个体化经颅磁治疗产后抑郁的脑影像研究

Individualized Transcranial Magnetic Therapy Postpartum Depression Base on fMRI

目的产后抑郁症(postpartum depression,PPD)属于抑郁症的一种亚型,不但严重影响家庭及工作的正常运行,甚至会产生自杀意念。随着神经成像技术的发展让我们更深一步了解了PPD脑损伤的机制,即前额叶-脑岛-杏仁核环路的异常代谢活动可能介导了PPD的发病。最近斯坦福加速智能神经调节疗法对耐药性抑郁症具有较高的缓解率,可能是临床快速治疗PPD的有效疗法。本研究拟明确个体化靶向(transcranial magnetic stimulation,TMS)治疗PPD的临床疗效与脑影响变化的关系。方法收集32例个体化经颅磁治疗前后的PPD患者(functional magnetic resonance imaging,fMRI)数据,并与32名健康对照的脑影响进行比较,并基于体素的镜像同伦连接性分析(voxel-mirro red homotopic connectivity,VMHC)治疗前后患者大脑半球功能连接的变化。结果发现经过TMS治疗后患者的汉密尔顿抑郁症量表(hamilton depression scale,HAMD-17)、爱丁堡产后抑郁量表(edinburgh postnatal depression Scale,EPDS)等与大脑半球间/内的功能连接均发生变化,特别是PPD患者在经过rTMS治疗后额叶、脑岛、杏仁核等脑区减少的镜像同伦连接性在治疗后表现出重组。此外,在rTMS治疗后左右脑岛之间连接性的增加与EPDS得分的降低显著相关。结论我们的结果揭示了人类大脑半球间/内的功能连接异常可能是导致PPD的关键因素,并为rTMS高效缓解PPD的病理机制和临床应用提供了证据。

ObjectivePostpartum depression disorder(PPD)is a subtype of depression,which not only seriously affects the normal operation of family and work,but even leading to suicidal ideation.With the development of neuroimaging technology,we have discovered the brain mechanism of PPD,and find that abnormal metabolic activity of the prefrontal-insula-amygdala circuit may mediate the pathogenesis of PPD.Recently,stanford accelerated intelligent neuromodulation therapy has a high responses rate for drug-resistant depression and it perhaps was an effective protocol for rapid remission PPD.This study tries to clarify the relationship between clinical efficacy of individualized targeted TMs treatment of PPD and the connectivity changes in brain.MethodsThe functional magnetic resonance imaging(fMRI)data of 32 patients with PPD before and after individualized transcranial magnetic therapy(transcranial magnetic stimulation,TMs)were collected,compared with the brain effects of 32 healthy controls,and the changes of cerebral hemisphere functional connectivity before and after treatment were analyzed based on Voxel Mirror Homotopic Connectivity.ResultsThe result of this research showed that the functional connections between Hamilton Depression scale(HAMD-17),the Edinburgh Postpartum Depression scale(EPDs)and cerebral hemispheres changed after TMs treatment,especially the Mirror Homotopic connectivity of the frontal,insula and amygdala were decreased in PPD,which showed recombination after rTMs therapy.In addition,increased connectivity between left and right insulas after rTMs therapy was significantly associated with the decrease of EPDs score.ConclusionOur results reveal that the abnormal lateral hemisphere functional connectivity was the biomarker of PPD,meanwhile provide evidence for pathological mechanism and clinical application of using rTMs therapy PPD.