电抽搐疗法对老年抑郁症患者低频振幅的影响以及相关脑网络的改变

背景　老年抑郁症是老年常见心理疾病，对老年人群的身心健康危害巨大，其临床表现同成年人抑郁症不同，治疗难度明显增加，而电抽搐疗法（ECT）对其疗效较为确切，但治疗机制尚不明确。国内外已有运用功能磁共振技术探讨ECT治疗抑郁症机制的研究，但涉及老年抑郁症的研究极少，因此，相关的研究探索将对进一步明确治疗机制具有重要意义。目的　初步探讨ECT对老年抑郁症患者低频振幅（ALFF）的影响以及相关脑网络的改变。方法　2013年10月-2017年12月选取在安徽省精神卫生中心住院的老年抑郁症患者12例，其均完成ECT治疗（治疗次数≤12次）。患者于ECT治疗前后进行临床结果评定〔采用24项汉密尔顿抑郁评定量表（24-HAMD）、汉密尔顿焦虑评定量表（HAMA）进行评定〕，接受静息态功能磁共振（rs-fMRI）和结构像扫描，计算分析ECT治疗前后ALFF差异，并提取指标差异脑区作为种子点来计算与全脑的功能连接，随后比较治疗前后全脑功能连接的变化。结果　患者ECT治疗后的HAMD总分、HAMA总分低于ECT治疗前（P<0.05）。患者ECT治疗后ALFF在左侧眶部额下回和右侧眶部额中回高于ECT治疗前，故提取出来2个ROI，其中ROI-1位于左侧眶部额下回（x=-36，y=51，z=-12，半径=6 mm），ROI-2位于右侧眶部额中回（x=9，y=66，z=-12，半径= 6 mm）。在以ROI-1为种子点的全脑功能连接分析中，相对于ECT治疗前，患者存在一个大的团块（887个体素，峰值坐标为x=18，y=0，z=6，t=8.61，位于苍白球）在ECT治疗后的全脑功能连接有显著改变，在后扣带回、丘脑、苍白球显著增强；在以ROI-2为种子点的全脑功能连接分析中，相对于ECT治疗前，患者ECT治疗后的全脑功能连接在左侧额中回和右侧岛盖部额下回显著提高。结论　老年抑郁症患者ECT治疗后左侧眶部额下回和右侧眶部额中回的ALFF有显著提高，且这些ALFF显著增高的区域和后扣带回、丘脑、苍白球、左侧额中回和右侧岛盖部额下回等脑区之间的功能连接增强，可能同ECT抗抑郁治疗机制有关。

Effect of Electroconvulsive Therapy on Amplitude of Low Frequency Fluctuations and Related Brain Network Changes in Elderly Depressive Patients

Background　Depression is a common psychological disease in the elderly，which seriously impairs the physical and mental health of this group.Its clinical manifestations are different from those of young and middle-aged adults，and the treatment difficulty is significantly increased.Although electroconvulsive therapy（ECT） is relatively good for it，the treatment mechanism is not clear.Although there are many fMRI studies about ECT for depression，elderly depression is rarely explored.So exploration of this treatment for elderly depression is necessary for clarifying the mechanism.Objective　To investigate the impact of ECT on amplitude of low-frequency fluctuations（ALFF） and related brain network changes in elderly depressive patients.Methods　Twelve inpatients with depression aged from 60-80 were recruited from Anhui Mental Health Center during October 2013 to December 2017.All of them received ECT for no more than 12 times.The treatment effects were evaluated by comparing pre- and post-ECT parameters such as scores of the 24-item version of Hamilton Depression-Rating Scale（24-HAMD） and Hamilton Anxiety-Rating Scale（HAMA），rs-fMRI with brain structure scan，ALFF，and whole-brain structural connection network evaluated based the seed points that can be used to delimit functionally distinct cortical areas.Results　Mean scores of 24-HAMD and HAMA after ECT in depressiue patients were all lower than the baseline（P<0.05）．Post-ECT ALFF value in the orbital part of the left inferior frontal gyrus and of the right middle frontal gyrus increased significantly compared with baseline，so these two regions were determined as the ROI，and named as ROI-1（x=-36，y=51，z=-12，radius=6 mm），and ROI-2（x=9，y=66，z=-12，radius=6 mm），respectively.ROI-1-based whole-brain functional connectivity analysis found that compared with baseline，functional connections of a large mass（x=18，y=0，z=6，t=8.61） in the globus pallidus showed significantly improvements after ECT，and the enhancement was especially obvious in the cingulate gyrus，thalamus and globus pallidus.ROI-2-based whole-brain functional connectivity analysis revealed that after the ECT，the functional connections of the left middle frontal gyrus and the opercular part of the right inferior island inferior gyrus.Conclusion　After receiving ECT，ALFF of the left orbital frontal inferior gyrus and the right orbital frontal middle gyrus were significantly increased， and the functional connections between these areas and the brain areas such as the posterior cingulate gyrus， thalamus， pallidus， left frontal middle gyrus and right insular frontal inferior gyrus were enhanced，which may be related to the mechanism of ECT antidepressant treatment.