摘要
目的观察存在自杀未遂史的青少年抑郁症患者不同脑区皮质厚度及临床症状变化,并分析皮质厚度与临床症状的关系。方法纳入存在自杀未遂史的青少年抑郁症患者94例[自杀未遂组(SU组)]、无自杀未遂史的青少年抑郁症患者80例[无自杀组(NSU组)],同时招募年龄、性别匹配的健康青少年85名[对照组(CON组)]。采用3.0T MRI对三组头颅进行3D T 1 WI、FLAIR序列扫描以获取皮质厚度,采用抑郁自评量表(SDS)、焦虑自评量表(SAS)以及贝克自杀意念量表(BSI)对所有受试者进行抑郁、焦虑、自杀意念情况评分;采用Pearson或Spearman及广义线性模型(GLM)分析青少年抑郁症患者不同脑区皮质厚度与SDS、SAS、BSI评分的关系。结果与CON组比较,NSU组额缘沟和额缘回、枕下回和枕下沟等43个脑区皮质厚度差异均有统计学意义(P<0.05);SU组额缘沟和额缘回、枕下回和枕下沟、横额极沟和横额极回等50个脑区皮质厚度差异均有统计学意义(P<0.05)。NSU组、SU组左侧角回、左侧直回、左侧内侧眶沟、右侧颞上回颞平面、双侧颞横沟皮质厚度比较,差异均有统计学意义(P<0.05)。与CON组比较,SU组及NSU组SDS、SAS、BSI评分均升高;与NSU组比较,SU组SAS、BSI评分均升高(P<0.05)。SU组的左侧中央沟、左侧边缘沟、左侧枕颞内侧沟和舌回、右侧下岛周沟皮质厚度与SDS评分均呈负相关(P<0.05);左侧枕下回、右侧额中沟皮质厚度与SAS评分均呈负相关(P<0.05),左侧枕颞内侧沟和舌回、右侧中央沟、右侧后横副脑沟皮质厚度与SAS评分均呈正相关(P<0.05);左侧下岛周沟、右侧枕中沟和月状沟皮质厚度与BSI评分均呈正相关(P<0.05)。NSU组左侧内侧眶沟、右侧中央旁沟和中央旁小叶、右侧长岛回皮质厚度与SDS评分均呈正相关(P<0.05),右侧枕上回和枕横沟皮质厚度与SDS评分均呈负相关(P<0.05);左侧枕前沟、右侧前中扣带回皮质厚度与SAS评分均呈正相关(P<0.05);左侧额缘沟和额缘回、左侧前中扣带回等皮质厚度与SAS评分均呈负相关(P<0.05);左侧前中扣带回、左侧腹侧后扣带回、左侧长岛回、左侧舌回皮质厚度与BSI评分均呈负相关(P<0.05);左侧顶下沟、右侧缘上回皮质厚度与BSI评分均呈正相关(P<0.05)。GLM分析结果显示,随着年龄的增长两组在左侧内侧前额叶(CI分别为0.008,0.020)及额上回(CI分别为0.020,0.040)的结构或功能上变化的速率不同;即使在控制年龄、受教育程度、病程与评分效应后,两组在右侧舌回基线水平的皮质厚度(CI分别为0.030,0.053)仍然存在差异。结论相较于无自杀未遂史的抑郁症患者,存在自杀未遂史的青少年抑郁症患者多数脑区皮质厚度增加,抑郁、焦虑、自杀意念等临床症状加重。部分脑区皮质厚度与抑郁、焦虑程度及自杀意念有关。自杀意念可能与额叶、岛叶或颞叶的皮质厚度增加有关。
Objective To explore alterations in cortical thickness across different brain regions and clinical symptom profiles in adolescents with depression who have attempted suicide,and to analyze their relationship.Methods 94 depressed adolescents with a history of attempted suicide(SU group),80 depressed adolescents without suicide history(NSU group),and 85 age-and gender-matched healthy controls(CON group)were enrolled.All participants were assessed with Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS),and Beck Scale for Suicide Ideation(BSI).3.0T MRI was used to acquire 3D T 1-weighted and FLAIR images.Cortical thicknesses were compared among the three groups.Pearson or Spearman and Generalized Linear Models(GLM)were employed to examine their associations with clinical symptoms.Results Compared with CON group,the majority of cortical regions were significantly thicker in the SU and NSU groups.More specifically,the NSU group deviated from CON group in 43 regions,including the frontomarginal sulcus and frontomarginal gyrus,inferior occipital gyrus and inferior occipital sulcus,et al(P<0.05).The SU group differed from CON group in 50 regions,including the frontomarginal sulcus and frontomarginal gyrus,inferior occipital gyrus and inferior occipital sulcus,transverse frontopolar sulcus and transverse frontopolar gyrus,et al(P<0.05).Comparisons of cortical thickness between the NSU group and the SU group in the left angular gyrus,left straight gyrus,right planum temporale,left medial orbital sulcus,and bilateral transverse temporal sulci showed statistically significant differences(P<0.05).Both the SU and NSU groups exhibited higher scores of SDS,SAS,and BSI than the CON group;moreover,the SU group scored higher than the NSU group on SAS and BSI(P<0.05).In the SU group,cortical thicknesses of the left central sulcus,left marginal sulcus,left medial occipitotemporal sulcus,left lingual gyrus,and right inferior perisylvian sulcus showed significant negative correlations with SDS score(P<0.05);cortical thicknesses of the left inferior occipital gyrus,right middle frontal sulcus showed significant negative correlations with SAS score(P<0.05);cortical thicknesses of the left medial occipitotemporal sulcus and lingual gyrus,right central sulcus,and right posterior transverse collateral sulcus showed significant positive correlations with SAS score(P<0.05);cortical thicknesses of the left inferior perisylvian sulcus,right middle occipital sulcus,and lunate sulcus showed significant positive correlations with BSI score(P<0.05).In the NSU group,cortical thicknesses of the left medial orbital sulcus,right paracentral sulcus and paracentral lobule,and right long insular gyrus showed significant positive correlations with SDS score(P<0.05);cortical thickness of the right superior occipital gyrus and transverse occipital sulcus showed a significant negative correlation with SDS score(P<0.05);cortical thicknesses of the left anterior occipital sulcus and right anterior mid-cingulate gyrus showed significant positive correlations with SAS score(P<0.05);cortical thicknesses of the left frontomarginal sulcus and frontomarginal gyrus and the left anterior mid-cingulate gyrus showed significant negative correlations with SAS score(P<0.05);cortical thicknesses of the left anterior mid-cingulate gyrus,left ventral posterior cingulate cortex,left long insular gyrus and left lingual gyrus showed significant negative correlations with BSI score(P<0.05);cortical thicknesses of the left intraparietal sulcus and right supramarginal gyrus showed significant positive correlations with BSI score(P<0.05).Generalized linear modelling revealed that,with age increasing,SU group diverged from NSU group in the rate of structural/functional changes within the left medial prefrontal cortex(CI=0.008,0.020)and the superior frontal gyrus(CI=0.020,0.040).Even after covarying for age,education level,disease course and symptom scores,baseline differences persisted in the right lingual gyrus(CI=0.030,0.053).Conclusion Compared with depressed adolescents without suicide history,those depressed adolescents with a history of attempted suicide exhibit more extensive cortical thickness abnormalities and more severe clinical symptoms such as depression,anxiety,and suicidal ideation.Cortical thicknesses of some encephalic regions are correlated with depression,anxiety and suicide ideation.Suicidal ideation may be associated with cortical thickness abnormalities primarily located in the frontal,insular,or temporal lobes.
作者
蒋景名
闫萍
肖虎
伊木然·苏比
李思佳
徐蕊
罕迦尔别克·库锟
王云玲
JIANG Jingming;YAN Ping;XIAO Hu(The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《精神医学杂志》
2025年第3期241-249,共9页
Journal of Psychiatry
基金
“天山英才”科技创新领军人才项目(编号:2023TSYCL0027)
国家重点研发计划项目(编号:2023YFC2414200)。
关键词
大脑皮质
皮质厚度
抑郁症
自杀未遂
青少年
Cerebral cortex
Cortical thickness
Depression
Suicidal attempt
Adolescents
