CAJ | 학술논문

目的：探讨早期阶段双相障碍躁狂患者杏仁核静息态功能磁共振功能连接的改变。方法对23例符合《美国精神障碍诊断与统计手册第四版》（DSM-Ⅳ）的双相障碍Ⅰ型躁狂发作诊断标准且病程小于2年的患者及46名性别、年龄与患者匹配的正常对照进行静息态磁共振扫描；以贝克—拉范森躁狂评定量表（Bech-Rafaelsdn mania rating scale，BRMS）评估患者临床症状；在Matlab平台上应用SPM及DPARSF软件选取双侧杏仁核为种子点进行基于感兴趣区的功能连接分析，并比较两组差异；对功能连接强度及量表分进行相关分析。结果与对照组相比，患者组左侧杏仁核与左侧额叶内侧回和左侧前扣带回的静息态磁共振功能连接降低（P<0.001，未校正）；右侧杏仁核与左侧额叶内侧回和左侧前扣带回、双侧颞上回、右侧岛叶和尾状核静息态磁共振功能连接降低（P<0.001，未校正）。未发现患者组功能连接差异脑区的功能连接强度与BRMS分有统计学相关性（均P>0.05）。结论早期阶段双相障碍躁狂患者杏仁核与额叶皮质—边缘结构的功能连接降低，支持双相障碍存在额叶—边缘系统功能障碍的假说。
목적：탐토조기계단쌍상장애조광환자행인핵정식태공능자공진공능련접적개변。방법대23례부합《미국정신장애진단여통계수책제사판》（DSM-Ⅳ）적쌍상장애Ⅰ형조광발작진단표준차병정소우2년적환자급46명성별、년령여환자필배적정상대조진행정식태자공진소묘；이패극—랍범삼조광평정량표（Bech-Rafaelsdn mania rating scale，BRMS）평고환자림상증상；재Matlab평태상응용SPM급DPARSF연건선취쌍측행인핵위충자점진행기우감흥취구적공능련접분석，병비교량조차이；대공능련접강도급량표분진행상관분석。결과여대조조상비，환자조좌측행인핵여좌측액협내측회화좌측전구대회적정식태자공진공능련접강저（P<0.001，미교정）；우측행인핵여좌측액협내측회화좌측전구대회、쌍측섭상회、우측도협화미상핵정식태자공진공능련접강저（P<0.001，미교정）。미발현환자조공능련접차이뇌구적공능련접강도여BRMS분유통계학상관성（균P>0.05）。결론조기계단쌍상장애조광환자행인핵여액협피질—변연결구적공능련접강저，지지쌍상장애존재액협—변연계통공능장애적가설。
Objective To explore the resting statefunctional connectivity alterations and study the neural underpin?nings of patients in the early stage of bipolar disoder. Methods Resting-state fMRI data were collected from 23 patients who meet DSM-IV diagnostic criteria for current manic episode and with duration less than 2 years and from 46 age-and gender-matched healthy control subject. Functional connectivity maps from the amygdala were computed for each subject. Correlation analysis was performed between the FC values and Bech-Rafaelsdn Mania Rating Scale. Results Compared with health controls, bipolar disorder patients had significantly decreased left amygdala connectivity to the left medial frontal cortex and left anterior cingulate cortex(P<0.001,without correction)as well as decreased right amygdala connectivity to the left medial frontal cortex, left anterior cingulated, bilateral superior temporal gyrus, right insula and the caudate nucleus(P<0.001,without correction). There was no correlation between the altered amygdala functional connectivity and clinical symptom scores(P>0.05). Conclusions A reduced connectivity between the amygdala and fron?to-limbic structure indicates the fronto-limbic network dysfunction in the early stage of bipolar disorder, which suggest that a disruption brain connectivity within frontal–limbic system may be a possible biomarker for bipolar I disorder.