400-182-1988
神经影像学研究的证据表明,重度抑郁症患者的自杀意念与多个大脑区域的结构和功能异常相关[1-2],尤其是执行功能障碍。而前额叶背外侧皮质(dlpfc)与情绪症状之间存在很强的关联,但dlpfc功能是否可以成为有自杀意念抑郁症的生物标志物尚无定论[3]。
近红外脑功能成像技术(fnirs)可以利用650-1000nm之间的光源,穿透有机组织并被血红蛋白吸收,通过神经血管耦合机制反映脑功能变化。一方面,它相对便宜、便携、易于开展,并且可以提供与功能性磁共振(fmri)相当的时间分辨率,且能适用于多种自然环境[4-6]。
研究表明,自传体记忆功能障碍是情感障碍的标志,可能是抑郁症患者存在过度负面情绪的主要原因,它可以推动和预测抑郁症的发作和维持,而改善该功能可以缓解抑郁症状[7]。
因此,华中科技大学张妍教授团队联合江汉大学在《journal of affective disorders》(if=6.533)杂志上发表了一篇研究[8],该研究利用fnirs探索在情绪自传体记忆测试时患者dlpfc的血流动力学变化,这些受试者为有/无自杀意念的年轻抑郁症患者。
用情感图片作为线索,勾起受试者对过去某些特定情节的记忆等,以唤起受试者的情绪。试验范式如下:
采用武汉资联虹康生产的bs-7000设备,16个发射光源和16个接收探头,共53通道,通道排布如下:
表1 p值来自 χ2检验和单因素方差分析, "a"代表单因素方差分析, "b"代表χ2检验
图3 (a)在eamt期间,健康对照组与无自杀意念抑郁组在负面情绪下hbo水平的变化。
(b)健康对照组和无自杀意念抑郁组负情绪下左dlpfc平均hbo分布的直方图。*:p<0.05
图4 (a)在eamt期间,健康对照组与无自杀意念抑郁组在负面情绪下hbo水平的变化。
(b)健康对照组和自杀意念抑郁组正性情绪下右dlpfc平均hbo分布的直方图。*:p<0.05
五、结论
1、有自杀意念的抑郁症个体在右侧dlpfc的执行功能方面存在一定的缺陷[1]du, l., zeng, j., liu, h., tang, d., meng, h., li, y., fu, y., 2017. fronto-limbic disconnection in depressed patients with suicidal ideation: a resting-state functional connectivity study. [j]. affect. disord. 215, 213-217
[2]minzenberg, m.j., lesh, t.a., niendam, t.a., cheng, y., carter, c.s., 2016. conflictrelated anterior cingulate functional connectivity is associated with past suicidal ideation and behavior in recent-onset psychotic major mood disorders.[j]. neuropsychiatry clin. neurosci. 28 (4), 299-305.
[3]y.q. lee, g.w.n. tay, c.s.h. ho.clinical utility of functional near-infrared spectroscopy for assessment and prediction of suicidality: a systematic review.[j]. frontiers in psychiatry, 12 (2021),716276.
[4]ho, c.s.h., lim, l.j.h., lim, a.q., chan, n.h.c., tan, r.s., lee, s.h., ho, r.c.m., 2020. diagnostic and predictive applications of functional near-infrared spectroscopy for major depressive disorder: a systematic review. [j].frontiers in psychiatry 11, 378.
[5]scholkmann, f., kleiser, s., metz, a.j., zimmermann, r., mata pavia, j., wolf, u., wolf, m., 2014. a review on continuous wave functional near-infrared spectroscopy and imaging instrumentation and methodology. neuroimage 85 (pt 1), 6–27.
[6]chenghua gu et al. caveolae in cns arterioles mediate neurovascular coupling brian. nature. 2020.[7]sumner, j.a., mineka, s., adam, e.k., craske, m.g., vrshek-schallhorn, s., wolitzkytaylor, k., zinbarg, r.e., 2014. testing the car-fa-x model: investigating the mechanisms underlying reduced autobiographical memory specificity in individuals with and without a history of depression. j. abnorm. psychol. 123 (3), 471–486.
[8]zheng m, da h, pan x, et al. dorsolateral prefrontal activation in depressed young adults with and without suicidal ideation during an emotional autobiographical memory task: a fnirs study.[j] j affect disord. 2023;326:216-224.