Predictive neural biomarkers of clinical response in depression: A meta-analysis of functional and structural neuroimaging studies of pharmacological and psychological therapies
Predictive neural biomarkers of clinical response in depression: A meta-analysis of functional and structural neuroimaging studies of pharmacological and psychological therapies
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DOI：
10.1016/j.nbd.2012.05.008
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发表时间：
2013-04-01
影响因子：
6.1
通讯作者：
Costafreda, Sergi G.
中科院分区：
文献类型：
--
作者：
Fu, Cynthia H. Y.;Steiner, Herbert;Costafreda, Sergi G.
我们对临床实践中最常用的循证治疗（即药理学和心理学治疗）的神经预测因子进行了系统回顾和荟萃分析。审查了在开始治疗前接受正电子发射断层扫描（PET）或功能或结构磁共振成像（MRI）扫描的当前患有重度抑郁发作的无药物受试者的调查。来自15个独立样本的20项研究的结果被纳入功能成像荟萃分析，来自6个独立样本的9项研究被纳入结构神经成像荟萃分析。具有预后价值的区域激活包括重复性良好的发现，即前扣带回基线活动增加预示改善的可能性更高。同样，纹状体和纹状体的基线激活增加与临床反应较差的可能性较高相关。结构神经影像学研究表明，右海马体积的减少是治疗反应较差的统计学显著预测因素。总的来说，可测量的预测信息与脑成像技术是多模态和区域分布，因为它包含功能以及结构的相关性，其中包括几个大脑区域内的额纹状体边缘系统网络。为了开发临床相关的预后标志物，需要在个体水平上具有高的预测准确性。预测临床反应将有助于对患者进行分层，并在早期阶段识别可能需要更强化或联合治疗的患者。我们认为，结构和功能神经影像学显示出显着的潜力，在抑郁症的治疗临床反应的预后标志物的发展。(C)2012 Elsevier Inc. All rights reserved.
We performed a systematic review and meta-analysis of neural predictors of response to the most commonly used, evidence based treatments in clinical practice, namely pharmacological and psychological therapies. Investigations of medication-free subjects suffering from a current major depressive episode who underwent positron emission tomography (PET) or functional or structural magnetic resonance imaging (MRI) scans prior to the initiation of treatment were reviewed. Results of 20 studies from 15 independent samples were included in the functional imaging meta-analysis and 9 studies from 6 independent samples in the structural neuroimaging meta-analysis. Regional activations with prognostic value include the well replicated finding that increased baseline activity in the anterior cingulate is predictive of a higher likelihood of improvement. As well, increased baseline activation in the insula and striatum is associated with higher likelihood of a poorer clinical response. Structural neuroimaging studies indicated that a decrease in right hippocampal volume is a statistically significant predictor of poorer treatment response. Overall, the predictive information that is measurable with brain imaging techniques is both multimodal and regionally distributed as it contains functional as well as structural correlates which encompass several brain regions within a frontostriatal limbic network. To develop clinically relevant, prognostic markers will require high predictive accuracy at the level of the individual. Predicting clinical response will help to stratify patients and to identify at an early stage those patients who may require more intensive or combined therapies. We propose that structural and functional neuroimaging show significant potential for the development of prognostic markers of clinical response in the treatment of depression. (C) 2012 Elsevier Inc. All rights reserved.