OBJECTIVE Major depressive disorder(MDD) is a highly heterogeneous mental illness.Further classification may help characterize its heterogeneity.The purpose of this study was to examine metabolomic and brain connectom...OBJECTIVE Major depressive disorder(MDD) is a highly heterogeneous mental illness.Further classification may help characterize its heterogeneity.The purpose of this study was to examine metabolomic and brain connectomic associations with traditional Chinese medicine(TCM) diagnostic classification of MDD.METHODS Fifty unmedicated depressed patients were classified into Liver Qi Stagnation(LQS,n=30) and Heart and Spleen Deficiency(HSD,n=20) subtypes according to TCM diagnosis.Healthy volunteers(n=28) were included as controls.Gas chromatography-mass spectrometry(GC-MS) and diffusion tensor imaging were used to detect serum and urinary metabolomic profiles and whole-brain white matter connectivity,respectively.RESULTS In metabolomic analysis,28 metabolites were identified for good separations between TCM subtypes and healthy controls in serum and urine samples.While both TCM subtypes had similar profiles in proteinogenic branched-chain amino acids and energy metabolism-related metabolites that were differentiated from healthy controls,the LQS subtype additionally differed from healthy controls in multiple amino acid metabolites that are involved in the biosynthesis of monoamine and amino acid neurotransmitters.Several metabolites are differentially associated with the two subtypes.In connectomic analysis,The LQS subtype showed significant differences in multiple network metrics of the angular gyrus,middle occipital gyrus,calcarine sulcus,and Heschl′ s gyrus when compared to the other two groups.The HSD subtype had markedly greater regional connectivity of the insula,parahippocampal gyrus,and posterior cingulate gyrus than the other two groups,and microstructural abnormalities of the frontal medial orbital gyrus and middle temporal pole.The insular betweenness centrality was strongly inversely correlated with the severity of depression and dichotomized the two subtypes at the optimal cutoff value with acceptable sensitivity and specificity.CONCLUSION The LQS subtype may represent an MDD subpopulation mainly characterized by abnormalities in the biosynthesis of monoamine and amino acid neurotransmitters,closer associations with stress-related pathophysiology,and aberrant connectivity of the audiovisual perception-related temporal-occipital network,whereas the HSD subtype is more closely associated with hyperconnectivity and microstructural abnormalities of the limbicparalimbic network.Certain metabolomic and connectomic variables are potential biomarkers for TCM diagnostic subtypes which is perhaps an alternative classification for depressive disorders.展开更多
目的探讨抑郁障碍和双相障碍患者脑白质网络节点强度的差异,分析患者不同脑区的结构连接受损情况及其在鉴别中的作用。方法纳入91例基线诊断为抑郁发作的患者,经过≥9年的自然观察随访后,最终确定23例维持抑郁障碍诊断(单相组)和18例维...目的探讨抑郁障碍和双相障碍患者脑白质网络节点强度的差异,分析患者不同脑区的结构连接受损情况及其在鉴别中的作用。方法纳入91例基线诊断为抑郁发作的患者,经过≥9年的自然观察随访后,最终确定23例维持抑郁障碍诊断(单相组)和18例维持双相障碍诊断(双相组)的患者纳入分析。同时纳入30名健康对照者(对照组)。受试者在入组时均接受弥散张量成像扫描,采用确定性纤维追踪技术构建脑白质结构加权网络。比较三组间脑白质网络的节点连接强度差异,进一步采用受试者操作特征(receiver operator characteristic,ROC)曲线评估差异脑区对抑郁障碍和双相障碍鉴别诊断的价值。结果双相组在左前扣带回的节点强度较单相组降低(3.89±0.76 vs.4.74±0.60),在右尾状核(4.94±1.26 vs.3.46±0.99)、右苍白球(1.98±0.67 vs.1.25±0.29)的节点强度较单相组升高(P<0.01,FWE校正)。左前扣带回、右尾状核、右苍白球3个脑区的连接强度联合鉴别抑郁障碍和双相障碍绘制ROC曲线,曲线下面积(area under the curve,AUC)为0.95(95%CI:0.91~0.99;P<0.01),敏感度0.89,特异度0.87。结论脑结构网络的节点强度差异可以作为一个潜在的影像学生物标志物识别抑郁障碍和双相障碍,联合差异脑区的节点强度可以得到更好的识别率。展开更多
目的探讨血清可溶性髓样细胞触发受体2(triggering receptor expressed on myeloid cells-2,sTREM2)水平对脑小血管病(cerebral small vessel disease,CSVD)患者的临床诊断价值,以及与抑郁症及其严重程度的关系。方法选取2023年12月至2...目的探讨血清可溶性髓样细胞触发受体2(triggering receptor expressed on myeloid cells-2,sTREM2)水平对脑小血管病(cerebral small vessel disease,CSVD)患者的临床诊断价值,以及与抑郁症及其严重程度的关系。方法选取2023年12月至2024年11月石河子大学第一附属医院神经内科住院治疗的CSVD患者208例(CSVD组),根据汉密尔顿抑郁量表评分分为抑郁组(CSVD+D组)112例和非抑郁组(CSVD-D组)96例,根据汉密尔顿抑郁量表17项将抑郁组(CSVD+D组)分为轻度抑郁患者(8~17分)80例、中度抑郁患者(18~24分)27例和重度抑郁患者(≥25分)5例;另同时选取同期健康体检者208例作为对照组。比较各组临床资料,采用多因素logistic回归分析CSVD患者发生抑郁症的影响因素以及sTREM2与抑郁程度的关系;采用ROC曲线分析血清sTREM2水平对CSVD患者发生抑郁症的预测价值。结果CSVD组血清sTREM2水平显著高于对照组[(5.95±3.82)μg/L vs(1.40±1.21)μg/L,P<0.01]。ROC曲线分析显示,血清sTREM2水平诊断CSVD的曲线下面积为0.917,敏感性为87.52%,特异性为85.64%,最佳截断值为2.272μg/L。CSVD+D组血清sTREM2水平高于CSVD-D组[(6.40±3.93)μg/L vs(5.01±2.87)μg/L,P<0.01]。多因素logistic回归分析显示,血清sTREM2水平是CSVD患者发生抑郁症的独立影响因素(OR=1.115,95%CI:1.019~1.220,P=0.018)。不同抑郁程度CSVD患者血清sTREM2水平比较,差异有统计学意义(P<0.05)。多因素有序logistic回归分析显示,血清sTREM2水平是CSVD+D组患者轻、中度抑郁的独立影响因素(OR=1.113,95%CI:1.013~1.223,P=0.026;OR=1.135,95%CI:1.004~1.284,P=0.043)。血清sTREM2水平预测CSVD患者发生抑郁症的曲线下面积为0.603。结论血清sTREM2水平与CSVD患者有关,其检测结果可能为临床诊断CSVD提供一定的参考价值,并对CSVD患者抑郁症的发生存在潜在预测价值。展开更多
基金National Natural Science Foundation of China(81403502)General Research Fund ofResearch Grants Council of Hong Kong (17124418).
文摘OBJECTIVE Major depressive disorder(MDD) is a highly heterogeneous mental illness.Further classification may help characterize its heterogeneity.The purpose of this study was to examine metabolomic and brain connectomic associations with traditional Chinese medicine(TCM) diagnostic classification of MDD.METHODS Fifty unmedicated depressed patients were classified into Liver Qi Stagnation(LQS,n=30) and Heart and Spleen Deficiency(HSD,n=20) subtypes according to TCM diagnosis.Healthy volunteers(n=28) were included as controls.Gas chromatography-mass spectrometry(GC-MS) and diffusion tensor imaging were used to detect serum and urinary metabolomic profiles and whole-brain white matter connectivity,respectively.RESULTS In metabolomic analysis,28 metabolites were identified for good separations between TCM subtypes and healthy controls in serum and urine samples.While both TCM subtypes had similar profiles in proteinogenic branched-chain amino acids and energy metabolism-related metabolites that were differentiated from healthy controls,the LQS subtype additionally differed from healthy controls in multiple amino acid metabolites that are involved in the biosynthesis of monoamine and amino acid neurotransmitters.Several metabolites are differentially associated with the two subtypes.In connectomic analysis,The LQS subtype showed significant differences in multiple network metrics of the angular gyrus,middle occipital gyrus,calcarine sulcus,and Heschl′ s gyrus when compared to the other two groups.The HSD subtype had markedly greater regional connectivity of the insula,parahippocampal gyrus,and posterior cingulate gyrus than the other two groups,and microstructural abnormalities of the frontal medial orbital gyrus and middle temporal pole.The insular betweenness centrality was strongly inversely correlated with the severity of depression and dichotomized the two subtypes at the optimal cutoff value with acceptable sensitivity and specificity.CONCLUSION The LQS subtype may represent an MDD subpopulation mainly characterized by abnormalities in the biosynthesis of monoamine and amino acid neurotransmitters,closer associations with stress-related pathophysiology,and aberrant connectivity of the audiovisual perception-related temporal-occipital network,whereas the HSD subtype is more closely associated with hyperconnectivity and microstructural abnormalities of the limbicparalimbic network.Certain metabolomic and connectomic variables are potential biomarkers for TCM diagnostic subtypes which is perhaps an alternative classification for depressive disorders.
文摘目的探讨抑郁障碍和双相障碍患者脑白质网络节点强度的差异,分析患者不同脑区的结构连接受损情况及其在鉴别中的作用。方法纳入91例基线诊断为抑郁发作的患者,经过≥9年的自然观察随访后,最终确定23例维持抑郁障碍诊断(单相组)和18例维持双相障碍诊断(双相组)的患者纳入分析。同时纳入30名健康对照者(对照组)。受试者在入组时均接受弥散张量成像扫描,采用确定性纤维追踪技术构建脑白质结构加权网络。比较三组间脑白质网络的节点连接强度差异,进一步采用受试者操作特征(receiver operator characteristic,ROC)曲线评估差异脑区对抑郁障碍和双相障碍鉴别诊断的价值。结果双相组在左前扣带回的节点强度较单相组降低(3.89±0.76 vs.4.74±0.60),在右尾状核(4.94±1.26 vs.3.46±0.99)、右苍白球(1.98±0.67 vs.1.25±0.29)的节点强度较单相组升高(P<0.01,FWE校正)。左前扣带回、右尾状核、右苍白球3个脑区的连接强度联合鉴别抑郁障碍和双相障碍绘制ROC曲线,曲线下面积(area under the curve,AUC)为0.95(95%CI:0.91~0.99;P<0.01),敏感度0.89,特异度0.87。结论脑结构网络的节点强度差异可以作为一个潜在的影像学生物标志物识别抑郁障碍和双相障碍,联合差异脑区的节点强度可以得到更好的识别率。