未服药双相抑郁与单相抑郁患者多体素磁共振波谱和弥散峰度成像研究

Multivoxel magnetic resonance spectroscopy and diffusion kurtosis imaging in medication-free bipolar and unipolar depression patients

目的:比较双相抑郁和单相抑郁患者脑代谢物及脑部微观结构差异,探索可以用来鉴别双相抑郁和单相抑郁的客观影像学指标。方法:收集2017年9月—2019年1月于汕头大学精神卫生中心门诊就医的20例单相抑郁患者(单相抑郁组)和10例双相抑郁患者(双相抑郁组),另外同期招募20名健康人员(健康对照组),进行T2加权成像、多体素磁共振波谱成像及弥散峰度成像检查。结果:与健康对照组相比,单相、双相抑郁组患者大部分脑区出现了较一致的脑代谢物水平及弥散峰度成像参数的变化,但单相及双相抑郁患者胆碱复合物和谷氨酸的变化在不同脑区则有所不同。双相抑郁患者平均弥散峰度值降低的脑区更加广泛,前扣带回、前额叶白质、左侧丘脑的平均弥散峰度值比单相抑郁组降低(P值均<0.05)。结论:双相抑郁患者脑微观结构受到的损伤比单相抑郁更严重。双相抑郁患者前额叶白质谷氨酸及左侧前额叶白质胆碱复合物浓度升高,可能是单相及双相抑郁在代谢物改变上的重要鉴别点。

Objective:To compare the differences in brain metabolites and brain microstructure between patients with bipolar depression and unipolar depression,and to explore objective imaging indicators that can be used to identify bipolar depression and unipolar depression.Methods:20 patients with unipolar depression(unipolar depression group)and 10 patients with bipolar depression(bipolar depression group)who were treated in the outpatient department of Shantou University Mental Health Center from September 2017 to January 2019 were collected,and an additional 20 healthy individuals(healthy control group)were recruited during the same period.All study subjects underwent T2-weighted imaging,multivoxel magnetic resonance spectroscopy and diffusion kurtosis imaging.Results:Compared with the healthy control group,the unipolar and bipolar depression groups showed more consistent changes in brain metabolite levels and diffusion kurtosis imaging parameters in most brain regions,but changes in choline-containing compounds and glutamate differed in different brain regions in unipolar and bipolar depression patients.The decrease of the mean kurtosis of diffusion in the bipolar depression group was more extensive,and the mean kurtosis of the anterior cingulate gyrus,prefrontal white matter,and left thalamus were lower than that of the unipolar depression group(all P<0.05).Conclusion:Brain microstructure damage is more severe in patients with bipolar depression than in unipolar depression.Increased concentrations of glutamate in the prefrontal white matter and choline-containing compounds in the left prefrontal white matter in patients with bipolar depression may be important distinguishing points for metabolite changes in unipolar and bipolar depression.