抑郁症患者童年创伤经历对其脑区功能及人格特征的影响

Influence of childhood traumatic experience of depression patients on brain function and personality characteristics

目的?探索抑郁症患者的童年创伤经历对其脑区功能和人格特征的影响。方法采用匹配病例对照研究设计,收集重庆医科大学附属第一医院精神科门诊病例,通过年龄、性别、受教育年限、抑郁严重程度等配对有童年创伤经历(观察组)与无童年创伤经历(对照组)的抑郁症患者各25例。以两组患者静息态功能磁共振成像监测的脑区激活自发低频振幅(mALFF)信号、功能连接(FC)及大五人格问卷为观察指标,比较两组患者各项指标的差异。结果经体素水平P<0.001、团块水平P<0.05的高斯随机场(GRF)校正,观察组左侧海马/海马旁回脑区及右侧楔前叶脑区的mALFF信号值低于对照组。外向性、开放性、宜人性、责任心这4个大五人格问卷分量表的得分两组间比较差异无统计学意义(P均>0.05),而观察组神经质分量表得分较对照组高,差异有统计学意义(P<0.01)。两组患者左侧海马/左侧海马旁回脑区及右侧楔前叶脑区mALFF信号值与神经质分量表得分均呈负相关(r=-0.397,P<0.01;r=-0.401,P<0.01)。与对照组相比,观察组左侧海马与右侧颞上回连接增加,与左侧中央后回连接减弱。结论有童年创伤经历的抑郁症患者左侧海马/左侧海马旁回及右侧楔前叶的脑区功能受损更重,更具神经质人格特质。本研究同时提示可能存在屏蔽创伤记忆过度唤起的脑保护神经影像学机制。

Objective To explore the impacts of childhood traumatic experience of depression patients on the brain function and personality characteristics.Methods A matched case-control study design was used to recruit the outpatients of Department of Psychiatry,the First Affiliated Hospital of Chongqing Medical University.Depression patients with or without childhood traumatic experience(observation group or control group,n=25)were matched by age,gender,years of education,and severity of depression.The resting state functional magnetic resonance brain spontaneous amplitude of lowfrequency fluctuation(mALFF)signal,functional connectivity(FC)and the neuroticism extraversion openness five-factor inventory(NEO-FFI)were used as observation indexes to compare the differences between the 2 groups.Results Corrected by the Gauss random field(GRF)with voxel level P<0.001 and mass level P<0.05,the mALFF signal values in the left hippocampus/parahippocampal gyrus and in the right precuneus in the observation group were significantly lower than those in the control group.There were no significant differences between the 2 groups in extraversion,openness,agreeableness or responsibility of NEO-FFI(all P>0.05),while the score of neuroticism in the observation group was significantly higher than that in the control group(P<0.01).There were negative correlations between neuroticism score and mALFF signal value in left hippocampus/left parahippocampal gyrus or right precuneus in both groups(r=-0.397,P<0.01;r=-0.401,P<0.01).Compared with the control group,the functional connection between the left hippocampus and the right superior temporal gyrus was increased,and the functional connection between the left hippocampus and the left central posterior gyrus was decreased in the observation group.Conclusion The function of left hippocampus/left parahippocampal gyrus and right precuneus is more greatly impaired in depression patients with childhood traumatic experience,and they have more neurotic personality traits.At the same time,this study suggests that there may be a brain protective neuroimaging mechanism to shield the excessive arousal of traumatic memory.