双相抑郁患者小脑结构和功能连接研究

There are increasing evidences that supported the disorganized structure and function of cerebellum in patients with bipolar disorders (BD), which could be one of biological markers for BD. However, the explicit relationship between the etiology and pathogenesis of BD and the impairment of cerebellum is needed to study in future. In this study, eighty patients who meet DSM-IV-TR criteria for depressive episode of BD and twenty healthy controls will be enrolled, and the patients will be treated according to the guideline for treatment of patients with BD. The 17-item Hamilton depression scale (HAMD17) and Young manic rating scale (YMRS) will be used to assess the clinical effacy. The technologies of muti-modality brain imaging based on 3.0T MRI (3D-MRI, DTI, resting and task state fMRI) will be applied to investigate the changes of cerebellum morphology, structure and function, and their connectivity network during depressive episode phase, remission phase and stable phase, which would be compared to those in gender, age and education matched healthy controls. These findings could provide the experimental evidence for the constructional and functional connectivity network of cerebellum in patients with BD, and find the clues to the biological markers for etiology, prognosis and outcome of bipolar depression.

愈来愈多证据表明，双相障碍患者存在小脑结构和功能紊乱，并可能是疾病的特异性生物学标志之一。然而，双相障碍病因学及发病机理与小脑损害的确切关系仍有待深入研究。本课题纳入符合DSM-IV-TR双相障碍抑郁发作诊断标准的患者80例和健康对照者20例，患者按照双相障碍治疗指南接受治疗。采用17项汉密尔顿抑郁量表（HAMD17）和杨氏躁狂量表（YMRS）评估临床疗效；使用基于3.0T MRI的多模态脑影像学技术（结构性磁共振成像、磁共振弥散张量成像和静息态、任务态功能性磁共振成像），分别在抑郁发作期、临床治愈期和稳定期检测小脑形态、结构和功能变化及其连接网络，并与性别、年龄和受教育年限等匹配的健康对照者进行比较。研究结果预期将会为双相障碍患者的小脑结构和功能连接网络提供实验依据，以及发现双相抑郁发作病因、预后及转归的生物学标记线索。

双相障碍病因及发病机制至今尚不清楚，现有研究提示患者多个脑区结构与功能存在异常，但因缺乏特异性，仍有待深入研究。近年来，小脑的非运动功能也逐渐被发现并获得认可，尤其是小脑认知情感综合征日益受到神经精神学科领域的关注。基于双相障碍临床特征与小脑认知情感综合征的密切关联，本研究采用多模态脑影像学技术（结构性磁共振成像、磁共振弥散张量成像和静息态、任务态功能性磁共振成像），探索在抑郁发作期、临床治愈期和稳定期检测小脑形态、结构和功能变化及其连接网络。.本研究纳入共纳入双相抑郁患者、单相抑郁（抑郁症）患者和健康对照者各81例，采用17项汉密尔顿抑郁量表HAMD17）和杨氏躁狂量表（YMRS）评估临床疗效。初步统计分析的研究结果显示：双相障碍患者与健康对照者比较差异有统计学意义的脑区为右侧海马旁回、双侧丘脑、豆状核、壳核区域、左侧额中回；双相抑郁患者急性期干预前后比较，发现差异有统计学意义的脑区为左侧小脑后叶、右侧壳核、右侧颞中回、左侧中央前回。研究结果预期将会为双相障碍患者的小脑结构和功能连接网络提供实验依据，以及发现双相抑郁发作病因、预后及转归的生物学标记线索。