轻度抑郁障碍患者五音疗法治疗前后脑改变的磁共振成像研究

Research on magnetic resonance imaging of brain changes in patients with mild depressive disorder before and after pentatonic therapy

目的基于多模态磁共振评估五音疗法治疗轻度抑郁障碍患者治疗前后的脑改变。方法纳入自2021年1月至2022年6月精神心理科就诊的轻度抑郁障碍患者250例,按照随机数表法分为试验组200例,对照组50例。试验组给予为期8周的五音疗法治疗干预,对照组仅常规随访。通过比较两组患者治疗前后心理学量表差异判定五音疗法疗效。比较两组全脑结构、差异脑区及相应脑区弥散张量成像各向异性分数(FA)值的变化,表征五音疗法治疗有效的轻度抑郁障碍患者的特异性脑改变。结果试验组经五音疗法治疗后17项汉密尔顿抑郁评分标准(HAMD)和汉密尔顿焦虑量表(HAMA)评分减低,差异有统计学意义(P<0.05),左侧杏仁核及右侧额上回灰质体积较治疗前缩小,左侧额上回、额中回、额下回、右侧杏仁核及双侧扣带回、海马体的灰质体积较治疗前增加,且左侧额上回、额中回、额下回、双侧扣带回、海马体及杏仁核灰质体积变化百分比随HAMA减分率增加而增加,差异有统计学意义(P<0.05),右侧额中回、额下回及双侧纹状体、扣带回、海马体FA值治疗后较治疗前提高,差异有统计学意义(P<0.05)。治疗后一般症状及体征中面色、思维反应、目光、情志、睡眠情况有所好转,差异有统计学意义(P<0.05);性功能、口舌未见明显好转,差异无统计学意义(P>0.05)。结论五音疗法对于轻度抑郁障碍患者的治疗效果显著,并存在不同脑区的特异性改变,多模态磁共振可以用作为表征抑郁障碍患者脑改变的神经影像学工具,为临床诊断及评估抑郁障碍提供定量影像学支持。

Objective To evaluate the brain changes in patients with mild depressive disorder before and after pentatonic therapy based on multimodal magnetic resonance imaging.Methods A total of 250 patients with mild depressive disorder in the Department of Psychiatry from January 2021 to June 2022 were included,and they were divided into the experimental group(n=200)and the control group(n=50)according to the random number table method.The experimental group was treated with pentatonic therapy for 8 weeks,while the control group was only followed up regularly.The therapeutic efficacy of pentatonic therapy was judged by comparing the difference of psychological scale between the two groups of patients before and after treatment.The changes of the whole brain structure,different brain regions and the fractional anisotropy(FA)of diffusion tensor imaging between the two groups were compared,and the specific brain changes of patients with mild depressive disorder who were effectively treated by pentatonic therapy were characterized.Results After pentatonic therapy,the scores of Hamilton depression rating scale(HAMD)-17 and Hamilton anxiety scale(HAMA)in the experimental group decreased,with statistically significant differences(P<0.05).The gray matter volumes of left amygdala and right frontal gyrus decreased compared with those before treatment,while those of left frontal gyrus,middle frontal gyrus,inferior frontal gyrus,right amygdala,bilateral cingulate gyrus and hippocampus increased compared with those before treatment,and the percentage changes of gray matter volumes of left frontal gyrus,middle frontal gyrus,inferior frontal gyrus,bilateral cingulate gyrus,hippocampus and amygdala increased with the increase of HAMA reduction rate,with statistical significance(P<0.05).After treatment,the FA values of right middle frontal gyrus,inferior frontal gyrus,bilateral corpus striatum,cingulate gyrus and hippocampus increased compared with those before treatment,with statistically significant differences(P<0.05).After treatment,the general symptoms and signs,such as complexion,thinking reaction,eyes,emotion and sleep,improved,with statistically significant differences(P<0.05).The sexual function and tongue did not improve significantly,without statistically significant differences(P>0.05).Conclusion Pentatonic therapy is effective for patients with mild depressive disorder,and there are specific changes in different brain regions.Multimodal magnetic resonance can be used as a neuroimaging tool to characterize the brain changes of patients with depressive disorder,and provide quantitative imaging support for clinical diagnosis and evaluation of depressive disorder.