摘要
目的比较抑郁障碍(MDD)肝气郁结证及肾阳亏虚证患者脑功能与血清肿瘤坏死因子-α(TNF-α),并通过TNF-α水平与脑功能的相关性,探讨中医药治疗MDD不同中医证候类型患者可能的脑区靶点。方法2017年10月—2020年10月在北京中医药大学第三附属医院、首都医科大学宣武医院及北京安定医院的中度MDD肾阳亏虚证、肝气郁结证患者各17例,健康对照组17例为北京中医药大学师生及北京中医药大学第三附属医院职工。同一受试者均在同一天完成静息态功能磁共振成像(rs-fMRI)及血清留取。酶联免疫吸附测定法检测血清TNF-α水平;使用SPM软件及DPASF软件处理核磁影像数据,完成脑功能评估及相关性分析。结果MDD肝气郁结证组及肾阳亏虚证组患者血清TNF-α水平均高于健康对照组,且肝气郁结证组高于肾阳亏虚证组(P<0.01)。与健康对照组比较,MDD肾阳亏虚证患者左侧楔前叶及左侧顶上小叶存在异常激活状态,肝气郁结证患者右侧颞上回、右侧岛叶、左侧枕下回、左侧颞下回、左侧楔叶、右侧楔前叶、左侧楔前叶存在异常激活状态。肾阳亏虚证患者血清TNF-α水平与右侧背外侧额上回、右侧额中回、左侧枕中回、左侧中央前回、左侧直回的分数低频振幅(fALFF)值正相关(P<0.05),与左侧楔前叶、右侧颞下回、右侧枕中回、右侧小脑fALFF值负相关(P<0.05)。而肝气郁结证患者只有小脑fALFF值与血清TNF-α正相关(P<0.05)。结论MDD肝气郁结证及肾阳亏虚证患者脑功能及血清TNF-α水平存在差异,肾阳亏虚证患者可能更偏向于在注意力相关的脑区存在异常,且与抑郁相关的炎症反应相关性更强,主要为背外侧前额叶的异常。而肝气郁结型患者可能更偏向于视觉相关的脑区存在异常,炎症反应与脑区的相关性弱于肾阳亏虚证患者。
Objective To observe the changes in brain function and serum tumor necrosis factor alpha(TNF-α)in MDD patients with liver qi stagnation or kidney yang deficiency patterns,and to preliminarily discuss the possible targets of brain region in the TCM treatment of different patterns of MDD through the correlation between TNF-αand brain functions.Methods Three groups of participants(patients with moderate MDD with kidney yang deficiency pattern,patients with moderate MDD with liver qi stagnation pattern,and healthy participants)(n=17)were recruited from October 2017 to October 2020.The former two groups were recruited from the Third Affiliated Hospital of Beijing University of Chinese Medicine,Xuanwu Hospital and Anding Hospital,and the healthy control group was recruited from students and teachers at Beijing University of Chinese Medicine and staffs at the Third Affiliated Hospital of Beijing University of Chinese Medicine.The participants in each group were with matched gender,age and years of education.All participants completed resting-state fMRI and serum collection on the same day.Serum TNF-αlevel was detected by ELISA;MRI data was processed by SPM and DPASF for brain function assessment and correlation analysis.Results The level of TNF-αin patients with either pattern was higher than that in the control group,and it was higher in the liver qi stagnation group than that in the kidney yang deficiency group(P<0.01).Compared with the control group,the left precuneus and the left superior parietal lobe were abnormally activated in patients with kidney yang deficiency pattern;while abnormal activation was found in the right superior temporal gyrus,right insula,left inferior occipital gyrus,left inferior temporal gyrus,left cuneus,right precuneus,and left precuneus in patients with liver qi stagnation pattern.The serum TNF-αin patients with kidney yang deficiency was positively correlated with the fALFF values of right dorsolateral superior frontal gyrus,right middle frontal gyrus,left middle occipital gyrus,left precentral gyrus,and left rectal gyrus(P<0.05),while it was negatively correlated with the fALFF values of the left precuneus,right inferior temporal gyrus,right middle occipital gyrus and right cerebellum(P<0.05).In patients with liver qi stagnation,only the fALFF value of cerebellum was positively correlated with serum TNF-α(P<0.05).Conclusion There seem to be differences in brain function and serum TNF-αlevels in MDD patients with liver qi stagnation pattern and kidney yang deficiency pattern.Patients with kidney yang deficiency may have more abnormalities in attention-related brain regions and stronger correlation with depression-related inflammatory responses,mainly related to abnormalities of the dorsolateral prefrontal lobe.However,patients with liver qi stagnation may have more abnormalities in vision-related brain regions,and the correlation between inflammation and brain regions is probably weaker than that of patients with kidney yang deficiency.
作者
肖康
欧政杭
苏晓鹏
杜芸
曲淼
XIAO Kang;OU Zhenghang;SU Xiaopeng;DU Yun;QU Miao(First Affliated Hospital,Army Medical University,Chongqing 400038,China;Chifeng Municipal Hospital of Inner Mongolia,Chifeng 024000,China;Bejing University of Chinese Medicine,Beijing 100029,China;Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《北京中医药大学学报》
CAS
CSCD
北大核心
2022年第9期903-912,共10页
Journal of Beijing University of Traditional Chinese Medicine
基金
国家重点研发计划项目(No.2020YFC2003100,No.2020YFC2003103)
国家自然科学基金项目(No.81573905,No.81973759)。
关键词
抑郁
肝气郁结证
肾阳亏虚证
肿瘤坏死因子-Α
静息态功能性磁共振
major depressive disorder
liver qi stagnation pattern
kidney yang deficiency pattern
tumor necrosis factor alpha
resting state functional magnetic resonance
