基于定量磁共振波谱探讨重度抑郁症患者海马代谢与治疗反应的关系

Evaluation of treatment response of patients with major depressive disorder based on quantitative magnetic resonance spectroscopy

目的应用定量磁共振波谱(MRS)技术探讨重度抑郁症患者海马代谢与治疗反应的关系。方法收集2018年3月至2020年3月江苏大学附属医院45例和2020年8月至2022年8月嘉兴市第一医院8例共53例重度抑郁症患者,2018年3月至2020年3月江苏大学附属医院20名和2020年8月至2022年8月嘉兴市第一医院7名共27名健康志愿者。对两组对象进行MRS扫描,以定量波谱后处理软件进行海马中乙酰天门冬氨酸盐(NAA)、胆碱(Cho)、肌酸(Cr)及谷氨酸盐复合物(Glx)代谢的预处理分析。应用17项汉密尔顿抑郁量表(HDRS-17)评估抑郁患者的抑郁程度。采用Pearson相关分析治疗前后代谢物变化与HDRS-17评分变化之间的关系。结果重度抑郁组海马中Cho、NAA及Glx水平均明显低于健康对照组(均P<0.05);治疗后,非难治性抑郁患者海马中NAA、Cho及Glx水平均出现了逆转,而难治性抑郁患者中除Cho较治疗前升高外,其他代谢物与治疗前比较差异均无统计学意义(均P>0.05)。另外,NAA水平变化与HDRS-17评分变化呈负相关(r=-0.632,P<0.01)。结论通过MRS为重度抑郁患者治疗后海马神经修复效应提供了在体证据,即d NAA可能是观察治疗反应的主要神经影像学指标。

Objective To investigate the characteristics of metabolism in the hippocampus of major depression(MDD)patients and healthy people by using quantitative magnetic resonance spectroscopy(MRS).Methods Fifty-three major depressive patients(MDD group,45 MDD patients were from the Department of Neurology Outpatients of the Affiliated Hospital of Jiangsu University from March 2018 to March 2020,and 8 MDD patients were from the Department of Neurology Outpatients of Jiaxing First Hospital from August 2020 to August 2022)before and after treatment and 27 healthy controls(healthy control group,there were 20 healthy volunteers from the Affiliated Hospital of Jiangsu University from March 2018 to March 2020 and 7 healthy volunteers from Jiaxing First Hospital from August 2020 to August 2022)underwent MRS scan,pretreatment analysis of NAA,Cho,Cr and Glx in hippocampus with quantitative spectrum post-processing software,and SPSS V.24.0 and GraphPad 7.0 were used for statistical analysis and graphical processing.The degree of depression before and after treatment were assessed by Hamilton depression scale(HDRS)17 item versions.Results Before treatment,Cho,NAA and Glx concentrations in hippocampus of MDD group were significantly lower than the healthy control group(P<0.05).After treatment,the concentrations of NAA,Cho,and Glx in the hippocampus of patients with non-refractory depression(n-RD)all reversed.However,except for Cho,other metabolites in patients with refractory depression(RD)were no significant difference than before.Moreover,this study found that only changes in NAA levels(dNAA)were negatively correlated with changes of HDRS-17(dHDRS).Conclusion Furthermore,we provided the first evidence in patients with MDD for neurorestorative effects in the hippocampus by MRS,dNAA was a major neuroimaging indicator to observe the treatment response.