太极拳对阈下抑郁患者相关脑区可塑性的影响：一项多模态功能核磁研究

Subthreshold depression is considered to be an early stage of depressive disorder and is an important stage in the early prevention and treatment of depression. Tai Chi is an important means to interfere with subthreshold depression. It has the function of relieving stress, improving depression, and being safe and easy to practice. However, the neural mechanism of Taijiquan in subthreshold depression has not yet been clarified. Studies have found that to study the changes of a brain region or a neural circuit formed by some brain regions can not fully explain the mechanism of depression. The existing Taijiquan research also found that it not only affects the structure and function of the local brain region. It also has effects on multiple related functional networks. This suggests that the use of multimodal fMRI techniques to characterize the plasticity of the whole brain network structure and functional connectivity characteristics. It could help to further investigate the mechanism of Taijiquan intervention in subthreshold depression.This study aims to use multimodal fMRI to explore the brain imaging characteristics of subthreshold depression and use randomized controlled trials to observe the effect of Taijiquan training on subthreshold depression and its neuroimaging mechanism. The research results of this topic will help us to understand the pathogenesis of subliminal depression more deeply and provide theoretical guidance for the early prevention and treatment of subliminal depression.

阈下抑郁被认为是抑郁障碍的前期状态，是抑郁症早期防治的重要阶段。虽已有少量研究对阈下抑郁相关的大脑形态及功能进行探讨，但多从某一脑区或某个功能网络的角度，目前仍无研究从多模态的角度全面探讨其神经影像机制。对阈下抑郁机制的研究不足限制了对阈下抑郁的早期诊断。太极拳作为一种身心运动，具有缓解压力与改善抑郁的作用，其形式十分适合用于阈下抑郁的早期干预，然而目前太极拳对阈下抑郁的影响及对相应脑区可塑性的改变等知识仍很匮乏。本项目旨在运用多模态核磁探索阈下抑郁的脑影像学特点并采用随机对照试验观察12周太极拳训练对阈下抑郁的影响及其可能的神经机制。本项目的研究结果将有助于更深入的了解阈下抑郁的发病机制，并且为太极拳等身心运动用于阈下抑郁的早期防治提供理论指导。

阈下抑郁被认为是抑郁障碍的前期状态，是抑郁症早期防治的重要阶段。研究其发病机制与干预手段意义重大。太极拳作为中国传统特色的身心运动，具有缓解压力与改善抑郁的作用，可用于阈下抑郁的早期干预,但其作用机制尚不清楚。.本项目运用多模态核磁，从脑区的结构与功能改变的角度，探索阈下抑郁的脑影像学特点。采用随机对照试验观察12周，每周3次，每次60分钟的24式简化杨氏太极拳训练对阈下抑郁患者行为学及其脑区结构与功能可塑性的影响。.研究结果发现，阈下抑郁患者较健康被试，大脑结构与功能连接发生改变。阈下抑郁被试的前额叶-杏仁核环灰质体积与功能连接与健康人群存在差异。以伏隔核和尾状核为种子点，分析全脑功能连接，发现阈下抑郁组的功能连接强度显著低于健康对照组。.12周太极拳训练干预前后，阈下抑郁被试的汉密尔顿抑郁量表、病人健康问卷-9、知觉压力量表得分具有统计学差异，表明太极拳可改善阈下抑郁患者的抑郁程度和压力水平。神经生物学分析显示，太极拳组觉醒后30分钟时唾液皮质醇浓度、皮质醇觉醒反应（CAR）的曲线下面积和曲线下增加面积低于对照组。表明太极拳可调节阈下抑郁患者下丘脑-垂体-肾上腺轴功能，调节压力皮质醇水平。功能磁共振分析发现，太极拳训练后，被试的脑桥、蓝斑核、中缝核和小脑的灰质体积增加，前额叶-杏仁核环路功能连接增强，且结构与功能的改变均与抑郁水平的改善呈正相关。进一步通过中介调节分析太极拳干预后阈下抑郁人群的抑郁量表评分、神经生物学标志物和影像学之间的相关性，发现在唾液皮质醇下降的阈下抑郁被试中，太极拳通过调节额叶区域灰质体积对HAMD得分表现改变具有显著的调节作用。.综上，12周的太极拳训练可改善阈下抑郁患者的抑郁程度和压力知觉水平，调控压力皮质醇水平，影响大脑相关结构与功能，是阈下抑郁防治的有效手段。.本研究进一步揭示了阈下抑郁病理特点及发病机制，同时也为太极拳防治阈下抑郁提供了科学依据。