摘要
目的探讨伴童年创伤的青少年抑郁症患者运用眼动脱敏与再加工(eye movement desensitization and reprocessing,EMDR)联合舍曲林治疗前后和单纯舍曲林治疗前后脑功能网络的变化,并评估联合治疗的优势。材料与方法前瞻性纳入67例伴童年创伤的青少年抑郁症患者,收集一般资料和汉密尔顿抑郁量表(Hamilton Depression Rating Scale,HAMD)评分,其中EMDR联合舍曲林治疗组33例,单纯舍曲林治疗组34例,治疗周期为8周。治疗前后均行静息态和结构像数据采集,用去除小脑的Dosenbach图谱提取142个感兴趣区(region of interest,ROI)内的平均血氧水平依赖(blood oxygen level dependent,BOLD)信号并构建基于边的功能连接矩阵。行配对样本t检验比较治疗前后的功能连接矩阵的组间差异。将差异边归类于Yeo7网络模型中得到大尺度脑网络功能连接矩阵,并计算7个网络内和网络间的差异边的数量。结果与基线相比联合治疗组和舍曲林治疗组的HAMD评分降低(t=16.11、13.20,P<0.001),且都存在广泛脑功能连接改变。联合治疗组差异包括49个ROI和39条连接(均P<0.05),功能连接减少的主要是默认模式网络(default mode network,DMN)内部和腹侧注意网络(ventral attention network,VAN)内部的网络,增加的主要是DMN与额顶网络(frontoparietal network,FPN)之间的网络和与背侧注意网络(dorsal attention network,DAN)中ROI相连的网络;舍曲林治疗组差异包括32个ROI和19条连接(均P<0.05),功能连接减少的主要是DMN内部的网络,增加的主要是与DAN中ROI相连的网络。结论联合治疗和单纯舍曲林治疗都有较好的抗抑郁效果。相较于单纯舍曲林治疗,联合治疗中,DMN与FPN的功能连接增强提示其协调性提升。联合治疗的效果更广泛。
Objective:To investigate brain functional network changes in adolescents with depression and childhood trauma after eye movement desensitization and reprocessing(EMDR)combined with sertraline versus sertraline monotherapy,and evaluate the advantages of combined therapy.Materials and Methods:A total of 67 adolescent patients with depression and childhood trauma were enrolled.General demographic data and Hamilton Depression Rating Scale(HAMD)scores were collected.Participants were divided into two groups:33 receiving EMDR combined with sertraline and 34 receiving sertraline monotherapy.All underwent 8-week treatment.Clinical evaluations included the Hamilton Depression Rating Scale(HAMD).Pre-and post-treatment resting-state and structural imaging data were acquired.Functional connectivity matrices were constructed using average blood oxygen level-dependent(BOLD)signals from 142 regions of interest(ROI)defined by the cerebellum-removed Dosenbach atlas.Paired-sample t-tests compared intergroup differences in functional connectivity matrices.Differential edges were categorized into large-scale brain networks using the Yeo7 model,and the number of differential edges within/between seven networks was calculated.Results:Both groups showed significant HAMD score reductions(combined therapy:t=16.11,P<0.001;monotherapy:t=13.20,P<0.001)and widespread brain functional connectivity changes.The combined therapy group had 49 differential ROIs and 39 differential edges(all P<0.05),with reduced connectivity primarily within the default mode network(DMN)and ventral attention network(VAN),and increased connectivity between DMN-frontoparietal network(FPN)and DMN-dorsal attention network(DAN).The sertraline group had 32 differential ROIs and 19 differential edges(all P<0.05),with reduced connectivity mainly within DMN and increased connectivity involving DAN.Conclusions:Both treatments demonstrated effective antidepressant outcomes.Combined therapy induced enhanced DMN-FPN connectivity,suggesting improved coordination between cognitive flexibility and emotion regulation,with broader therapeutic effects compared to monotherapy.
作者
雷洪俊
彭娟
张道恩
汪清建
任垚
左云凤
张高峰
LEI Hongjun;PENG Juan;ZHANG Daoen;WANG Qingjian;REN Yao;ZUO Yunfeng;ZHANG Gaofeng(Department of Imaging,the Second Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China)
出处
《磁共振成像》
北大核心
2026年第1期22-28,共7页
Chinese Journal of Magnetic Resonance Imaging
基金
合肥市科技计划(科技合作)项目[编号:遵市科合HZ字(2024)423号]。
关键词
青少年抑郁症
眼动脱敏与再加工
功能磁共振成像
磁共振成像
脑功能网络
大尺度脑网络
adolescent depression
eye movement desensitization and reprocessing
functional magnetic resonance imaging
magnetic resonance imaging
brain functional networks
large-scale brain networks
