BJPsych：重度抑郁患者脑灰质体积减小

　　关于重度精神障碍所致的脑部机构改变尚无一直的研究结论，造成这种状况的部分原因或在于部分研究未将一些关键的临床变量纳入考虑。

　　《英国精神病学杂志》（The British Journal of Psychiatry）6月在线版发布的一篇研究结果显示重度抑郁患者的额颞边缘地区脑灰质体积减小，这与病程长短有关与药物治疗模式无关。研究者提示，长期的患有抑郁障碍对脑灰质存在负面影响。

　　研究为评估重度抑郁障碍对脑灰质体积的影响，采用基于体素的形态学分析将66名处于不同疾病阶段的抑郁患者于32名健康受试者组成的对照组进行比较。将研究组66名患者平均分为首发组、复发缓解期组及治疗抵抗/慢性抑郁组。使脑容积与临床变量相关。

　　结果发现，研究组患者右额上回、左内侧额叶和左扣带回表现出一种显著的整体效应（P<0.05，家庭智慧误差修正）。治疗抵抗/慢性病人额颞区脑灰质体积最小，病程的延长与右内侧额叶皮质及左脑岛内灰质体积减小成负相关。

Effects of illness duration and treatment resistance on grey matter abnormalities in major depression
Background
Findings of brain structural changes in major depressive disorder are still inconsistent, partly because some crucial clinical variables have not been taken into account.
Aims
To investigate the effect of major depressive disorder on grey matter volumes.
Method
Voxel-based morphometry was used to compare 66 patients with depression at different illness stages (22 each with first-episode, remitted-recurrent and treatment resistant/chronic depression) with 32 healthy controls. Brain volumes were correlated with clinical variables.
Results
Voxel-based morphometry showed a significant group effect in right superior frontal gyrus, left medial frontal gyrus and left cingulate gyrus (P<0.05, family wise error-corrected). Patients whose condition was treatment resistant/chronic exhibited the smallest volumes in frontotemporal areas. Longer illness duration was negatively correlated with decreases in right medial frontal cortex and left insula.
Conclusions
Frontotemporolimbic areas are smaller in the patients with severe depression and are associated with duration of illness, but not with medication patterns, suggesting negative effects of long-lasting major depressive disorder on grey matter.