Stengler-Wenzke Katarina, Müller Ulrich, Barthel Henryk, Angermeyer Matthias C, Sabri Osama, Hesse Swen
Department of Psychiatry, University of Leipzig, Leipzig, Germany.
Neuropsychobiology. 2006;53(1):40-5. doi: 10.1159/000090702. Epub 2006 Jan 4.
Two thirds of patients with obsessive-compulsive disorder (OCD) respond to treatment with selective serotonin reuptake inhibitors (SSRIs). The neurobiological mechanisms of SSRI action and failure to respond to SSRI treatment remain to be elucidated.
The aim of this pilot study was to quantify changes in the availability of serotonin transporter (SERT) in the course of SSRI treatment and to relate these changes to improvements of clinical symptoms.
Ten patients with OCD were investigated at baseline and 5 of them after 1 year of SSRI treatment with citalopram 60 mg per day using brain single photon emission computed tomography and [123I]beta-CIT. Specific-to-nondisplaceable [123I]beta-CIT binding ratios (V3'') were calculated in SERT-rich brainstem, midbrain and thalamus using a magnetic resonance imaging-based region of interest (ROI) analysis. Symptom severity was evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).
V3'' differed significantly between pretreatment and follow-up scans in all three brain regions, thalamus, midbrain as well as in brainstem. In thalamic ROI, differ ences in SERT availability and Y-BOCS ratings correlated. In midbrain, a trend toward a significant association was found. In brainstem, no relationship was revealed.
Higher occupancy of SERT by citalopram seems to be associated with better clinical response after 1 year of SSRI treatment of patients with OCD.
三分之二的强迫症（OCD）患者对选择性5-羟色胺再摄取抑制剂（SSRI）治疗有反应。SSRI作用的神经生物学机制以及对SSRI治疗无反应的原因仍有待阐明。
这项初步研究的目的是量化SSRI治疗过程中5-羟色胺转运体（SERT）可用性的变化，并将这些变化与临床症状的改善联系起来。
对10例强迫症患者进行基线调查，其中5例在使用每天60毫克西酞普兰进行SSRI治疗1年后，采用脑单光子发射计算机断层扫描和[123I]β-CIT进行调查。使用基于磁共振成像的感兴趣区域（ROI）分析，计算富含SERT的脑干、中脑和丘脑中特异性与非置换性[123I]β-CIT结合率（V3''）。用耶鲁-布朗强迫症量表（Y-BOCS）评估症状严重程度。
在丘脑、中脑以及脑干这三个脑区，预处理扫描和随访扫描之间的V3''存在显著差异。在丘脑ROI中，SERT可用性差异与Y-BOCS评分相关。在中脑，发现有显著关联的趋势。在脑干中，未发现相关性。
西酞普兰对SERT的占有率较高似乎与强迫症患者接受SSRI治疗1年后更好的临床反应相关。
