【作者】 徐伊；

【导师】 肖计划； 徐安定；

【作者基本信息】 暨南大学 ， 神经病学， 2004， 硕士

【摘要】 目的：用SPECT测定抑郁症患者局部脑血流(rCBF)改变，比较乙酰唑胺脑负荷试验后脑血流灌注变化，观察抑郁症患者脑血流下降区域的脑血管的调节能力，以及是否存在潜在缺血灶，并探讨脑血流量变化与抑郁严重程度之间的关系。 方法： 收集18例未经抗抑郁治疗的符合(CCMD-3)抑郁症诊断标准的抑郁症患者，以19例正常人作为对照组，行单光子发射计算机断层扫描(SPECT)检查，观察其脑血流灌注情况。以Hamilton抑郁量表和焦虑量表作为反映抑郁严重程度的指标，观察脑血流改变和抑郁严重程度之间的关系。抑郁症患者48h后口服乙酰唑胺2g，再行SPECT检查(乙酰唑胺脑SPECT)。观察服用乙酰唑胺前后脑内缺血的变化。 结果： 与对照组比较，抑郁组患者双侧额叶、颞叶的rCBF显著下降(p＜0.01～0.05)，左顶叶、右基底节rCBF也明显降低(p＜0.05)；同时，抑郁症患者局部脑血流低灌注存在不对称性，以左侧更加明显。服用乙酰唑胺后，原脑内各血流灌注下降部位恢复正常血供，未发现潜在缺血病灶。抑郁症患者rCBF与HAMD量表总分无明显相关，而与其某些亚相因子显著相关，双侧额叶rCBF与HAMA量表总分呈负相关。 结论： 抑郁症患者存在某些特定部位脑血流灌注下降；乙酰唑胺脑负荷SPECT实验未发现抑郁症患者存在潜在缺血部位，而且使其局部脑血流低灌注状态恢复正常。提示抑郁症患者脑rCBF改变区域的血管调节能力良好，其血流下降的原因并非血管本身器质性病变所致。更多还原

【Abstract】 Objective:To observe regional cerebral blood flow (rCBF) changes using SPECT, cerebral vasoreactivity and possible potential cerebral hypoperfusion using acetazolamide SPECT stress test in patients with depressive disorder; as well as to determine the correlation of cerebral hypoperfusion with the severity of depression. Method:Eighteen unmedicated patients fulfilling the CCMD-3 criteria for depressive disorder and nineteen healthy control subjects were included. Baseline SPECT was performed in both patients and control subjects, and acetazolamide SPECT stress test was performed 2 days later in patients after orally administration of 2 g acetazolamide. Hamilton Depression (HAMD) score and Hamilton Anxiety (HAMA) score was determined to represent the severity of depression. Result:Compared with the control subjects, obvious decrease of rCBF in both sides of frontal and temporal lobes, as well as in left parietal lobe and right basal ganglia with smaller extent, was found (P<0.05~0.01). Meanwhile, the cerebral hypoperfusion in both sides was asymmetric-lower in the left. After administration of acetazolamide, the decreased rCBF of all regions in patients was significantly improved, recovered to normal levels, and no potential cerebral ischemic region was found. Furthermore, the rCBF was correlated with certain subtype factors, but not the total score, of the HAMD score, while the decrease of rCBF in both frontal lobes was correlated with total score of HAMA. Conclusion:Cerebral hypoperfusion exists in patients with depressive disorder; acetazolamide SPECT stress test failed to evoke potential cerebral hypoperfusion, and by contrast, made the decreased rCBF recover to normal level. That suggests the cerebral vasoreactivity is intact in patients with depressive disorder, the decrease of rCBF is not due to the organic reasons of vessels.更多还原