Joe Alexius Y, Tielmann Thomas, Bucerius Jan, Reinhardt Michael J, Palmedo Holger, Maier Wolfgang, Biersack Hans-Juergen, Zobel Astrid
Department of Nuclear Medicine; University of Bonn, Bonn, Germany.
J Nucl Med. 2006 Aug;47(8):1319-25.
Major depression (MD) is the most frequent psychiatric disorder with a predicted increase within the next decade. The understanding of the neurobiologic basis of its cause, antidepressive treatment effects, and identification of treatment outcome predictors is of crucial importance to warrant efficient medical care. The aim of our study was to investigate differences of regional cerebral blood flow (rCBF) in MD between responders and nonresponders in the beginning and differences during the course of treatment.
99mTc-Labeled d,l-hexamethylpropyleneamine oxime brain scans under resting conditions were performed on 65 patients with MD. All patients were treated with citalopram as an antidepressive monotherapy. SPECT scans were performed 2 times, at the beginning (t1) and after 4 wk of medication (t2). Voxel-by-voxel analyses were performed using SPM. Unpaired t test, paired t test, and multigroup analysis were used on a significance threshold of P < 0.005 (uncorrected) to identify significant differences in rCBF between responders and nonresponders at t1, within both groups over time of treatment (t2-t1), as well as a group x time interactions.
Thirty-five patients responded after 4 wk of treatment. Distinct differences between responders and nonresponders were found at the beginning of treatment and also relating to changes in rCBF during treatment. Responders showed a higher posterior cingulate activity at t1. Furthermore, an opposite direction of rCBF changes during treatment could be observed in this area.
The differences in rCBF in responders and nonresponders in the posterior cingulate at t1 and the opposite directed changes in rCBF in both groups during treatment in this region suggest that the posterior cingulate function plays a key role in the pathophysiology of depression and may have a predictive value for antidepressive treatment outcome.
重度抑郁症（MD）是最常见的精神疾病，预计在未来十年内发病率会上升。了解其病因的神经生物学基础、抗抑郁治疗效果以及确定治疗结果预测指标对于确保有效的医疗护理至关重要。我们研究的目的是调查MD患者中反应者与无反应者在治疗开始时以及治疗过程中的局部脑血流量（rCBF）差异。
对65例MD患者在静息状态下进行99mTc标记的d，l-六甲基丙烯胺肟脑扫描。所有患者均接受西酞普兰作为抗抑郁单一疗法治疗。在治疗开始时（t1）和用药4周后（t2）进行单光子发射计算机断层扫描（SPECT）。使用统计参数映射（SPM）进行逐体素分析。采用独立样本t检验、配对t检验和多组分析，显著性阈值设定为P < 0.005（未校正），以确定t1时反应者与无反应者之间、两组在治疗期间（t2 - t1）rCBF的显著差异以及组×时间交互作用。
35例患者在治疗4周后有反应。在治疗开始时以及与治疗期间rCBF的变化方面，反应者与无反应者之间存在明显差异。反应者在t1时后扣带回活动较高。此外，在该区域可观察到治疗期间rCBF变化的相反方向。
t1时反应者与无反应者在后扣带回的rCBF差异以及两组在该区域治疗期间rCBF的相反方向变化表明，后扣带回功能在抑郁症的病理生理学中起关键作用，并且可能对抗抑郁治疗结果具有预测价值。
