| Objective(s): At present,the pathogenesis of major depressive disorder(MDD)is not yet clear and there is no objective evaluation index to predict the curative effect.Thus,functional magnetic resonance imaging(f MRI),f MRI technology can measure blood flow response which is related to brain function by blood oxygenation level-dependent(BOLD),which can reflect neuronal activity of brain sensitively and find that functional changes in specific brain areas indirectly reflect neural activity.It plays a great role in revealing the pathogenesis of MDD and evaluating the efficacy of antidepressants.Most previous f MRI studies focus on static analysis.However,the brain is essentially a dynamic system,and dynamic index analysis based on sliding time analysis may have more information than static index.Therefore,this study intends to compare and analyze the symptoms and dynamic and static functional imaging changes of MDD patients before and after votioxetine treatment.In order to provide imaging reference for the pathogenesis of MDD patients and the treatment mechanism of antidepressants.Methods: in this study,39 patients with MDD who had not taken medication for the first time and 24 healthy controls were enrolled.Basic data of all subjects were collected,17-item Hamilton Depression Scale(HAMD-17),repeatable battery for the assessment of neuropsychological status(RBANS)score,f MRI data,etc.HAMD-17 scores and RBANS scores and f MRI data were collected again after 12 weeks of votioxetine monotherapy in the MDD group.In this study,DAPBI software was used to obtain the fractional Amplitude of low frequency fluctuation(fALFF)brain map of all subjects.The brain regions with significant differences in f ALFF between MDD patients at baseline and HC group were compared(p < 0.05),and then the brain regions with statistical differences in f ALFF were taken as regions of interest(ROI).resting-state functional connectivity(rs FC)analysis and dynamic functional connectivity(d FC)analysis of ROI and whole brain were performed.In addition,hippocampus was independently selected as ROI in this study,and d FC analysis was conducted on four subregions of the left and right hippocampal rostral and caudal hippocampus and the whole brain,to further explore the relationship between hippocampus and its subregions and the pathogenesis of MDD and the mechanism of drug therapy.Results:1.Enrollment status: A total of 39 MDD patients were enrolled in this study,including 24 in the HC group.Due to loss of follow-up,incomplete data,head movement correction and other reasons,22 MDD patients and 22 in the HC group were finally included.There was no significant difference in gender,age and education level between MDD group and HC group(P > 0.05).2.Analysis of clinical data:(1)Compared with the HC group at baseline,the total score of HAMD-17 in MDD patients was significantly higher than that in HC group,the total score of RBANS was significantly lower than that in HC group,and the scores of RBANS,language and delayed memory were significantly lower than those in HC group(P < 0.05).(2)Before and after treatment in MDD patients,after12 weeks of treatment,the total score of HAMD-17 was significantly lower than the baseline period,with an average score reduction rate of 66.49%,the total score of RBANS was significantly higher than the baseline period,with an average score increase rate of 5.32%,and the scores of immediate memory,attention and delayed memory in RBANS factor were significantly higher than the baseline period(P <0.05).(3)After 12 weeks of treatment,HAMD-17 scores in MDD group were still significantly higher than those in HC group at the end of 12 weeks(P < 0.05),the total score of RBANS was not significantly different from that of healthy control group(P > 0.05),but the visuospatial structure and language of RBANS were still significantly lower than those of HC group(P < 0.05).3.Dynamic and static brain function changes:(1)fALFF: Compared with HC group at baseline,the f ALFF of left Calcarine and left Cerebelum Crus1 decreased,while the f ALFF of left superior temporal gyrus increased in MDD patients.There was no significant difference between f ALFF after and before MDD treatment(p >0.05).(2)rs FC: Compared with HC group,rs FC of left Calcarine,right medial superior frontal gyrus and left medial superior frontal gyrus were enhanced in MDD patients at baseline.Compared with baseline period,rsFC of left superior temporal gyrus,left posterior central gyrus,left anterior central gyrus and right paracentral lobule were enhanced after treatment.(3)d FC: Compared with the HC group,d FC variability in the left talar cortex and left Cerebelum Crus 2,and in the left Cerebelum Crus 1 and right precuneus in MDD patients at baseline was decreased.d FC variability decreased in the right Rostral hippocampus and left inferior frontal gyrus triangle.Compared with baseline period,d FC variability of left superior temporal gyrus and left precuneus decreased after treatment.4.Correlation analysis of fALFF,rsFC,dFC and clinical data: In MDD patients,the f ALFF value of left distance cortex at baseline was positively correlated with the course of the disease(r=0.522,p=0.013),and the d FC value of left precunate lobe at the end of the 12 th week was negatively correlated with the total score of HAMD-17 at the end of the 12 th week(r=-0.436,p=0.048),and was positively correlated with the reduction rate of HAMD-17(r=0.4374,p=0.0474).Conclusion(s):1.Based on the analysis of cognitive function and clinical symptoms,12-week treatment with votioxetine can improve the depressive symptoms and cognitive function of MDD patients,but cannot completely relieve them,suggesting that further consolidation and maintenance therapy is needed for depression treatment.2.Functional activities of the occipital lobe,cerebellum,temporal lobe,frontal lobe,precuneus and other brain regions were abnormal in the baseline period of MDD patients,suggesting that functional changes in these brain regions may be the pathological basis of the onset of MDD patients.f ALFF value of the left Calcarine in the baseline period was positively correlated with the course of the disease,suggesting that the longer the course of the disease,the more severely the function of the left talar cortex was impaired.3.After 12 weeks of votioxetine treatment,compared with baseline period,functional connections between left superior temporal gyrus and frontoparietal network(anterior central gyrus,posterior central gyrus,paraventral lobule,precuneus)were changed,suggesting that votioxetine may play an antidepressant role by regulating functional connections between left superior temporal gyrus and frontoparietal network,and left superior temporal gyrus and frontoparietal network may be key brain regions in the treatment mechanism of MDD.4.Compared with HC group,dFC variability in the right coracoid hippocampus and left inferior frontal gyrus triangle increased in MDD patients at baseline,and d FC values in the right coracoid hippocampus and left inferior frontal gyrus triangle were not correlated with RBANS scores and factor scores,HAMD-17 scores,and course of disease.It is suggested that the abnormal functional connection between the right coracoid hippocampus and the left inferior frontal gyrus triangle may be a neuroimaging indicator of the pathogenesis of MDD independent of symptoms and course of disease. |
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