焦虑性抑郁障碍磁共振成像研究进展

Advance in magnetic resonance imaging of anxious major depressive disorder

焦虑性抑郁障碍(anxious major depressive disorder,AMDD)是抑郁症的一种重要亚型,AMDD有着更频繁的抑郁发作、更严重的症状、更差的治疗反应和结局以及更高比例的自杀企图,但其神经生物机制尚未完全明确。目前AMDD患者大脑结构改变多集中于前额叶、纹状体等灰质区域以及钩束、上纵束、胼胝体等部分白质纤维束;脑功能改变主要位于默认模式网络、执行网络、认知控制网络、突显网络、边缘系统;上述脑区改变与AMDD情绪、认知、执行等功能障碍密切相关。未来的研究应该努力减少临床异质性,明确疾病的定义,拓展关键脑区的研究。文章分别从结构磁共振和功能磁共振成像角度系统综述了AMDD的脑结构与功能改变,促进了对AMDD神经生物学机制的理解,并为疾病的早期识别和开发新的有效的治疗方案提供强有力的证据。

Anxious major depressive disorder(AMDD)is an important subtype of depression,which is noted for more frequent depressive episodes,more severe symptoms,worse outcomes,poor treatment response,and higher incidence of suicide attempts than typical depression.The neurobiological mechanisms underlying AMDD remain unclear.Structural brain alterations in AMDD patients predominantly involve gray matter areas like the frontal lobes and striatum,and white matter tracts including the uncinate fasciculus,superior longitudinal fasciculus,and corpus callosum.Functional changes are primarily observed in the default mode network,executive network,cognitive control network,salience network,and limbic system.These changes are closely associated with AMDD-related dysfunctions in emotion,cognition,and executive processes.Future studies should focus on reducing clinical heterogeneity,refining disease definition,and intensifying research on key brain regions.This review provides a systematic review of structural and functional brain alterations in AMDD from structural and functional magnetic resonance imaging perspectives.It enhances the understanding of AMDD's neurobiological mechanisms and provides robust evidence for the early diagnosis and the development of new effective treatment.