Vythilingam Meena, Heim Christine, Newport Jeffrey, Miller Andrew H, Anderson Eric, Bronen Richard, Brummer Marijn, Staib Lawrence, Vermetten Eric, Charney Dennis S, Nemeroff Charles B, Bremner J Douglas
Mood and Anxiety Disorders Program, National Institute of Mental Health, 15K North Drive, Room 111, MSC 2670, Bethesda, MD 20892-2670, USA.
Am J Psychiatry. 2002 Dec;159(12):2072-80. doi: 10.1176/appi.ajp.159.12.2072.
Smaller hippocampal volume has been reported only in some but not all studies of unipolar major depressive disorder. Severe stress early in life has also been associated with smaller hippocampal volume and with persistent changes in the hypothalamic-pituitary-adrenal axis. However, prior hippocampal morphometric studies in depressed patients have neither reported nor controlled for a history of early childhood trauma. In this study, the volumes of the hippocampus and of control brain regions were measured in depressed women with and without childhood abuse and in healthy nonabused comparison subjects.
Study participants were 32 women with current unipolar major depressive disorder-21 with a history of prepubertal physical and/or sexual abuse and 11 without a history of prepubertal abuse-and 14 healthy nonabused female volunteers. The volumes of the whole hippocampus, temporal lobe, and whole brain were measured on coronal MRI scans by a single rater who was blind to the subjects' diagnoses.
The depressed subjects with childhood abuse had an 18% smaller mean left hippocampal volume than the nonabused depressed subjects and a 15% smaller mean left hippocampal volume than the healthy subjects. Right hippocampal volume was similar across the three groups. The right and left hippocampal volumes in the depressed women without abuse were similar to those in the healthy subjects.
A smaller hippocampal volume in adult women with major depressive disorder was observed exclusively in those who had a history of severe and prolonged physical and/or sexual abuse in childhood. An unreported history of childhood abuse in depressed subjects could in part explain the inconsistencies in hippocampal volume findings in prior studies in major depressive disorder.
在单相重度抑郁症的研究中，仅有部分而非全部研究报告了海马体体积较小的情况。生命早期的严重应激也与海马体体积较小以及下丘脑 - 垂体 - 肾上腺轴的持续变化有关。然而，先前针对抑郁症患者的海马体形态学研究既未报告也未控制童年期创伤史。在本研究中，对有或无童年期虐待史的抑郁症女性以及健康未受虐待的对照受试者的海马体和对照脑区体积进行了测量。
研究参与者包括32名患有当前单相重度抑郁症的女性——21名有青春期前身体和/或性虐待史，11名无青春期前虐待史——以及14名健康未受虐待的女性志愿者。由一名对受试者诊断不知情的单一评估者在冠状位MRI扫描上测量整个海马体、颞叶和全脑的体积。
有童年期虐待史的抑郁症受试者左海马体平均体积比未受虐待的抑郁症受试者小18%，比健康受试者小15%。三组之间右海马体体积相似。无虐待史的抑郁症女性左右海马体体积与健康受试者相似。
仅在有童年期严重且长期身体和/或性虐待史的成年女性重度抑郁症患者中观察到海马体体积较小。抑郁症受试者未报告的童年期虐待史可能部分解释了先前重度抑郁症研究中海马体体积研究结果的不一致性。
