应更加重视伏隔核:基于MRI早期PSD患者核团体积及形态改变  

Nucleus accumbens should be paid more attention:based on the nuclear volume and morphological changes on MR images in patients with early post-stroke depression

作　　者：吴明祥[1] 陈宇[1] 李刚[1] 杨敏洁[1] 龚静山[1] 徐坚民[1] 张景忠[1] 郭毅[1] WU Ming-xiang;CHEN Yu;LI Gang;YANG Minjie;GONG Jingshan;XU Jianmin;ZHANG Jingzhong;GUO Yi(Department of Radiology,the Second Medical College of Jinan University,Shenzhen People′s Hospital,Shenzhen 518020,China)

机构地区：[1]暨南大学第二临床医学院深圳市人民医院放射科,深圳528020

出　　处：《放射学实践》2018年第8期820-824,共5页Radiologic Practice

基　　金：深圳市科技计划项目(JCYJ20150403102020233)

摘　　要：目的:基于MRI分析脑梗死后早期抑郁症(PSD)患者的伏隔核、海马和杏仁核的体积及形态变化,探讨早期PSD的发病机制。方法:对28例梗死后抑郁症(PSD)和18例梗后无抑郁症(PSND)和13例单纯抑郁症(De)患者及11例健康志愿者(对照组)行高分辨MR扫描,采用计算机自动分割及顶点分析方法,测量双侧伏隔核、海马和杏仁核的体积并进行标准化处理,采用组间分析法比较各组间各部位体积和形态的差异。结果:PSD组的双侧伏隔核和海马的体积均小于PSND、De和对照组,双侧杏仁核体积小于De和对照组、仅稍高于PSND组,其中双侧伏隔核体积的组间差异有统计学意义(P<0.05),进一步两两比较,右侧伏隔核体积的组间差异有统计学意义的是PSD与NC组(P<0.01),PSD与De组(P<0.001),PSND与NC组(P<0.05),以及PSND与De组(P<0.001);左侧伏隔核体积的组间差异有统计学意义的是PSD与De组(P<0.01)以及PSND与De组(P<0.05)。核团形态的组间差异有统计学意义(P<0.05)的部位主要为右侧伏隔核的顶部及尾部、双侧海马体部的腹内侧。结论:早期PSD患者的伏隔核、海马和杏仁核即存在体积及形态改变,尤其是伏隔核,提示中脑腹侧背盖区-伏隔核多巴胺奖赏环路的损害可能是早期PSD发病机制中的主要原因之一。Objective:To investigate the alterations of the volumes and 3D shapes of nucleus accumbens,hippocampus and amygdala in patients with post-stroke depression(post-stroke depression,PSD).Methods:28 patients with PSD and 18 stroke patients without depression(PSND group),13 patients with depression(De group)and 11 healthy volunteers(normal control group,NC)underwent high resolution MRI.Computer automatic segmentation and vertex analysis techniques were used to measure the volume of bilateral nucleus accumbens,hippocampus and amygdale,and then data stan-dardization was performed.Intergroup analysis was used to compare the differences of volume and morphological features among the four groups.Results:The volume of bilateral nucleus and hippocampus in PSD group was smaller than that in PSND,De and NC group.The volume of bilateral amygdala was smaller than that in De and NC group,and only slightly higher than that in PSND group.The volume changes of bilateral nucleus accumbens among groups were statistically significant(P<0.05);at right accumbens nucleus,inter-group differences with statistical significance were found in following groups:PSD vs NC group(P<0.01),PSD vs De group(P<0.001),PSND vs NC group(P<0.05),PSND vs De group(P<0.05);and at left accumbens,those were found in following groups:PSD vs De group(P<0.01),PSND vs De group(P<0.05).The difference of morphologic changes of the top and tail of the right accumbens nucleus and the ventromedial body of the bilateral hippocampus were statistically significant(P<0.05).Conclusion:In patients with early PSD,volume and morphological structure changes in nucleus accumbens,hippocampus and amygdale can be found,especially in nucleus accumbens.Thus we can speculate that the damage of ventral tegmental area-nucleus accumbens(VTA-NAc)dopamine reward loop may be one of the main caused for the pathogenesis of early PSD.

关 键 词：伏隔核 形态 梗死后抑郁症 磁共振成像 顶点分析 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]