Objective To analyze the performance of amplitude of low frequency fluctuation(ALFF)in predicting the therapeutic efficacy of escitalopram in patients with depressive dissorder based on functional magnetic resonance imaging(fMRI)technology.Methods From April 2017 to June 2021,87 patients with depressive disorder who visited the Outpatient Department of Beijing Anding Hospital,Capital Medical University were selected as the research subject.All patients received 12 weeks of treatment with escitalopram.The efficacy was evaluated using the Hamilton Depression Scale-17 items(HAMD-17)at baseline and after 12 weeks of treatment.Patients with a post-treatment score of≤7 points were included in the remission group(n=42),while those with a score greater than 7 points were included in the non-remission group(n=45).During the baseline period,fMRI scans were performed on two groups of patients and ALFF values were calculated.The brain regions with differences in ALFF values between the two groups were compared.Pearson correlation was used to analyze the association between ALFF values in different brain regions and HAMD-17 scores.Receiver operating characteristic(ROC)curve was used to test the performance of differential brain region ALFF values in predicting the therapeutic efficacy of escitalopram.Results The baseline ALFF values of the bilateral calcarine gyrus/cuneiform gyrus and right lingual gyrus/parahippocampal gyrus in the non-remission group were higher than those in the remission group,and the difference was statistically significant(PFWE<0.05).The ALFF values of different brain regions were positively correlated with the HAMD-17 score of patients after 12 weeks of treatment(P<0.05),and negatively correlated with the HAMD-17 score reduction rate(P<0.05),and the differences were statistically significant.ROC curve analysis showed that the comprehensive prediction of the treatment efficacy of escitalopram was best based on the ALFF values of two different brain regions in the bilateral calcarine gyrus/cuneiform gyrus and right lingual gyrus/parahippocampal gyrus,with an area under the curve of 82.6%,sensitivity of 60.0%,and specificity of 95.2%.Conclusions The baseline local brain functional activity characteristic of depressive dissorder patients can serve as the potential marker to predict the efficacy of antidepressants,while enhanced functional activity in the visual network brain region may be a predictive factor for the poor therapeutic efficacy of escitalopram.

目的 基于功能磁共振成像（fMRI）技术分析抑郁症患者大脑低频振幅（ALFF）预测艾司西酞普兰的治疗效果。方法 选取2017年4月—2021年6月于首都医科大学附属北京安定医院门诊就诊的87例抑郁症患者为研究对象。所有患者接受12周的艾司西酞普兰药物治疗。于基线期、治疗12周末采用17项汉密尔顿抑郁量表（HAMD-17）评估疗效，将治疗后评分≤7分的患者纳入缓解组（n=42）,>7分纳入未缓解组（n=45）。在基线期对两组患者进行静息态fMRI扫描并计算ALFF值，比较两组患者ALFF值存在差异的脑区，采用Pearson相关分析差异脑区ALFF值与HAMD-17评分的相关性，并通过受试者工作特征（ROC）曲线检验差异脑区ALFF值预测艾司西酞普兰治疗效果的效能。结果 未缓解组患者基线期双侧距状回/楔叶和右侧舌回/海马旁回的ALFF值高于缓解组，差异有统计学意义（PFWE<0.05）。差异脑区的ALFF值与患者治疗12周末HAMD-17评分呈正相关（P<0.05），与HAMD-17减分率呈负相关（P<0.05）。ROC曲线分析显示，双侧距状回/楔叶和右侧舌回/海马旁回两个差异脑区ALFF值综合预测艾司西酞普兰治疗效果最好，曲线下面积为82.6%，敏感度为60.0%，特异度为95.2%。结论 基线期抑郁症患者的局部大脑功能活动特征可作为潜在标志预测抗抑郁剂疗效，视觉网络脑区的功能活动增强可能是艾司西酞普兰治疗效果欠佳的预测因素。

国家自然科学基金（82101597,82071531）;; 北京市医院管理中心“青苗”计划（QML20231901）~~