脑卒中后抑郁患者小脑磁共振波谱成像参数肌酸与胆碱的改变  

~1H-MRS-measured choline and creatine in cerebellum of patients with post-stroke depression

作　　者：阳秀琪 郑石磊[1] 张祥林[1] 

机构地区：[1]辽宁医学院第一附属医院,辽宁锦州121000

出　　处：《解放军医学院学报》2016年第8期845-848,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨首发左基底节梗死后伴发抑郁患者小脑磁共振波谱成像（^1H-MRS）参数肌酸（creatinine,Cr）及胆碱（choline,Cho）的变化特征。方法纳入辽宁医学院第一附属医院2014年3月-2015年9月50例首次左侧基底节梗死患者,其中卒中后抑郁（post-stroke depression,PSD）组与脑梗死后非抑郁（post-stroke non-depressed,PSND）组各25例,健康对照组25例。首发左基底节梗死的患者（发病1周）与健康对照组均行^1H-MRS扫描,定位于双侧小脑白质,采集胆碱、肌酸波谱图,同时行汉密尔顿抑郁量表（Hamilton depression scale,HAMD）评分,根据HAMD结果分为PSD和NPSD,比较各组双侧小脑Cho及Cho/Cr的差异及其与HAMD评分的相关性。结果 ^1H-MRS显示,脑梗死后1周PSD组双侧小脑Cho/Cr较正常对照组显著升高（右PSD：1.33±0.42,对照组：0.84±0.28,P=0.000;左PSD：1.14±0.37,对照组：0.80±0.26,P=0.001）,且PSD组右侧小脑Cho/Cr较NPSD组同侧小脑亦明显升高（NPSD：1.03±0.32,P=0.004）,但PSD组与NPSD组左侧小脑Cho/Cr差异无统计学意义（NPSD：0.96±0.34,P=0.063）。此外,PSD组双侧小脑白质的Cho/Cr与其HAMD评分存在相关性（左：r=0.422,P=0.035;右：r=0.545,P=0.005）。结论首次左侧基底节梗死后伴抑郁的患者小脑Cho/Cr值升高。Objective To measure choline（Cho） and creatine（Cr） in cerebellum of patients with depression after first left basal ganglia infarction by magnetic resonance spectroscopy. Methods Fifty patients with first left basal ganglia infarctions admitted to the First Affiliated Hospital of Liaoning Medical University from March 2014 to September 2015 were recruited in this study, and another 25 matched healthy controls were recruited. Patients and controls underwent ~1H-MRS scan locating in bilateral cerebellar white matter and the spectrum of Cho and Cr was recorded respectively at the first week after onset. Hamilton depression scale（HAMD） was also administered at the same time. According to the result of HAMD, the patients were divided into two groups： poststroke non-depressed（PSND） group（n=25） and post-stroke depression（PSD） group（n=25）. The differences of Cho and Cr measured by ~1H-MRS between these groups were compared and their correlation with the HAMD score was analyzed. Results Compared with controls, Cho/Cr ratio in bilateral cerebellum of PSD patients was significantly higher [right PSD：（1.33±0.42）, control：（0.84±0.28）, P=0.000; left PSD：（1.14±0.37）, control：（0.80±0.26）, P=0.001]. In the right side of the cerebellum, the Cho/Cr ratio in patients with PSD increased significantly compared with PSND patients [（1.33±0.42） vs（1.03±0.32）, P=0.004]. However, there was no significant difference in Cho/Cr ratio in left cerebellar between PSD group and PSND group [（1.14±0.37） vs（0.96±0.34）, P=0.063]. Cho/Cr in bilateral cerebellar white matter was correlated with HAMD score in PSD patients（left： r=0.422, P=0.035; right： r=0.545, P=0.005）. Conclusion Cho/Cr ratio increases in cerebellar in patients with depression after first left basal ganglia infarction.

关 键 词：卒中后抑郁 磁共振波谱 小脑 

分 类 号：R445.2[医药卫生—影像医学与核医学] R749.1[医药卫生—诊断学]