精神医学52巻4号

2010年04月発行

特集 内因性精神疾患の死後脳研究

気分障害に組織病理学的異常はあるか？

著者： 池田研二¹

所属機関： ¹財団法人慈圭病院・慈圭精神医学研究所

ページ範囲：P.353 - P.364

はじめに

　気分障害の死後脳研究は1980年代以降の統合失調症死後脳の神経病理学的な研究が盛んになった際に，統合失調症(shizophrenia；SC)と並んで双極性感情障害(bipolar disorder；BPD)と大うつ病(major depressive disorder；MDD)をSCと対比させる形で研究されることが多かった。そのうちに気分障害を中心とした研究も行われるようになり，今日に至っている。SCにサブタイプがあり，これを考慮に入れた研究が要求されるのと同じように，気分障害についても，早期発症と高齢発症では病態に違いがあると考えられ，両者を分けて考える必要がある。加齢性変化が加わってくる高齢者に起こるうつ病(late-life depression；LLD)にはより組織病理学的異常の関与の程度が大きいことは容易に想像されるが，LLDを取り上げた多くの研究報告がある。気分障害の研究はSC研究に連動して始まったが，一方で，MRIなどの形態画像で異常が指摘され，それがほぼ確実視されていること²⁵⁾，機能画像や神経心理学的な研究で脳，特に前頭葉の機能の低下が指摘されていることから，これらに対応する神経病理学的な検討がなされている。特にMRI研究は気分障害での死後脳の検討部位に示唆を与えた。それは，①前頭葉の(背側)前頭前野，前部帯状回や，②内側側頭葉の海馬領域と扁桃核などの辺縁系である。これとは別に，従来からのうつ病のモノアミン仮説に基づいて，③青斑核や縫線核の脳幹モノアミン神経系についても検討されている。さまざまな手段で死後脳研究がなされているが，組織病理学的異常の有無を問うという主旨から，①皮質の厚さ，神経細胞やグリア細胞のサイズや密度といった細胞の構築，構成の形態計測学的検討，②軸索，シナプス，樹状突起などの細胞要素の形態計測学的検討，③免疫組織化学を用いた形態計測学的研究，のように神経病理学的手法による報告を中心に，これまでの気分障害の死後脳研究報告について概観する。

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