广泛性焦虑障碍患者脑灰质体积改变特点及其与疗效的相关性研究

Aberrant gray matter volume in generalized anxiety disorder and its correlation with efficacy of escitalopram treatment

目的探索广泛性焦虑障碍的脑灰质体积(GM)变化特点,以及这些变化与艾司西酞普兰疗效之间的相关性。方法使用1.5T磁共振扫描仪,比较38例广泛性焦虑障碍患者(研究组)及30例性别、年龄、受教育年限相匹配健康对照(对照组)的GM差异;研究组给予艾司西酞普兰可变剂量10～20mg/d治疗8周,治疗8周末比较痊愈患者与未痊愈患者治疗前GM差异,运用DEPASF4.3 Advanced Edition软件处理影像数据,进行全脑GM比较并分析相关因素。结果研究组在右侧眶部额下回及左侧颞中回脑GM值均显著低于健康对照组(P<0.05,Alphasim校正);研究组左侧梭状回GM值与治疗前HAMA评分呈负相关(P<0.05,Alphasim校正);研究组两侧颞上回、枕叶、左侧背外侧额上回及右侧中央前回GM值与病程呈负相关(P<0.05,Alphasim校正);治疗8周末痊愈组患者13例,未痊愈患者25例,痊愈组在右侧梭状回、颞叶、右侧眶额叶、右侧枕下回、左侧内侧和旁扣带脑回及右侧额上回脑治疗前GM值高于未痊愈组(P<0.05,Alphasim校正)。结论广泛性焦虑障碍患者额叶及颞叶区域GM减少;部分脑区的GM与焦虑严重程度、病程呈负相关;基线时颞叶、额叶和枕叶的GM较大,预示接受艾司西酞普兰治疗有更好的疗效。

Objective To analyze the characteristics of gray matter volume(GM)in patients with generalized anxiety disorder(GAD) and its correlation with efficacy of escitalopram treatment. Methods Thirty eight patients with GAD and 30 sex-, age-and educational level-matched healthy subjects underwent head MRI examination. GAD patients were treated with flexible doses of escitalopram(10~20 mg/d) for 8 wks and MRI examination was performed again after treatment. The imaging data were processed by DEPASF 4.3 Advanced Edition software, the GM of the whole brain was compared and the relative factors were analyzed with AlphaSim correction. Results The volume of gray matter in right orbital inferior frontal gyrus and left middle temporal gyrus of GAD patients was significantly lower than that in healthy control group(P<0.05). The gray matter volume of the left fusiform gyrus was negatively correlated with the baseline HAMA score(P<0.05) in GAD patients. Bilateral superior temporal gyrus, occipital lobe, left dorsolateral superior frontal gyrus and right precentral gyrus were negatively correlated with the illness duration(P<0.05). There were 13 remitted patients and 25 non-remitted patients after 8 wks of treatment. In the remission group, the GM of right fusiform gyrus, temporal lobe, right orbital frontal lobe, right occipital gyrus,left medial and paracentral gyrus and right frontal gyrus were higher than those in the non-remission group(P<0.05). Conclusion The volume of gray matter in GAD patients decreased compared to healthy controls. Local gray matter volume is negatively correlated with baseline HAMA score and illness duration, suggesting that the GM value of GAD patients is more affected by the course of disease. The greater volume of gray matter in certain brain area may predict better outcome of escitalopram treatment.