Draganov Metodi, Vives-Gilabert Yolanda, de Diego-Adeliño Javier, Vicent-Gil Muriel, Puigdemont Dolors, Portella Maria J
Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB),Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
ITACA, Universitat Politècnica de València, Valencia, Spain.
J Affect Disord. 2020 Apr 1;266:572-577. doi: 10.1016/j.jad.2020.01.138. Epub 2020 Jan 26.
Previous magnetic resonance spectroscopic (MRS) studies have reported brain metabolic abnormalities in Major Depressive Disorder (MDD). Nevertheless, results have been inconsistent, focusing on fully developed major depression neglecting first episode patients (FED). Longitudinal studies have also been rare and with short follow-up periods. The aim of the current study was to investigate the differences between healthy controls and first episode patients at baseline, together with changes of metabolites after 1 year follow-up in the ventromedial prefrontal cortex.
H-MRS images were obtained from 64 healthy controls and 31 FED patients using a 3T Philips Achieva scanner and processed with TARQUIN software at baseline and after 1 year. Examined metabolites included Glx (corresponding to Glu+Gln-peak), Glu, NAAG, myo-Ins, Cr, GSH and GABA. Clinical improvement was assessed by HDRS-17 scale. Differences in the concentrations of metabolites were evaluated by MANOVA/MANCOVA and GLM repeated measures for longitudinal changes.
FED patients had significantly decreased glutamate levels at baseline (p < 0.05) along with significantly elevated GABA (p < 0.01) compared to healthy controls. At the follow up, myo- Ins levels were significantly increased compared to baseline (p < 0.05) LIMITATIONS: The limited sample size, together with the unexpectedly high response rate after treatment (83%) might suggest decreased representativeness of the sample.
Results indicate glutamatergic and GABAergic changes taking place within the ventromedial prefrontal region even at the early stage of depression prior to any medication treatment.
先前的磁共振波谱（MRS）研究报告了重度抑郁症（MDD）患者存在脑代谢异常。然而，结果并不一致，研究主要集中在完全发作的重度抑郁症患者，而忽视了首发患者（FED）。纵向研究也很少见，且随访期较短。本研究的目的是调查健康对照组与首发患者在基线时的差异，以及腹内侧前额叶皮质在1年随访后代谢物的变化。
使用3T飞利浦Achieva扫描仪对64名健康对照者和31名首发患者进行氢质子磁共振波谱（H-MRS）成像，并在基线和1年后用TARQUIN软件进行处理。检测的代谢物包括Glx（对应于Glu+Gln峰）、Glu、NAAG、肌醇、Cr、GSH和GABA。通过HDRS-17量表评估临床改善情况。通过多变量方差分析/协方差分析和广义线性模型重复测量来评估代谢物浓度的纵向变化差异。
与健康对照组相比，首发患者在基线时谷氨酸水平显著降低（p<0.05），同时GABA水平显著升高（p<0.01）。在随访时，肌醇水平与基线相比显著升高（p<0.05）局限性：样本量有限，以及治疗后意外高的反应率（83%）可能表明样本的代表性降低。
结果表明，即使在任何药物治疗之前的抑郁症早期，腹内侧前额叶区域也会发生谷氨酸能和γ-氨基丁酸能变化。
