Prediction of Nonremission to Antidepressant Therapy Using Diffusion Tensor Imaging
Prediction of Nonremission to Antidepressant Therapy Using Diffusion Tensor Imaging
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DOI：
10.4088/jcp.14m09577
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发表时间：
2016-04-01
影响因子：
5.3
通讯作者：
Rush, A. John
中科院分区：
文献类型：
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作者：
Grieve, Stuart M.;Korgaonkar, Mayuresh S.;Rush, A. John
目的：超过50%的非精神病性重度抑郁症（MDD）门诊患者使用任何一种抗抑郁药物（ADM）都不能达到缓解。目前没有临床上有用的预处理措施，通知决定处方或选择ADM。本报告探讨了基于弥散张量成像（DTI）测量脑连接的生物标志物是否可以识别具有足够高特异性的非缓解患者子集，从而避免使用可能失败的药物。方法：从社区和初级社区招募的MDD门诊患者-作为国际抑郁症最佳治疗预测研究的一部分，（2008年12月至2014年6月进行）。DSM-IV标准和17项汉密尔顿抑郁评定量表（HDRS 17）评分≥ 16分证实了非精神病性MDD的初步诊断。来自MDD患者（n = 74）的第一队列的数据用于计算终纹和扣带束（CgC）扣带部分的各向异性分数测量。根据我们以前的数据，我们假设可以用这两个值的比值来预测未缓解。缓解定义为在受试者中随机分配艾司西酞普兰、舍曲林或文拉法辛缓释剂开放标签治疗8周后HDRS 17评分≥ 7。第二个研究队列（n = 83）用于replication.Results：百分之三十四的所有参与者达到缓解。终纹各向异性分数与CgC的比值> 1.0的患者中，38%的患者为非缓解患者，准确率为88%。（测试队列;比值比[OR] = 9.6; 95% CI，2.0-45.9）; 24%，准确度为83%（重复队列; OR = 1.8; 95%CI，0.5-6.9）和29%，准确性为86%（汇总数据; OR = 4.0; 95%CI，1.5-11.1）。治疗适度分析显示艾司西酞普兰和舍曲林的特异性更高（χ 2 = 8.07; P=.003）。结论：据我们所知，这个简单的DTI衍生指标代表了第一个可靠识别MDD非缓解患者的脑生物标志物。该测试确定了一个有意义的比例nonremitters，具有很高的特异性，并可能有助于管理抑郁症的抗抑郁药治疗。(C)版权所有2016 Physicians Postgraduate Press，Inc.
Objective: Over 50% of outpatients with nonpsychotic major depressive disorder (MDD) do not achieve remission with any single antidepressant medication (ADM). There are currently no clinically useful pretreatment measures that inform the decision to prescribe or select ADMs. This report examines whether a biomarker based on diffusion tensor imaging (DTI) measures of brain connectivity can identify a subset of nonremitting patients with a sufficiently high degree of specificity that use of a medication that is likely to fail could be avoided.Methods: MDD outpatients recruited from community and primary-care settings underwent pretreatment magnetic resonance imaging as part of the international Study to Predict Optimized Treatment in Depression (conducted December 2008-June 2014). DSM-IV criteria and a 17-item Hamilton Depression Rating Scale (HDRS17) score >= 16 confirmed the primary diagnosis of nonpsychotic MDD. Data from the first cohort of MDD patients (n = 74) were used to calculate fractional anisotropy measures of the stria terminalis and cingulate portion of the cingulate bundle (CgC). On the basis of our previous data, we hypothesized that nonremission might be predicted using a ratio of these 2 values. Remission was defined as an HDRS17 score of = 7 following 8 weeks of open-label treatment with escitalopram, sertraline, or venlafaxine extended-release, randomized across participants. The second study cohort (n = 83) was used for replication.Results: Thirty-four percent of all participants achieved remission. A value > 1.0 for the ratio of the fractional anisotropy of the stria terminalis over the CgC identified 38% of the nonremitting participants with an accuracy of 88% (test cohort; odds ratio [OR] = 9.6; 95% CI, 2.0-45.9); 24% with an accuracy of 83% (replication cohort; OR = 1.8; 95% CI, 0.5-6.9) and 29% with an accuracy of 86% (pooled data; OR = 4.0; 95% CI, 1.5-11.1). Treatment moderation analysis showed greater specificity for escitalopram and sertraline (chi(2) = 8.07; P=.003).Conclusions: To our knowledge, this simple DTI-derived metric represents the first brain biomarker to reliably identify nonremitting patients in MDD. The test identifies a meaningful proportion of nonremitters, has high specificity, and may assist in managing the antidepressant treatment of depression. (C) Copyright 2016 Physicians Postgraduate Press, Inc.