卒中后抑郁患者小脑磁共振波谱成像改变的临床研究  

Clinical study on the changes in magnetic resonance spectroscopy of cerebellum in patients with post-stroke depression

作　　者：赵明奎[1] 隋汝波[1] 马贺骥[2] 李木子[1] 张霏霏[1] 李桂岚[1] 张磊[3] 

机构地区：[1]辽宁医学院附属第一医院神经内科,辽宁锦州121000 [2]辽宁医学院附属第一医院放射科,辽宁锦州121000 [3]辽宁医学院护理学院,辽宁锦州121000

出　　处：《解放军医学杂志》2016年第6期484-491,共8页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金专项基金(81371461;81241050);辽宁省自然科学基金(2013022018);辽宁医学院青年基金(Y2012Z014);辽宁省科学技术计划项目(2012225019)~~

摘　　要：目的应用氢质子磁共振波谱成像(1H-MRS)技术,探讨卒中后抑郁(PSD)患者小脑代谢的改变及其与抑郁严重程度的关系。方法以卒中患者作为研究对象,回顾性收集人口学、个人疾病史和生活方式的数据,对40例卒中患者及20例健康志愿者进行自评抑郁量表(SDS)和汉密尔顿抑郁量表(HAMD)评分。根据评分结果,将卒中患者分为卒中后抑郁(PSD)组和卒中后无抑郁(CONT)组。对PSD组、CONT组和正常对照(NORM)组进行T1WI、T2WI、DWI及1H-MRS检查,评估脑梗死体积和脑白质病变部位及严重程度,测定小脑半球N-乙酰天冬氨酸(NAA)/肌酸(Cr)、胆碱复合物(Cho)/Cr、Cho/NAA比值,并分析卒中后小脑代谢改变与HAMD评分间的关系。结果 CONT组双侧小脑NAA/Cr、Cho/Cr、Cho/NAA比值与NORM组比较差异均无统计学意义(P>0.05)。与NORM组和CONT组比较,PSD组病灶对侧小脑Cho/Cr、Cho/NAA比值均较高(P<0.05),病灶同侧小脑Cho/Cr、Cho/NAA比值差异无统计学意义(P>0.05),而双侧小脑NAA/Cr比值差异无统计学意义(P>0.05)。PSD组家庭APGAR问卷评分、ARWMC总分、发病14d时NIHSS评分、病灶对侧小脑Cho/Cr和Cho/NAA比值与CONT组比较差异有统计学意义(P<0.05)。多重线性回归分析显示,病灶对侧小脑Cho/Cr、Cho/NAA比值与HAMD评分具有相关性(P<0.05)。结论小脑可能参与了卒中后抑郁的发生。Objective To study the metabolic changes of cerebellum in patients with post-stroke depression （PSD） by proton magnetic resonance spectroscopy （1H-MRS） and discuss the relationships between the cerebellar changes and depression severity. Methods Stroke patients were selected as the subjects in present study. Data of demographic characteristics, individual history and life style of all subjects were collected. Forty patients with stroke and 20 healthy volunteers as control （NORM group） were enrolled. Hamilton Depression Scale （HAMD） and Self-rating Depression Scale （SDS） were used to test the subjects. According to the scores of depression severity, the stroke group was further divided into a group with post-stroke depression （PSD group） and a group without post-stroke depression （CONT group）. All the patients of 2 groups received TIWI, T2WI, DWI and H-MRS examination. The cerebral infarction volume and the distribution and severity of leukoaraiosis were evaluated. The ratios of NAA/Cr, Cho/Cr and Cho/NAA in the cerebellum were calculated. Moreover, the relationships between the ratios and the scores of HAMD were analyzed in all post-stroke patients. Results There was no significant difference in the ratios of NAA/Cr, Cho/ Cr and Cho/NAA in bilateral cerebellum between CONT group and normal control （NORM） group （P〉0.05）. The Cho/Cr andCho/NAA ratios in the cerebellum contralateral to the stroke region were higher in PSD group than in NORM and CONT groups （P〈0.05）, and the Cho/Cr and Cho/NAA ratios in the cerebellum ipsilateral to the stroke region were similar with those in NORM and CONT groups （P〉0.05）. However, there was no significant difference in the NAA/Cr ratios in bilateral cerebellum among three groups （P〉0.05）. The family APGAR questionnaire survey scores, age-related white matter changes （ARWMC） scale total scores, 14-day National Institutes of Health Stroke Scale （NIHSS） scoresj and the Cho/Cr and Cho/NAA ratios in the contralateral cerebe

关 键 词：卒中后抑郁 小脑 磁共振波谱成像 抑郁严重程度 

分 类 号：R743.9[医药卫生—神经病学与精神病学]