氟代脱氧葡萄糖 F18-Mefway PET/CT 测量内侧颞叶皮质和中缝核 5-羟色胺 1A 受体密度不能区分抑郁症患者的治疗反应。

Serotonin 1A receptor density measured by F18-Mefway PET/CT in mesiotemporal cortex and raphe does not discriminate therapeutic response in patients with major depressive episode.

机构信息

Department of Psychiatry, Neuromed Campus, Kepler University Hospital, Linz, Austria.

Institute of Nuclear Medicine, Neuromed Campus, Kepler University Hospital, Linz, Austria.

出版信息

Q J Nucl Med Mol Imaging. 2020 Jun;64(2):203-210. doi: 10.23736/S1824-4785.18.03039-X. Epub 2018 Jun 14.

DOI:10.23736/S1824-4785.18.03039-X

PMID:29916219

Abstract

BACKGROUND

More than 50% of patients with major depressive episode (MDE) fail to respond to initial treatment with first line pharmacological therapy. Altered receptor and serotonin transporter function are considered to be associated with mental disorders. Our investigation aimed on the density of the HT1A receptor in mesiotemporal cortex (MTC) and raphe measured by F18-Mefway in patients with MDD.

METHODS

Patients with untreated clinically suspected major depressive episode were recruited from June 2012 to May 2014. 49 patients were included into the study: 36 patients (73%) were identified as responders, whereas 13 (27%) were non-responders. Gender distribution was 26 men (56%) and 23 women (44%). For treatment, only a standard medication of a selective serotonin reuptake inhibitor (SSRI) with escitalopram in a range of 10-20 mg/day was permitted. Responders were defined by improvement of the MADRS>50%. Visually MTC had the highest uptake of F18-Mefway among all brain regions, an asymmetry could not be observed in any patient. An elliptical region was drawn over the amygdala and hippocampus area and a small circular region was drawn over the raphe nuclei. All data were calculated related to (unspecific) cerebellar uptake.

RESULTS

The quotient of the right MTC was 5.00 [4.33; 5.50] in all patients, in responders 5.00 [4.00; 5.75] and in non-responders 5.00 [4.50; 5.50] (P=0.56). The quotient of the left MTC presented with a median level of 4.50 [4.50; 5.50] in all persons. The responders had 4.50 [4.50; 5.75] which was not statistically significant to the data of the non-responders with 5.00 [4.50; 5.50] at P=0.64. The raphe had a median quotient of 2.50 [2.00; 3.00] in all and the cohort of responders, whereas non-responders had 2.50 [2.00; 2.50] (P=0.61). Also the absolute values of SUV in the three brain regions were not statistically different between the cohorts. Additionally, we did not find any sex-related differences in our patient group.

CONCLUSIONS

Serotonin 1A receptor density can be assessed efficiently by F18-Mefway and PET-CT in patients with MDE. The method can be estimated as a possible tool for clinical and academic investigation, marked tracer uptake can constantly be observed at MTC and the raphe. Anyhow, under conditions of real life in patient care, it is not possible to distinguish patients with a good prognosis who will respond to standard SSRI therapy from non-responders who would benefit from a different therapeutic approach starting earlier.

摘要

背景

超过 50%的重度抑郁发作（MDE）患者对一线药物治疗无反应。受体和 5-羟色胺转运体功能的改变被认为与精神障碍有关。我们的研究旨在通过 F18-Mefway 测量中脑边缘皮质（MTC）和中缝核的 HT1A 受体密度，以评估未经治疗的临床疑似重度抑郁发作患者。

方法

从 2012 年 6 月至 2014 年 5 月招募未经治疗的临床疑似重度抑郁发作患者。共有 49 名患者入组：36 名患者（73%）被确认为应答者，而 13 名（27%）为无应答者。性别分布为男性 26 名（56%），女性 23 名（44%）。治疗仅允许使用标准的选择性 5-羟色胺再摄取抑制剂（SSRI）药物，如依他普仑，剂量为 10-20mg/天。应答者的定义为 MADRS 评分改善>50%。视觉上，MTC 在所有脑区中对 F18-Mefway 的摄取最高，任何患者均未观察到不对称。在杏仁核和海马区绘制一个椭圆形区域，在中缝核绘制一个小圆形区域。所有数据均与（非特异性）小脑摄取相关进行计算。

结果

所有患者右 MTC 的商数为 5.00 [4.33；5.50]，应答者为 5.00 [4.00；5.75]，无应答者为 5.00 [4.50；5.50]（P=0.56）。左 MTC 的商数中位数为 4.50 [4.50；5.50]。应答者为 4.50 [4.50；5.75]，与无应答者的 5.00 [4.50；5.50]相比无统计学意义（P=0.64）。中缝核的中位数商数为 2.50 [2.00；3.00]，应答者和无应答者均如此，而无应答者的中位数商数为 2.50 [2.00；2.50]（P=0.61）。在两组中，三个脑区的 SUV 绝对值也没有统计学差异。此外，我们在患者组中未发现任何与性别相关的差异。

结论

F18-Mefway 和 PET-CT 可有效地评估 MDE 患者的 5-羟色胺 1A 受体密度。该方法可作为临床和学术研究的一种可能工具，在 MTC 和中缝核可观察到持续的标记物摄取。然而，在实际的患者护理环境中，不可能从对标准 SSRI 治疗有反应的预后良好的患者中区分出那些将受益于更早开始的不同治疗方法的无应答者。