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目的:探讨氯胺酮治疗前皮质下灰质体积与氯胺酮抗抑郁作用的关系。方法:纳入难治性或伴自杀意念的抑郁症患者45例，进行2周共6次氯胺酮静脉注射（0.5 mg/kg，3次/周）。采用蒙哥马利抑郁量表（Montgomery-?sberg Depression Rating Scale, MADRS）及贝克自杀意念量表第一部分（Beck Scale for Suicide Ideation-part one，SSI-Ⅰ）评估抑郁症状及自杀意念。患者治疗前进行3.0T MRI扫描，采集得到的3DTn 1数据采用Freesurfer软件进行自动化处理，计算皮质下灰质结构（海马、杏仁核、丘脑、尾状核、壳核、苍白球）体积，并与45名健康对照者（对照组）皮质下灰质体积进行比较。采用线性回归分析治疗前皮质下灰质体积与氯胺酮治疗后MADRS分数改变值及SSI-Ⅰ改变值的关系（改变值=治疗前分数-治疗后分数）。n 结果:与对照组相比，抑郁症组双侧海马体积减小[左侧：（2 993±276) mmn 3比（2 785±263） mmn 3，n F=12.928，n P=0.001；右侧：（3 117±254）mmn 3比（2 949±270）mmn 3，n F=8.217，n P=0.005]。难治性患者治疗前右侧丘脑体积与6次氯胺酮治疗后MADRS分数改变值呈正相关（n B=0.009，n t=3.434, n P=0.002）。n 结论:难治性抑郁症患者治疗前右侧丘脑体积越大，氯胺酮抗抑郁效果越好；治疗前丘脑体积可能是氯胺酮抗抑郁作用的预测指标。“,”Objective:To examine the relationship between subcortical volumes and ketamine’s antidepressant effects.Methods:Forty-five depressive patients with treatment resistance or suicide ideation were involved and received six infusions of ketamine for two weeks（0.5 mg/kg，thrice-weekly）. Depressive symptoms were assessed by Montgomery-?sberg Depression Rating Scale (MADRS) and suicide ideation was assessed by Beck Scale for Suicide Ideation-part one (SSI-Ⅰ). Subcortical volumes underwent 3.0T-weighted MRI. The Freesurfer software was used to process the Tn 1 images, which used a set of automated sequences to analyze subcortical volumes. Forty-five healthy controls were collected and their subcortical volumes were compared with the patients’ volumes. Linear regression analysis was used to determine the association between pre-treatment subcortical volumes and change in MADRS score as well as SSI scores after ketamine treatment (change=pre-treatment scores minus post-treatment scores).n Results:In comparison to the healthy controls, depressive patients had decreased bilateral hippocampal volumes (Left:(2 993±276) mmn 3vs. (2 785±263) mmn 3， n F=12.928， n P=0.001； Right: (3 117±254) mmn 3vs. (2 949±270) mmn 3, n F=8.217， n P=0.005). Pre-treatment volumes of right thalamus were positively correlated with change in MADRS scores after six infusions in patients with treatment resistance （n B=0.009，n t=3.434, n P=0.002）.n Conclusion:Six ketamine infusions exerted enhanced antidepressant effects in treatment-resistant depression patients with relatively larger thalamus. Volume of thalamus could be used as a biomarker of six ketamine’s antidepressants treatment outcome.