伴自杀意念青少年抑郁症患者动态脑功能改变与皮质醇水平的相关分析

Correlation between dynamic brain function changes and cortisol in adolescents with major depressive disorder who have suicidal ideation

目的探讨伴或不伴自杀意念青少年抑郁症患者动态脑功能改变及其与下丘脑-垂体-肾上腺轴的促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)和皮质醇激素水平的相关性。方法收集2018年3月至2021年1月暨南大学附属第一医院精神心理科门诊或住院抑郁症患者,采用静息态功能磁共振成像对48例青少年伴自杀意念抑郁症患者(MDD+SI)、38例不伴自杀意念抑郁症患者(MDD-SI)和41名健康对照者(对照组)进行扫描,采用滑动时间窗分析方法,计算3组动态局部一致性(dynamic regional homogeneity,dReHo)和动态功能连接(dynamic functional connectivity,dFC)值;在完成扫描后24 h内静脉采血,采用直接化学发光法测定ACTH和皮质醇水平。采用单因素协方差分析比较3组dReHo和dFC值,采用单因素方差分析比较3组激素水平。提取3组差异有统计学意义的脑区的dReHo和dFC值采用最小显著差异法校正进行事后检验,并与激素水平进行偏相关分析。结果3组间dReHo值差异有统计学意义的脑区为右侧小脑后叶(主要是CrusⅡ和Crus I)(F=9.44,P<0.001)及左侧楔前叶(F=10.93,P<0.05)。3组间dFC值差异有统计学意义的脑区为左侧楔前叶与左侧颞中回(F=9.60,P<0.001),左侧楔前叶与双侧楔前叶(F=9.66,P<0.001)。与对照组和MDD-SI组比较,MDD+SI组皮质醇水平较低(P=0.013、0.039),3组间ACTH水平差异无统计学意义。MDD+SI组左侧楔前叶dReHo值(r=0.350,P=0.018)、左侧楔前叶-左侧颞中回dFC值(r=0.362,P=0.015)均与皮质醇水平呈正相关。结论伴或不伴自杀意念青少年抑郁症患者均存在楔前叶和颞中回的动态功能改变;而小脑的动态功能改变可能为伴自杀意念抑郁症患者的特异性改变。伴自杀意念患者楔前叶和颞中回动态脑功能异常与其皮质醇水平异常存在相关性。

Objective:To investigate the dynamic brain function changes in adolescent depression patients with or without suicidal ideation,and to explore the characteristics and the hypothalamus-pituitary-adrenal axis of adrenocorticotropic hormone(ACTH)and the potential correlation between levels of the hormone cortisol.Methods:From March 2018 to January 2021,the First Affiliated Hospital of Jinan University conducted a study involving 48 adolescent patients with major depressive disorder(MDD)who have suicidal ideation(MDD+SI),38 MDD patients without suicidal ideation(MDD-SI),and 41 healthy control participants(HC).The study utilized resting state functional magnetic resonance imaging(fMRI)to analyze the brain activity of these individuals.The dynamic local consistency(dReHo)and dynamic functional connection(dFC)values for the three groups were computed utilizing a sliding time window analysis technique.Blood samples were obtained within 24 hours following the completion of the MRI scan to quantify ACTH and cortisol levels via direct chemiluminescence.A one-way analysis of covariance was employed to compare the dReHo and dFC values among the three groups,while a one-way analysis of variance was utilized to compare the hormone levels across the three groups.Significant differences in dReHo values among the three groups were identified in specific regions,as well as in dFC values,using the least significant differences method correction following inspection(P<0.05).Additionally,a partial correlation analysis was conducted to investigate the relationship between these dynamic indexes and hormone levels.Results:The difference of dReHo values among the three groups was found in the right posterior cerebellum(mainly CrusⅡand Crus I)(F=9.44,P<0.001),and the left precuneus(F=10.93,P<0.05).There were significant differences in dFC values between the three groups in the left precuneus and left middle temporal gyrus(F=9.60,P<0.001),and the left precuneus with bilateral precuneus(F=9.66,P<0.001).The correlation analysis revealed a positive relationship between the decreased dReHo(r=0.350,P=0.018)variability in the left precuneus,the decreased dFC(r=0.362,P=0.015)variability between the left precuneus and the left middle temporal gyrus(MTG),and the decreased cortisol level(P=0.013,0.039)in the group of MDD+SI.Conclusion:Adolescents diagnosed with MDD,both with and without suicidal ideation,exhibit dynamic functional alterations in the precuneus and middle temporal gyrus.The cerebellar function changes appear to be unique to those with suicidal ideation.Furthermore,the aberrant dynamic brain function observed in the precuneus and middle temporal gyrus is associated with abnormal cortisol levels in individuals with suicidal ideation.