伴自杀意念首发抑郁症患者小脑-大脑功能连接的fMRI研究

The changes of cerebellar-cerebral functional connectivity in first-episode depression patients with suicidal ideation:a functional magnetic resonance imaging study

目的:基于静息态fMRI探讨伴自杀意念的首发抑郁症患者小脑-大脑功能连接(FC)的改变。方法:前瞻性将2018年2月-2022年1月在本院就诊的58例伴自杀意念(SI组)和42例不伴自杀意念的抑郁症患者(NSI组)以及49例相匹配的健康志愿者(HC组)纳入本研究,对所有被试行静息态fMRI扫描。分别在双侧小脑的Crus-Ⅰ、-Ⅱ、-Ⅴ、-Ⅵ和蚓部勾画ROI,采用基于种子点的FC分析方法计算抑郁症患者小脑各ROI与大脑的FC值。对所有抑郁症患者进行抑郁相关的临床量表评估,包括24项汉密尔顿抑郁量表(HAMD24)和Beck自杀意念量表中文版(BSI-CV),HAMD24评分包括HAMD24总分及焦虑/躯体化、体质量、认知障碍、日夜变化、阻滞、睡眠障碍和绝望感共7项因子的评分;BSI-CV评分包括自杀意念因子和自杀危险因子两项评分。采用Pearson或Spearman相关分析对组间差异有统计学意义的小脑-大脑FC值(SI组、NSI组和HC组两两比较)与临床变量(病程、HAMD24评分和BSI-CV评分)进行相关性分析。结果:与HC组相比,SI组和NSI组的小脑与颞上回、中央前回、中央钩盖、中央旁小叶的FC值升高,小脑与额中回、颞叶、角回和后扣带回的FC值降低;与NSI组相比,SI组的小脑与颞中回和颞下回的FC值升高,与右侧角回的FC值降低。右侧小脑Crus-Ⅰ与大脑间的FC值与HAMD24总分及阻滞、体质量、日夜变化和认知障碍四项因子的评分均呈负相关(r=-0.308、-0.315、-0.273、-0.311、-0.263,P均<0.05);左侧小脑Crus-Ⅰ与额中回和后扣带回的FC值与体质量因子评分之间均呈负相关(r=-0.295、-0.289,P均<0.05),左侧小脑Crus-Ⅰ与颞上回的FC值与自杀危险因子评分呈负相关(r=-0.277,P<0.05),左侧小脑Crus-Ⅰ与中央钩盖的FC值与体质量因子评分呈正相关(r=0.278,P<0.05);左侧小脑Crus-Ⅰ与中央旁小叶的FC值与睡眠障碍因子评分呈正相关(r=0.382,P<0.05)。结论:静息态fMRI证实伴自杀意念的抑郁症患者的小脑与大脑之间的功能连接出现了紊乱,主要发生于执行网络和默认模式网络,从而为伴自杀意念抑郁症患者发病机制的研究提供了新思路。

Objective:To investigate the changes of cerebellar-cerebral functional connectivity(FC)in first-episode depression patients with suicidal ideation based on resting-state fMRI.Methods:From February 2018 to January 2022,58 depression patients with suicidal ideation(SI group),42 depression patients without suicidal ideation(NSI group)and 49 matched healthy controls(HC group)were prospectively recruited in this study.All subjects underwent resting-state functional magnetic resonance imaging.The regions of interest(ROIs)were drawn at lobules of Crus-Ⅰ、-Ⅱ、-Ⅴ、-Ⅵand vermis of bilateral cerebellum.Seed-based FC analysis method was used for measuring resting-state cerebellar-cerebral FC patterns in all ROIs.The patients with depression were evaluated by depression-related clinical scales,including Hamilton Depression Scale(HAMD24)and Beck scale for suicide ideation-Chinese version(BSI-CV).The HAMD24 scores included the total score of HAMD24 and the scores of seven factors:anxiety/somatization,weight loss,cognitive disturbance,diurnal variation,retardation,sleep disturbance and despair.BSI-CV score included SI factor and suicide risk factor.Pearson or Spearman correlation analysis was used to analyze the correlation between cerebellar-cerebral FC values with statistical significance among groups(multiple comparison among SI,NSI and HC groups)and clinical variables(illness duration,HAMD24 score,and BSI-CV score).Results:Compared with HC group,SI group and NSI group showed significantly increased cerebellar-cerebral FC in superior temporal gyrus,precentral gyrus,rolandic operculum and paracentral lobule,and decreased cerebellar-cerebral FC in middle frontal gyrus,temporal lobe,angular gyrus and posterior cingulate gyrus.Compared with NSI group,SI group showed increased cerebellar-cerebral FC in middle and inferior temporal gyrus.Moreover,cerebellar-cerebral FC in right angular gyrus in SI group was lower than that in NSI group.The values of abnormal cerebellar-cerebral FC of right Crus-Ⅰwere negatively correlated with the total HAMD24 score,and the scores of HAMD24 factors including retardation,weight loss,diurnal variation,and cognitive disturbance(r=-0.308,-0.315,-0.273,-0.311 and-0.263,respectively;all P<0.05).The FC values between left Crus-Ⅰof cerebellum and middle frontal gyrus and posterior cingulate gyrus were negatively correlated with the weight loss factor score(r=-0.295,-0.289,respectively;all P<0.05),and the FC values of left Crus-Ⅰof cerebellum and superior temporal gyrus were negatively correlated with the suicide risk factor score(r=-0.277,P<0.05).While the FC va-lues between left Crus-Ⅰof cerebellum and rolandic operculum were positively correlated with the weight loss factor score(r=0.278,P<0.05).The FC values of left Crus-Ⅰand paracentral lobule were positively correlated with the scores of sleep disorder factor(r=0.382,P<0.05).Conclusion:Based on resting-state fMRI,cerebellar-cerebral FC in depression patients with suicidal ideation has changed,mainly occurred in executive and default-mode networks,thus providing a new idea for the study of the pathogenesis of depression patients with suicidal ideation.