认知行为治疗对强迫症患者认知控制网络功能连接的影响

The effect of cognitive behavioral therapy on the functional connectivity of cognitive control network in patients with obsessive-compulsive disorder

目的 探讨认知行为治疗（cognitive behavioral therapy,CBT）对强迫症患者认知控制网络功能连接的影响.方法 纳入45例强迫症患者（患者组）及与之相匹配的健康对照者45名（对照组）,由4名治疗师为患者提供12周CBT.所有被试者均在基线及第12周末进行临床症状评估和磁共振扫描.由精神科医师应用SCID-Ⅰ、Y-BOCS、HAMD17和HAMA进行临床诊断和症状评估,分析患者治疗前后的临床症状变化;采用GRETNA软件包对静息态fMRI数据进行预处理,以Power264功能脑区的模板作为网络节点构建全脑功能网络,计算认知控制网络外部的功能连接强度,采用重复测量方差分析2组脑网络功能连接的变化.结果 共41例患者完成了CBT,患者组第12周末时强迫症状、焦虑症状、抑郁症状评分均较基线期下降,其中32例患者治疗有效（Y-BOCS减分率≥35％）.治疗有效的患者及对照者单因素重复测量方差分析及事后检验显示：（1）扣带回-岛盖控制网络与突显网络间功能连接值基线期患者组低于对照组（0.172±0.060与0.215±0.076,t=1.731,P=0.040）,患者组第12周末（0.186±0.171）较基线期功能连接值升高（t=2.480,P=0.010）.（2）扣带回-岛盖控制网络与皮质下网络功能连接值基线期患者组低于对照组（0.119±0.081与0.129±0.070,t=1.640,P=0.040）,患者组第12周末（0.130±0.161）较基线期功能连接值升高（t=2.421,P=0.020）.（3）额-顶控制网络与皮质下网络间功能连接值基线期患者组低于对照组（-0.004±0.039与0.021±0.054,t=2.280,P=0.020）,患者组第12周末（0.020±0.042）较基线期功能连接值升高（t=-2.300,P=0.020）.结论 CBT有效改善强迫症患者强迫症状的同时,可提高患者大脑认知控制网络的外部功能连接强度.

Objective To investigate the regulatory effect of cognitive behavioral therapy （CBT） on the functional connectivity of cognitive control network in untreated obsessive-compulsive disorder （OCD） patients,so as to provide evidence for understanding the neurobiological mechanism of CBT.Methods A total of 45 OCD patients and 45 matched normal controls were recruited at the outpatient clinic in Beijing Anding Hospital.Four therapists provided 14 times of CBT treatment for OCD patients.All subjects underwent clinical symptom assessment and magnetic resonance imaging at baseline and at the end of 12 weeks.The clinical symptoms were assessed by the psychiatrists using Y-BOCS,HAMD17 and HAMA.The clinical symptoms of OCD patients before and after CBT treatment were compared.The GRETNA software package was used to preprocess the resting-state fMRI data.The whole brain function network was constructed with the template of Power 264 functional brain area as the network node.The function connection intensity outside the cognitive control network was calculated,and the function connection of 2 groups of brain networks at two timepoints were compared by repeated measurement of variance analysis.Results A total of 41 patients completed CBT.The scores of obsessive-compulsive symptoms,anxiety symptoms and depressive symptoms decreased at the end of 12th week,of which 32 patients were improved （Y-BOCS reduction ≥35%）.Single factor repeated analysis of variance and post hoc tests were performed between patients with improvement and normal controls.At baseline,the functional connection between the cingulo-opercular network and the salience network of OCD patients was lower than that of the normal control （0.172±0.060 vs.0.215±0.076,t=1.731,P=0.040）,it increased after treatment （0.186±0.171 vs.0.172±0.060,t=2.480,P=0.010）.At baseline,the functional connection of cingulo-opercular network and subcortical network in OCD patients was lower than that of normal control （0.119±0.081 vs.0.129±0.070,t=1.640,P=0.040）,and it increased after treatment （0.130±0.161 vs.0.119±0.081,t=2.421,P=0.020）.At baseline,the functional connection between the frontal-parietal network and subcortical network was lower than that of normal controls （-0.004 ± 0.039 vs.0.021 ± 0.054,t=2.280,P=0.020）,and it increased after treatment （0.020±0.042 vs.-0.004±0.039,t=-2.300 P=0.020）.Conclusions CBT could effectively improve obsessive-compulsive symptoms accompanying with improvement of the external functional connectivity of cognitive control network in OCD patients.