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| 艾司氯胺酮快速抗抑郁的效果及对大脑功能连接的影响 |
| Rapid antidepressant effect of esketamine and the influence of esketamine on brain functional connectivity |
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| DOI：10.12089/jca.2025.05.001 |
| 中文关键词: 艾司氯胺酮 难治性抑郁症 功能连接 功能磁共振成像 |
| 英文关键词: Esketamine Treatment-resistant depression Functional connectivity Functional magnetic resonance imaging |
| 基金项目:国家重点研发计划项目（2024YFC2510200） |
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| 中文摘要: |
目的：探索静脉输注艾司氯胺酮用于难治性抑郁症（TRD）患者的临床疗效及治疗后2 h大脑功能连接（FC）的变化。
方法：选择2023年4—12月就诊的TRD患者41例，男19例，女22例，年龄13～60岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ或Ⅱ级。记录治疗前24 h、治疗后24 h、7 d、1个月、3个月的汉密尔顿抑郁评分-17（HAMD-17），在治疗前24 h以及治疗后2 h分别进行静息态功能磁共振成像。选择杏仁核、海马为种子点，进行全脑FC分析。根据治疗反应将患者分为两组：有反应组和无反应组。
结果：治疗后24 h有23例（85.2%）不再有自杀意念，治疗后3个月有11例（26.8%）达到缓解，21例（51.2%）有反应。以杏仁核为种子点，与治疗前比较，治疗后2 h颞下回、眶部额下回、中央后回以及补充运动区FC明显减弱（P<0.05）；以海马为种子点，与治疗前比较，治疗后2 h豆状壳核、颞上回、楔前叶FC明显减弱（P<0.05）。与无反应组比较，有反应组的杏仁核与眶部额下回的FC减弱差值明显降低（P<0.05）。
结论：静脉输注艾司氯胺酮对TRD患者具有快速抗抑郁作用；治疗后2 h杏仁核与颞下回、眶部额下回、中央后回、补充运动区，海马与豆状壳核、颞上回、楔前叶的功能连接减弱。 |
| 英文摘要: |
Objective: To investigate the clinical efficacy of intravenous esketamine infusion in patients with treatment-resistant depression (TRD) and the associated changes in brain functional connectivity (FC) two hours after infusion.
Methods: Forty-one TRD patients from April 2023 to December 2023, 19 males and 22 females, aged 13-60 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were recruited in this study. The 17-item Hamilton depression rating scale (HAMD-17) was used to assess depression severity 24 hours before treatment, 24 hours, 7 days, 1 month, and 3 months after treatment. Resting-state functional magnetic resonance imaging (fMRI) were conducted 24 hours before treatment and 2 hours after treatment. The amygdala and hippocampus were selected as seed regions for whole-brain FC analysis. According to the treatment response, patients were divided into two groups: response group and non-response group.
Results: Twenty-three patients (85.2%) no longer had suicidal ideation 24 hours after treatment, 11 patients (26.8%) achieved remission and 21 patients (51.2%) responded 3 months after treatment. With the amygdala as the seed region, compared with 24 hours before treatment, the FC of inferior temporal gyrus, orbitofrontal gyrus, postcentral gyrus, and supplementary motor area were significantly weakened 2 hours after treatment (P < 0.05). With the hippocampus as the seed region, compared with 24 hours before treatment, the FC of putamen, superior temporal gyrus, and anterior cuneus were significantly weakened 2 hours after treatment (P < 0.05). Compared with the non-response group,the decrease of FC in the amygdala and orbitofrontal gyrus was significantly reduced in the response group (P < 0.05).
Conclusion: Intravenous esketamine infusion exerts a rapid antidepressant effect in TRD patients, accompanied by significant modulation of brain networks as early as 2 hours post-treatment. |
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