Changes in regional cerebral blood flow abnormalities in late-life depression following response to electroconvulsive therapy
Changes in regional cerebral blood flow abnormalities in late-life depression following response to electroconvulsive therapy
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DOI：
10.1046/j.1440-1819.2002.00927.x
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发表时间：
2002-02-01
影响因子：
11.9
通讯作者：
Sato, M
中科院分区：
文献类型：
--
作者：
Awata, S;Konno, M;Sato, M
电休克治疗（ECT）对老年抑郁症患者局部脑血流（rCBF）异常的影响尚不清楚，这些发现在老年抑郁症中的临床意义尚未得到充分讨论。使用单光子发射计算机断层扫描（SPECT）与Tc-99 m-HMPAO（Tc-99 m-HMPAO），我们检查了9例老年抑郁症患者的rCBF模式的变化之前和之后的ECT反应与9名年龄和性别匹配的健康志愿者相比。在感兴趣区域（ROI）和逐体素基础上进行统计比较。在基于ROI的分析中，ECT前患者的平均rCBF与对照组相比显著降低，ECT后2周患者的平均rCBF与ECT前相比显著增加（正常化），ECT后12周患者的平均rCBF与ECT前相比仍增加。在逐体素分析中，与对照组相比，ECT前患者的双侧胼胝体前和下前扣带回皮质、双侧眶额尾侧皮质、右侧岛叶皮质和右侧后额中回的rCBF显著降低，ECT后2周和12周的rCBF模式相似。我们提出的假设是，平均rCBF减少可能有一个状态相关的属性，而持续的前边缘脑灌注不足可能有一个特质样的属性，这涉及到复发的脆弱性，以及药物治疗失败和疾病慢性化的倾向，在晚年抑郁症。
The impact of electroconvulsive therapy (ECT) on the regional cerebral blood flow (rCBF) abnormalities in late-life depression is still unknown and the clinical significance of these findings in late-life depression has not been fully discussed. Using-single photon emission computed tomography (SPECT) with Tc-99m-hexamethylpropylene amine oxime (Tc-99m-HMPAO), we examined the changes of rCBF patterns in nine late-life patients with major depressive episodes before and following response to ECT compared with nine age- and sex-matched healthy volunteers. Statistical comparisons were made on both region-of-interest (ROI) and voxel-by-voxel bases. In ROI-based analyses, a mean rCBF was significantly decreased in the patients before ECT compared with the control, significantly increased (normalized) in the patients 2 weeks after ECT compared with that before ECT, and still increased in the patients 12 weeks after ECT compared with that before ECT. In voxel-by-voxel analyses, a significant rCBF reduction was found in the bilateral pre- and subcallosal anterior cingulate cortex, the bilateral caudal orbitofrontal cortex, the right insular cortex and the right posterior middle frontal gyrus in patients before ECT compared with the control, and similar rCBF patterns were shown at 2 weeks and 12 weeks after ECT. We propose the hypothesis that a mean rCBF reduction may have a state-related property while persistent anterior paralimbic hypoperfusion may have a trait-like property, which relates to the relapse vulnerability as well as a tendency toward medication failure and illness chronicity in late-life depression.