弥散张量成像预测重度抑郁症的治疗结果。
Diffusion tensor imaging predictors of treatment outcomes in major depressive disorder.
机构信息
Mayuresh S. Korgaonkar, PhD, The Brain Dynamics Center, Sydney Medical School, The University of Sydney and Westmead Millennium Institute, Sydney and Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Westmead Hospital, Sydney, Australia; Leanne M. Williams, PhD, The Brain Dynamics Center, Sydney Medical School, The University of Sydney and Westmead Millennium Institute, Sydney, Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Westmead Hospital, Sydney, Australia and Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA; Yun Ju Song, PhD, The Brain Dynamics Center, Sydney Medical School, The University of Sydney and Westmead Millennium Institute, Sydney and Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Westmead Hospital, Sydney, Australia; Tim Usherwood, MD, BS, FRACGP, Department of General Practice, Sydney Medical School, Westmead, Sydney, Australia; Stuart M. Grieve, MBBS, BSc, DPhil, RANZCR, The Brain Dynamics Center, Sydney Medical School, The University of Sydney and Westmead Millennium Institute, Sydney and Sydney Translational Imaging Laboratory, Sydney Medical School, Sydney, Australia.
出版信息
Br J Psychiatry. 2014 Oct;205(4):321-8. doi: 10.1192/bjp.bp.113.140376. Epub 2014 Jun 26.
BACKGROUND
Functional neuroimaging studies implicate anterior cingulate and limbic dysfunction in major depressive disorder (MDD) and responsiveness to antidepressants. Diffusion tensor imaging (DTI) enables characterisation of white matter tracts that relate to these regions.
AIMS
To examine whether DTI measures of anterior cingulate and limbic white matter are useful prognostic biomarkers for MDD.
METHOD
Of the 102 MDD out-patients from the International Study to Predict Optimized Treatment for Depression (iSPOT-D) who provided baseline magnetic resonance imaging (MRI) data, 74 completed an 8-week course of antidepressant medication (randomised to escitalopram, sertraline or extended-release venlafaxine) and were included in the present analyses. Thirty-four matched controls also provided DTI data. Fractional anisotropy was measured for five anterior cingulate-limbic white matter tracts: cingulum cingulate and hippocampus bundle, fornix, stria terminalis and uncinate fasciculus. (Trial registered at ClinicalTrials.gov: NCT00693849.)
RESULTS
A cross-validated logistic regression model demonstrated that altered connectivity for the cingulum part of the cingulate and stria terminalis tracts significantly predicted remission independent of demographic and clinical measures with 62% accuracy. Prediction improved to 74% when age was added to this model.
CONCLUSIONS
Anterior cingulate-limbic white matter is a useful predictor of antidepressant treatment outcome in MDD.
背景
功能神经影像学研究表明，前扣带回和边缘系统功能障碍与重度抑郁症（MDD）和抗抑郁药的反应性有关。弥散张量成像（DTI）能够对与这些区域相关的白质束进行特征描述。
目的
探讨前扣带回和边缘白质的 DTI 测量值是否可用作 MDD 的预后生物标志物。
方法
在国际预测优化抑郁治疗研究（iSPOT-D）中，102 名 MDD 门诊患者提供了基线磁共振成像（MRI）数据，其中 74 名患者完成了 8 周的抗抑郁药物治疗（随机接受艾司西酞普兰、舍曲林或缓释文拉法辛），并纳入了本分析。34 名匹配的对照者也提供了 DTI 数据。对前扣带回-边缘白质的五条白质束进行了各向异性分数的测量：扣带回和海马束、穹窿、终纹和钩束。（试验在 ClinicalTrials.gov 上注册：NCT00693849。）
结果
交叉验证的逻辑回归模型表明，前扣带束和终纹束的连接改变显著预测了缓解，与人口统计学和临床指标无关，准确率为 62%。当将年龄添加到该模型中时，预测精度提高到 74%。
结论
前扣带-边缘白质是 MDD 抗抑郁治疗结果的一个有用的预测指标。
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