Department of Psychiatry, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Shenyang 110001, Liaoning, PR China.
J Psychiatr Res. 2013 Jun;47(6):733-9. doi: 10.1016/j.jpsychires.2013.02.003. Epub 2013 Mar 1.
Sex differences are observed in both epidemiological and clinical aspects of major depressive disorder (MDD). The cortico-limbic-striatal neural system, including the prefrontal cortex, amygdala, hippocampus, and striatum, have shown sexually dimorphic morphological features and have been implicated in the dysfunctional regulation of mood and emotion in MDD. In this study, we utilized a whole-brain, voxel-based approach to examine sex differences in the regional distribution of gray matter (GM) morphological abnormalities in medication-naïve participants with MDD. Participants included 29 medication-naïve individuals with MDD (16 females and 13 males) and 33 healthy controls (HC) (17 females and 16 males). Gray matter morphology of the cortico-limbic-striatal neural system was examined using voxel-based morphometry analyzes of high-resolution structural magnetic resonance imaging scans. The main effect of diagnosis and interaction effect of diagnosis by sex on GM morphology were statistically significant (p < 0.05, corrected) in the left ventral prefrontal cortex, right amygdala, right hippocampus and bilateral caudate when comparing the MDD and HC groups. Posthoc analyzes showed that females with MDD had significant GM decreases in limbic regions (p < 0.05, corrected), compared to female HC; while males with MDD demonstrated significant GM reduction in striatal regions, (p < 0.05, corrected), compared to HC males. The observed sex-related patterns of abnormalities within the cortico-limbic-strial neural system, such as predominant prefrontal-limbic abnormalities in MDD females vs. predominant prefrontal-striatal abnormalities in MDD males, suggest differences in neural circuitry that may mediate sex differences in the clinical presentation of MDD and potential targets for sex-differentiated treatment of the disorder.
性别差异在重度抑郁症（MDD）的流行病学和临床方面均有体现。皮质-边缘-纹状体神经回路，包括前额叶皮质、杏仁核、海马体和纹状体，其形态结构具有明显的性别差异，并且与 MDD 中情绪和情感的功能失调调节有关。在这项研究中，我们采用基于体素的全脑方法，研究了未经药物治疗的 MDD 患者大脑灰质（GM）形态异常的性别差异。研究对象包括 29 名未经药物治疗的 MDD 患者（16 名女性和 13 名男性）和 33 名健康对照者（HC）（17 名女性和 16 名男性）。通过高分辨率结构磁共振成像扫描的基于体素形态计量学分析，研究了皮质-边缘-纹状体神经回路的 GM 形态。在比较 MDD 组和 HC 组时，诊断的主效应和诊断与性别的交互效应在左侧腹侧前额叶皮质、右侧杏仁核、右侧海马体和双侧尾状核的 GM 形态上具有统计学意义（p < 0.05，校正）。事后分析表明，与女性 HC 相比，患有 MDD 的女性在边缘区域的 GM 减少明显（p < 0.05，校正）；而与男性 HC 相比，患有 MDD 的男性在纹状体区域的 GM 减少明显（p < 0.05，校正）。在皮质-边缘-纹状体神经回路中观察到的与性别相关的异常模式，例如 MDD 女性中以前额叶-边缘异常为主，而 MDD 男性中以前额叶-纹状体异常为主，这表明在 MDD 的临床表现中存在神经回路的差异，并且可能是性别差异治疗的潜在靶点。
