Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, China; Department of First Clinical Medicine, Shanxi Medical University, Taiyuan 030001, China.
Department of Clinical Medicine, Fenyang College of Shanxi Medical University, 032200, China.
Prog Neuropsychopharmacol Biol Psychiatry. 2021 Dec 20;111:110386. doi: 10.1016/j.pnpbp.2021.110386. Epub 2021 Jun 11.
While gastrointestinal (GI) symptoms are very common in patients with major depressive disorder (MDD), few studies have investigated the neural basis behind these symptoms. In this study, we sought to elucidate the neural basis of GI symptoms in MDD patients by analyzing the changes in regional gray matter volume (GMV) and gray matter density (GMD) in brain structure.
Subjects were recruited from 13 clinical centers and categorized into three groups, each of which is based on the presence or absence of GI symptoms: the GI symptoms group (MDD patients with at least one GI symptom), the non-GI symptoms group (MDD patients without any GI symptoms), and the healthy control group (HCs). Structural magnetic resonance images (MRI) were collected of 335 patients in the GI symptoms group, 149 patients in the non-GI symptoms group, and 446 patients in the healthy control group. The 17-item Hamilton Depression Rating Scale (HAMD-17) was administered to all patients. Correlation analysis and logistic regression analysis were used to determine if there was a correlation between the altered brain regions and the clinical symptoms.
There were significantly higher HAMD-17 scores in the GI symptoms group than that of the non-GI symptoms group (P < 0.001). Both GMV and GMD were significant different among the three groups for the bilateral superior temporal gyrus, bilateral middle temporal gyrus, left lingual gyrus, bilateral caudate nucleus, right Fusiform gyrus and bilateral Thalamus (GRF correction, cluster-P < 0.01, voxel-P < 0.001). Compared to the HC group, the GI symptoms group demonstrated increased GMV and GMD in the bilateral superior temporal gyrus, and the non-GI symptoms group demonstrated an increased GMV and GMD in the right superior temporal gyrus, right fusiform gyrus and decreased GMV in the right Caudate nucleus (GRF correction, cluster-P < 0.01, voxel-P < 0.001). Compared to the non-GI symptoms group, the GI symptoms group demonstrated significantly increased GMV and GMD in the bilateral thalamus, as well as decreased GMV in the bilateral superior temporal gyrus and bilateral insula lobe (GRF correction, cluster-P < 0.01, voxel-P < 0.001). While these changed brain areas had significantly association with GI symptoms (P < 0.001), they were not correlated with depressive symptoms (P > 0.05). Risk factors for gastrointestinal symptoms in MDD patients (p < 0.05) included age, increased GMD in the right thalamus, and decreased GMV in the bilateral superior temporal gyrus and left Insula lobe.
MDD patients with GI symptoms have more severe depressive symptoms. MDD patients with GI symptoms exhibited larger GMV and GMD in the bilateral thalamus, and smaller GMV in the bilateral superior temporal gyrus and bilateral insula lobe that were correlated with GI symptoms, and some of them and age may contribute to the presence of GI symptoms in MDD patients.
虽然胃肠道（GI）症状在重度抑郁症（MDD）患者中非常常见，但很少有研究调查这些症状背后的神经基础。在这项研究中，我们通过分析脑结构中区域灰质体积（GMV）和灰质密度（GMD）的变化，试图阐明 MDD 患者 GI 症状的神经基础。
研究对象来自 13 个临床中心，分为三组，每组均基于是否存在 GI 症状：GI 症状组（至少有一个 GI 症状的 MDD 患者）、非 GI 症状组（没有任何 GI 症状的 MDD 患者）和健康对照组（HCs）。对 335 名 GI 症状组患者、149 名非 GI 症状组患者和 446 名健康对照组患者进行了结构磁共振成像（MRI）采集。所有患者均接受了 17 项汉密尔顿抑郁评定量表（HAMD-17）的评估。采用相关分析和逻辑回归分析来确定改变的脑区与临床症状之间是否存在相关性。
GI 症状组的 HAMD-17 评分明显高于非 GI 症状组（P<0.001）。三组之间的双侧颞上回、双侧颞中回、左侧舌回、双侧尾状核、右侧梭状回和双侧丘脑的 GMV 和 GMD 均有显著差异（GRF 校正，簇-P<0.01，体素-P<0.001）。与 HC 组相比，GI 症状组双侧颞上回 GMV 和 GMD 增加，而非 GI 症状组右侧颞上回、右侧梭状回 GMV 和右侧尾状核 GMV 增加（GRF 校正，簇-P<0.01，体素-P<0.001）。与非 GI 症状组相比，GI 症状组双侧丘脑 GMV 和 GMD 增加，双侧颞上回和双侧岛叶 GMV 减少（GRF 校正，簇-P<0.01，体素-P<0.001）。这些改变的脑区与 GI 症状显著相关（P<0.001），但与抑郁症状无关（P>0.05）。MDD 患者发生 GI 症状的风险因素（p<0.05）包括年龄、右侧丘脑 GMD 增加和双侧颞上回及左侧岛叶 GMV 减少。
伴有 GI 症状的 MDD 患者抑郁症状更严重。伴有 GI 症状的 MDD 患者双侧丘脑 GMV 和 GMD 增加，双侧颞上回和双侧岛叶 GMV 减少，与 GI 症状相关，其中一些与年龄可能有助于 MDD 患者出现 GI 症状。
