摘要
目的探讨认知行为治疗(cognitive behavioral therapy,CBT)对抑郁症患者脑白质结构的作用。方法纳入符合DSM-Ⅳ-TR中抑郁症诊断标准的首次发病患者14例(患者组)以及15名与之性别、年龄、文化程度等相匹配的健康对照者(对照组)作为基线对照。患者组进行28周CBT,对照组不做任何干预,使用HAMD24评估患者抑郁症状严重程度。患者组在入组时和治疗完成后(第28周末)分别进行1次磁共振成像扫描,对照组仅在入组时进行1次扫描。采用基于纤维束示踪的空间统计方法计算脑白质各向异性分数(fractional anisotropy,FA)值,间接评估治疗前及治疗后抑郁症患者脑白质结构变化。采用Pearson相关分析分析病程、HAMD24评分与治疗前后发生变化的异常脑区FA值的相关性。结果患者组经28周CBT后,治疗后较治疗前抑郁症状明显改善(t=23.773,P<0.01)。与对照组相比,患者组在治疗前右侧额叶(MNI:x=20,y=14,z=58;P=0.001)、左侧颞叶(MNI:x=-50,y=-7,z=-24;P=0.006)、右侧海马区(MNI:x=21,y=-32,z=-5;P=0.004)、左侧角回(MNI:x=-45,y=-56,z=34;P=0.007)FA值低于对照组;治疗后右侧额叶(MNI:x=18,y=14,z=55;P=0.001)、右侧海马区(MNI:x=21,y=-33,z=-5;P=0.003)、左侧角回(MNI:x=-44,y=-57,z=34;P=0.006)FA值低于对照组;仅左侧颞叶FA值与对照组比较差异无统计学意义。患者组在治疗后较治疗前左侧小脑(MNI:x=-16;y=-55;z=-44;P=0.025)FA值增加。Pearson相关分析显示,治疗前:左侧颞叶FA值与病程(r=-0.188,P=0.520)、HAMD24评分(r=-0.105,P=0.722)均无相关性,左侧小脑FA值与病程(r=-0.090,P=0.760)、HAMD24评分(r=-0.224,P=0.441)均无相关性;治疗后:左侧颞叶FA值与HAMD24评分无相关性(r=-0.152,P=0.603),左侧小脑FA值与HAMD24评分也无相关性(r=-0.167,P=0.568)。结论CBT可能通过作用于抑郁症患者颞叶以及小脑白质结构的变化产生治疗效应。
Objective To investigate the effect of cognitive behavioral therapy(CBT)on the white matter microstructural changes in first-episode untreated major depressive disorder(MDD)adult patients.Methods Fourteen first-episode,medication-naïve MDD patients and 15 healthy subjects as controls underwent diffusion tensor imaging(DTI)scan and assessment at baseline.Then,the patients received 28-week CBT treatment,and were given the second scan when finished.Fractional anisotropy(FA)was compared to indirectly explore abnormality of white matter in depressed patients and healthy subjects,and before-after treatments,using whole brain tract-based spatial statistic(TBSS)analysis.The clinical symptoms were assessed by psychiatrists using HAMD24.The relationship between the FA values of regions changed before and after CBT and the duration,scores of HAMD24 were analyzed by using Pearson correlation analysis.Results Post-treatment,MDD patients showed a significant reduction in HAMD24(t=23.773,P<0.01).Compared with controls,the MDD patients showed a trend for lower value of FA in the right frontal lobe(MNI:x=20,y=14,z=58,P=0.001),the left temporal lobe(MNI:x=-50,y=-7,z=-24,P=0.006),the right hippocampus(MNI:x=21,y=-32,z=-5,P=0.004)and the left angular region(MNI:x=-45,y=-56,z=34,P=0.007)before CBT.After CBT,MDD patients still showed lower value of FA in the right frontal lobe(MNI:x=18,y=14,z=55,P=0.001),the right hippocampus(MNI:x=21,y=-33,z=-5,P=0.003)and the left angular region(MNI:x=-44,y=-57,z=34,P=0.006),and only the FA value of left temporal lobe came back to normal after 28 weeks treatment.MDD patients also showed increased FA value in the left cerebellum(MNI:x=-16,y=-55,z=-44,P=0.025)from pro-to post-treatment.Duration were not correlated with left temporal lobe(r=-0.188,P=0.520)and left cerebellum(r=-0.090,P=0.760)in patients.Scores of HAMD24 were also not correlated with left temporal lobe(before CBT:r=-0.105,P=0.722;after CBT:r=-0.152,P=0.603)and left cerebellum(before CBT:r=-0.224,P=0.441;after CBT:r=-0.167,P=0.568)in patients.Conclusion CBT may induce white matter changes in temporal lobe and cerebellum in MDD patients,and may play a role in improving depressive symptom.
作者
滕昌军
王纯
张宁
马辉
钟元
谭雅容
肖朝勇
Teng Changjun;Wang Chun;Zhang Ning;Ma Hui;Zhong Yuan;Tan Yarong;Xiao Chaoyong(Department of Medical Psychology,Nanjing Brain Hospital,Nanjing Medical University,Nanjing 210029,China;Department of Psychiatry 4(Mood Disorders Department),Nanjing Brain Hospital,Nanjing Medical University,Nanjing 210029,China;School of Psychology,Nanjing Normal University,Nanjing 210097,China;Department of Radiology,Nanjing Brain Hospitaly Nanjing Medical University,Nanjing 210029,China)
出处
《中华精神科杂志》
CAS
CSCD
北大核心
2019年第6期379-386,共8页
Chinese Journal of Psychiatry
基金
国家自然科学基金(81201064
81571344)
江苏省自然科学基金(BK20161109)
江苏省科技计划(重点病种)项目(BE2015609)。
关键词
抑郁症
认知疗法
弥散张量成像
颞叶
基于纤维束示踪的空间统计学
Depressive disorder
Cognitive therapy
Diffusion tensor imaging
Temporal lobe
Tract-based spatial statistic
