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目的:分析抑郁症（MDD）患者接受改良电休克治疗（MECT）前后其脑磁共振成像（MRI）的变化。方法:纳入2017年6月至2019年6月于杭州市第七人民医院及浙江大学医学院附属邵逸夫医院就诊的MDD患者105例。分析经MECT前后颅脑MRI资料，依据治疗前颅脑MRI结构分为两组：异常者为研究组（n n=51），正常者为对照组（n n=54），比较两组临床资料的差异、MECT治疗前后汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评分及并发症发生情况。n 结果:MRI显示51例患者颅脑结构异常，其中16例海马萎缩，18例脑容积缩小，10例颅内囊肿，7例大枕大池。MECT前后颅脑结构无明显变化。研究组发病年龄［（24.15±1.64）岁］小于对照组［（29.33±2.71）岁］（n t=-7.751，n P < 0.05），女性、有家族史以及有精神病性症状的患者比例均高于对照组（57.4%比47.1%、81.5%比56.9、55.6%比35.3%）（χ n 2=4.96、7.50、4.33，均n P < 0.05）。多因素logistic回归发现，家族史是无关因素（ n P=0.997），MDD患者脑结构异常与年龄呈负相关（n OR=3.89，n 95%CI=2.083~7.281，n P < 0.01），与性别、精神病性症状呈正相关（ n OR=12.05、0.08，n 95%CI=2.063~70.439、0.010~0.698，均n P < 0.05）。两组患者在接受MECT后HAMD、HAMA评分均降低（均 n P < 0.05）。研究组发生头昏头痛、呕吐、肌肉酸痛、谵妄、记忆障碍的概率均高于对照组（50.98%比27.78%，43.14%比22.22%，29.41%比11.11%、23.53%比7.41%、64.71%比33.33%）（χ n 2=5.93、5.24、5.49、5.27、10.33，均n P < 0.05）。n 结论:MDD患者多伴脑结构异常，发病年龄越小、女性及伴有精神病性症状越容易发生异常。MECT能明显改善抑郁症状，并且对脑结构不会造成明显影响，但脑结构异常的患者更容易出现并发症。“,”Objective:To observe the changes in brain magnetic resonance imaging (MRI) in patients with major depressive disorder (MDD) after modified electroconvulsive therapy (MECT) relative to before treatment.Methods:A total of 105 patients with MDD who received treatment in Hangzhou Seventh People\'s Hospital and Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from June 2017 to June 2019 were included in this study. The brain MRI data pre- and post-MECT were collected. These patients were divided into study group (abnormal brain structure, n n = 51) and control group (normal brain structure; n n = 54) according to brain structure pre-treatment as shown on MRI. Clinical efficacy, scores of the Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety pre and post-treatment, and the incidence of complications were compared between the two groups.n Results:MRI data revealed that 51 patients had abnormal brain structure, including 16 patients with hippocampal atrophy, 18 patients with brain volume reduction, 10 patients with intracranial cyst, and 7 patients with large occipital cistern. These patients had no obvious changes in brain structure after MECT compared with before MECT. The age of onset was lower in the study group than in the control group [(24.15 ± 1.64) years n vs. (29.33 ± 2.71) years, n t = -7.751, n P < 0.05]. The proportion of female patients (57.4% n vs. 47.1%), the proportion of patients with a family history of MDD (81.5% n vs. 56.9%), and the proportion of patients with psychotic symptoms (55.6% n vs. 35.3%) were significantly higher in the study group than in the control group (n χ2 = 4.96, 7.50, 4.33, all n P < 0.05). Multivariate logistic regression showed that family history was a factor unrelated to MDD ( n P = 0.997). Abnormal brain structure in patients with MDD was negatively correlated with age (n OR = 3.89, 95% n CI = 2.083 - 7.281, n P < 0.01) and it was positively correlated with sex and psychotic symptoms ( n OR = 12.05, 0.08, 95% n CI = 2.063 - 70.439, 0.010 - 0.698, both n P < 0.05). The Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety scores decreased after MECT in both groups (both n P < 0.05). The proportions of patients having dizziness/headache (50.98% n vs. 27.78%), vomiting (43.14% n vs. 22.22%), muscle soreness (29.41% n vs. 11.11%), delirium (23.53% n vs. 7.41%), and memory impairment (64.71% n vs. 33.33%) were significantly higher in the study group than in the control group (n χ2 = 5.93, 5.24, 5.49, 5.27, 10.33, all n P < 0.05).n Conclusion:Most patients with MDD have an abnormal brain structure. Female patients at a low age of onset with psychotic symptoms tend to have an abnormal brain structure. MECT can greatly improve depressive symptoms and has no obvious impact on brain structure. Patients with MDD who have an abnormal brain structure are more likely to have complications.