伴不同失眠严重程度的单、双相抑郁障碍患者杏仁核亚区的功能连接分析
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高层次公共卫生技术人才建设项目( 学科骨干-03-27);首都卫生发展科研专项( 2024-2-1174);首都医科大学附属北京安定医院院级课题( YJ201901)


Functional connectivity of amygdala subregions in unipolar and bipolar depressive disorder patients with insomnia of varying severity
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    摘要:

    目的 探讨伴不同失眠严重程度的单相抑郁障碍(UDD)与双相抑郁障碍(BDD)患者杏仁 核亚区的功能连接差异。方法 本研究为横断面研究。招募2021 年3 月—2022 年6 月于首都医科大 学附属北京安定医院门诊就诊或住院的患者147 例,包括BDD 患者60 例和UDD 患者87 例;同期,通过 广告形式公开招募健康对照组53 名。收集所有受试者的一般资料、临床资料及静息态功能磁共振成像 (fMRI)数据。根据17 项汉密尔顿抑郁量表(HAMD-17)失眠亚量表将两组患者各分为失眠低分组(LI 组, HAMD-17 失眠亚量表总分≤ 3 分)和失眠高分组(HI组,HAMD-17 失眠亚量表总分≥ 4 分)。然后以杏 仁核的8 个亚区为种子点,计算这些种子点与全脑所有其他体素之间的功能连接,并采用单因素协方差 分析进行组间比较。发现显著结果后,进一步采用Spearman 相关分析方法计算杏仁核亚区的功能连接 与患者的抑郁、焦虑、躁狂症状之间的相关性。经筛查后,纳入BDDHI组28 例、BDDLI 组28 例、UDDHI 组38 例、UDDLI 组41 例。结果 BDDHI 组、BDDLI 组、UDDHI 组、UDDLI 组与健康对照组调整后的 HAMD-17 总分、HAMA 总分比较,差异有统计学意义(均P< 0.05);事后分析结果显示,所有患者组的上 述量表总分均高于健康对照组,差异有统计学意义(均P< 0.05)。4 组右侧杏仁核纹状体区与左侧小脑 前叶之间的功能连接比较,差异有统计学意义(PFWE=0.001);事后分析结果显示,BDDHI 组、UDDHI 组、 UDDLI 组的功能连接高于健康对照组,UDDLI 组的功能连接高于BDDLI 组,差异有统计学意义(均P < 0.05)。未用药患者与健康对照组的敏感性分析结果显示,4 组间功能连接差异的方向均与该分析结果 一致。Spearman 相关分析结果显示,右侧杏仁核纹状体区与左侧小脑前叶之间的功能连接在BDDHI 组 中与调整后的HAMD-17 总分呈显著负相关(r=-0.539,P=0.003,95%CI:-0.792~-0.201);在BDDLI 组中 与HAMA 总分呈显著正相关(r=0.515,P=0.005,95%CI:0.141~0.723)。结论 伴不同失眠严重程度的 UDD、BDD 患者右侧杏仁核纹状体区与左侧小脑前叶之间的功能连接存在显著差异,且该功能连接 与不同亚型BDD 患者的临床症状的相关性存在差异。

    Abstract:

    Objective To explore the functional connectivity differences of amygdala subregions in unipolar depressive disorder( UDD) and bipolar depressive disorder( BDD) patients with insomnia of varying severity. Methods This study was a cross-sectional study. A total of 147 outpatients or inpatients at Beijing Anding Hospital, Capital Medical University, between March 2021 and June 2022 were recruited, including 60 patients with BDD and 87 patients with UDD. At the same time, 53 participants for the healthy control group were recruited through public advertisements. General information, clinical data, and resting state functional magnetic resonance imaging( fMRI) data of all subjects were collected. Based on the insomnia subscale of the 17-item Hamilton Depression Rating Scale( HAMD-17), the two groups of patients were divided into a low insomnia group( LI group, HAMD-17 insomnia subscale total score ≤ 3) and a high insomnia group (HI group, HAMD-17 insomnia subscale total score ≥ 4). Using the 8 subregions of the amygdala as seed points, functional connectivity between these seed points and all other voxels in the whole brain was calculated, and one-way analysis of covariance was used for intergroup comparisons. After identifying significant results, Spearman correlation analysis was further used to calculate the correlations between functional connectivity of amygdala subregions and patients' symptoms of depression, anxiety, and mania. After screening, 28 patients were enrolled in the BDDHI group, 28 in the BDDLI group, 38 in the UDDHI group, and 41 in the UDDLI group. Results There were statistically significant differences in the adjusted HAMD-17 total scores and HAMA total scores between the BDDHI group, BDDLI group, UDDHI group, UDDLI group, and the healthy control group( all P < 0.05). Post-analysis comparisons revealed that the total scores on the aforementioned scales were higher in all patient groups than those in the healthy control group, with statistically significant differences( all P < 0.05). There were statistically significant differences in functional connectivity between the right amygdala-striatal region and the left anterior cerebellar lobe in the four groups( PFWE=0.001). Post-analysis comparisons revealed that functional connectivity was higher in the BDDHI, UDDHI, and UDDLI groups than in the healthy control group, and that functional connectivity in the UDDLI group was higher than in the BDDLI group, and these differences were statistically significant( all P<0.05). The sensitivity analysis between non-medicated patients and healthy control group showed that the direction of functional connectivity differences among the four groups was consistent with the results of this analysis. Spearman correlation analysis showed that the functional connectivity between the right amygdala-striatal region and the left anterior cerebellar lobe was significantly negatively correlated with the adjusted HAMD-17 total score in the BDDHI group[ r= -0.539,P=0.003, 95%CI( -0.792, -0.201)]. In the BDDLI group, there was a significant positive correlation with the total HAMA score[ r=0.515, P=0.005, 95%CI( 0.141, 0.723)]. Conclusions There are significant differences in the functional connectivity between the right amygdala-striatal region and the left anterior cerebellar lobe in UDD and BDD patients with insomnia of varying severity, and the correlation between this functional connectivity and clinical symptoms varies across different subtypes of BDD.

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杨帆,赵茜,李潇雅,等.伴不同失眠严重程度的单、双相抑郁障碍患者杏仁核亚区的功能连接分析[J].神经疾病与精神卫生,2026,26(7):464-471. DOI:10.3969/j. issn.1009-6574.2026.07.002.

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  • 在线发布日期: 2026-07-23