Paralimbic hypoperfusion in unipolar depression.
Paralimbic hypoperfusion in unipolar depression.
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发表时间：
1994-06
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通讯作者：
H. Mayberg;P. Lewis;W. Regenold;H. Wagner
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作者：
H. Mayberg;P. Lewis;W. Regenold;H. Wagner
方法采用99 mTc-六甲基丙二胺肟单光子发射计算机断层扫描（SPECT）技术，对13例药物治疗无效的重度单相抑郁症患者和11例年龄匹配的正常对照者进行相对局部脑血流量测定。结果所有患者在研究时均为临床抑郁症患者，并服用抗抑郁药物。与非抑郁症健康对照组相比，抑郁症患者双侧额叶皮质、前颞叶皮质、前扣带回和尾状核的相对血流量显著降低。最大的下降出现在大脑边缘区域，特别是下额叶和扣带皮层。顶叶皮质、枕叶皮质或丘脑未见显著变化。精神评定量表与区域血流相关性较差，除了精神活动减慢的程度，这与额叶和扣带回灌注呈负相关。结论这些发现暗示临床抑郁症患者的边缘脑区的选择性功能障碍，独立于他们的药物使用，并支持特定的神经系统调节情绪的概念。识别这些区域异常可能在抑郁症的诊断和治疗中具有临床实用性。
METHODS Relative regional cerebral blood flow was measured with SPECT using 99mTc-hexamethylpropyleneamine oxime in 13 patients with severe unipolar depression that was nonresponsive to drug therapy and 11 age-matched nondepressed controls. RESULTS All patients were clinically depressed and taking antidepressant drugs at the time of the study. The relative blood flow was significantly decreased bilaterally in the frontal cortex, anterior temporal cortex, anterior cingulate gyrus and caudate in the depressed patients compared with the nondepressed healthy controls. The greatest decreases were seen in the paralimbic regions, specifically, the inferior frontal and cingulate cortex. No significant changes were seen in the parietal cortex, occipital cortex or thalami. Psychiatric rating scales correlated poorly with regional blood flow, except for the degree of psychomotor slowing, which was negatively correlated with frontal and cingulate perfusion. CONCLUSION These findings implicate selective dysfunction of paralimbic brain regions in clinically depressed patients, independent of their medication use, and support the concept of specific neural systems that regulate mood. Recognition of these regional abnormalities may have clinical utility in both the diagnosis and treatment of depression.