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摘要


腦源性神經滋養因子(brain-derived neurotrophic factor, BDNF)在神經發育生長、神經分化、神經細胞成熟、神經細胞存活與調控調節神經可塑性的調節上佔有重要的角色。而BDNF調節異常也被認為跟許多神經精神疾病背後的病生理機轉有關,例如:重度憂鬱症。重度憂鬱症的發病機制目前雖然尚不清楚,Duman團隊在1995年率先在老鼠憂鬱模型上,提出BDNF-憂鬱症-抗憂鬱反應假說。其證據在於給予憂鬱小鼠電療(electroconvulsive therapy, ECT)或是抗憂鬱劑治療後,其海馬迴與皮質的BDNF濃度會升高。後續憂鬱症人體研究也發現類似的成果,周邊血液中的BDNF濃度在治療後可以由原本低於正常人標準,提升至與正常人相似。同時憂鬱症患者與自殺患者死後腦部解剖發現,BDNF與相關受器TrkB的蛋白質與mRNA濃度減少,且BDNF基因易有甲基化的發現,都間接證實憂鬱症可能跟BDNF或是神經突觸調節有關。後續研究更發現BDNF基因型亦會影響到抗憂鬱療程的療效,且不同基因型在不同抗憂鬱療程可能有不同的角色,也開啟未來BDNF基因型做為預測工具的可能性。

參考文獻


Fujimura H, Altar CA, Chen R, et al. Brain-derived neurotrophic factor is stored in human platelets and released by agonist stimulation. Thromb Haemost 2002;87:728-34.
Molendijk ML, Spinhoven P, Polak M, et al. Serum BDNF concentrations as peripheral manifestations of depression: evidence from a systematic review and meta-analyses on 179 associations(N=9484). Mol Psychiatry 2014;19:791-800.
Zhao G, Zhang C, Chen J, et al. Ratio of mBDNF to proBDNF for Differential Diagnosis of Major Depressive Disorder and Bipolar Depression. Mol Neurobiol 2017;54:5573-82.
Zhou C, Zhong J, Zou B, et al. Meta-analyses of comparative efficacy of antidepressant medications on peripheral BDNF concentration in patients with depression. PLoS One 2017;12:e0172270.
Rocha RB, Dondossola ER, Grande AJ, et al. Increased BDNF levels after electroconvulsive therapy in patients with major depressive disorder: A meta-analysis study. Journal of psychiatric research 2016;83:47-53.

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