CAJ | 학술논문

目的利用静息态磁共振脑功能成像(fMRI)技术,评价伴有不同程度抑郁症状的原发性失眠(primary insomnia,PI)患者脑默认网络差异及其发生的神经网络机制.方法于2012年1月至2015年6月收集不伴抑郁症状的单纯PI患者15例,PI伴有轻、中度抑郁症状患者各20例,健康对照组(healthy control,HC)40例,以双侧后扣带回/楔前叶为种子点,对比HC与PI伴抑郁症状组间脑默认网络差异;对比PI伴有不同程度抑郁症状各组间脑默认网络差异.分别提取右侧中间扣带回和海马旁回的信号与汉密尔顿抑郁量表(HAMD)评分结果进行相关性分析.结果与HC组对比,PI伴有抑郁组功能连接增强脑区包括:双侧楔前叶、左枕中回、顶上小叶、额上回;功能连接减弱脑区包括:左侧前扣带回.与单纯PI组相比,PI伴有轻度抑郁症状组功能连接减弱脑区包括:双侧额中回、右侧枕中回/楔前叶、中央后回,无功能连接增强脑区;与伴轻度抑郁症状PI组相比,PI伴有中度抑郁组功能连接增强脑区包括:右侧小脑后叶、中间扣带回、左侧岛叶/额下回、外核、顶下小叶,功能连接减弱脑区包括:左侧颞上回、右侧海马旁回.右侧海马旁回、右侧中间扣带回信号与HAMD评分相关性分析结果分别为:r=-0.697,P=0.006;r=0.224,P=0.441.结论 PI伴有抑郁症状患者存在脑默认网络异常;伴有不同程度抑郁症状PI患者之间存在脑默认网络差异;海马旁回功能连接与HAMD评分显著负相关,中间扣带回功能连接与HAMD评分相关性不显著,但趋势一致.
목적 이용정식태자공진뇌공능성상(fMRI)기술,평개반유불동정도억욱증상적원발성실면(primary insomnia,PI)환자뇌묵인망락차이급기발생적신경망락궤제.방법 우2012년1월지2015년6월수집불반억욱증상적단순PI환자15례,PI반유경、중도억욱증상환자각20례,건강대조조(healthy control,HC)40례,이쌍측후구대회/설전협위충자점,대비HC여PI반억욱증상조간뇌묵인망락차이;대비PI반유불동정도억욱증상각조간뇌묵인망락차이.분별제취우측중간구대회화해마방회적신호여한밀이돈억욱량표(HAMD)평분결과진행상관성분석.결과 여HC조대비,PI반유억욱조공능련접증강뇌구포괄:쌍측설전협、좌침중회、정상소협、액상회;공능련접감약뇌구포괄:좌측전구대회.여단순PI조상비,PI반유경도억욱증상조공능련접감약뇌구포괄:쌍측액중회、우측침중회/설전협、중앙후회,무공능련접증강뇌구;여반경도억욱증상PI조상비,PI반유중도억욱조공능련접증강뇌구포괄:우측소뇌후협、중간구대회、좌측도협/액하회、외핵、정하소협,공능련접감약뇌구포괄:좌측섭상회、우측해마방회.우측해마방회、우측중간구대회신호여HAMD평분상관성분석결과분별위:r=-0.697,P=0.006;r=0.224,P=0.441.결론 PI반유억욱증상환자존재뇌묵인망락이상;반유불동정도억욱증상PI환자지간존재뇌묵인망락차이;해마방회공능련접여HAMD평분현저부상관,중간구대회공능련접여HAMD평분상관성불현저,단추세일치.
Objective To assess abnormal default mode network (DMN) and its potential mechanisms in insomnia patients with varying depression symptom via resting state functional magnetic resonance imaging (fMRI).Methods We recruited 15 cases of primary insomnia (PI) without depression symptom, 40 cases of insomnia patients with varying depressions, including mild depression (n =20) and moderate depression (n =20), and 40 cases of healthy controls (HC) with age and gender matched.We set bilateral posterior cingulate cortex and precuneus (PCC/PC) as seed regions, and compared the DMN changes between HC group and PI with depression symptoms group.We then compared the DMN changes between PI with mild and moderate depression groups.Finally, we extracted right cingulate cortex and parahippocampal signals and made Pearson correlation coefficient analysis with the Hamilton Depression Scale (HAMD) scores.Results The connectivity of PI with depression symptoms group was increased in brain regions including bilateral precuneus, left middle occipital gyrus, superior parietal lobe, superior frontal lobe, and was decreased in brain regions including left anterior cingulate cortex, compared with HC group.Compared with PI without depression symptoms group, the connectivity of PI with mild depression symptoms group was decreased in brain regions including bilateral middle frontal gyrus, right middle occipital gyrus/precuneus, and was not increased in brain regions in insomnia with mild group.Compared with PI with mild depression symptoms group, the connectivity of PI with moderate depression symptoms group was increased in brain regions including right cerebellum posterior lobe, middle cingulate cortex, left insular lobe/inferior frontal lobe, extra nuclear and inferior parietal lobe, and was decreased in brain regions in insomnia with moderate depression symptoms group including left superior temporal lobe and right parahippocampal gyrus.Pearson correlation coefficient analysis showed significant correlation between signals of right parahippocampal gyrus and HAMD scores (r =-0.697,P =0.006), while not between signals of right middle cingulate cortex and HAMD scores (r =0.224, P =0.441).Conclusions There were abnormal DMN in PI with depression symptoms group, and in PI with varying degrees of depression symptoms groups.Our results revealed specified brain regions of cognitive dysfunction and neural pathological mechanisms which were affected by PI with depression symptom.