磁共振弥散张量成像联合血浆神经递质对缺血性卒中急性期抑郁评估的研究  

Magnetic Resonance Diffusion Tensor Imaging Combined with Plasma Neurotransmitters for Assessment of Depression of Acute Stage Ischemic Stroke

作　　者：苏牟潇[1] 陈刚[1] 陈忠伦[1] 张顺源[1] Su Mouxiao;Chen Gang;Chen Zhonglun(Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市中心医院神经内科,检验科,放射科,四川绵阳621000

出　　处：《四川医学》2019年第5期457-461,共5页Sichuan Medical Journal

基　　金：绵阳市科技计划项目(编号:14S-01-11)

摘　　要：目的 探讨缺血性卒中患者急性期脑白质纤维结构改变,联合血浆神经递质,对早期识别卒中后抑郁(Post-stroke depression,PSD)的价值。方法对连续入组的47例急性缺血性脑卒中患者,根据汉密尔顿抑郁量表(Hamilton depression Rating Scale,HDRS)17项评分分为卒中后抑郁组(PSD组)和卒中后非抑郁组(NPSD组),对患者进行美国国立卫生研究院卒中评分(National Institute of Health Stroke Scale,NIHSS)评分,收集脑内解剖结构各项异性分数(fractional anisotropy,FA),采用高效液相色谱-荧光检测法检测两组患者血浆谷氨酸(Glu)、γ-氨基丁酸(γ-GABA)、去甲肾上腺素(NE)、5-羟色胺(5-HT)水平。结果单因素分析结果显示:PSD组右额下回、胼胝体膝部及压部FA值较非PSD组有明显下降,差异有统计学意义( P <0.05)。PSD组HDRS评分与右额下回、胼胝体膝部、胼胝体压部FA值以及血浆Glu及5-HT水平呈显著负相关。多因素logistic回归分析结果显示:卒中后急性期PSD发生与右额下回、胼胝体膝部及压部FA值独立相关。结论缺血性卒中急性期右额下回、胼胝体膝部及压部FA值下降可能是PSD的独立危险因素,联合血浆Glu及5-HT检测可能有助于PSD的早期识别。Objective To investigate the value of early changes in white matter fiber structure and plasma neurotransmitter in patients with ischemic stroke in early recognition of post-stroke depression(PSD). Methods 47 patients with acute ischemic stroke were divided into post-stroke depression group(PSD group)and post-stroke non-depression group(NPSD)according to 17 scoring items of the Hamilton Depression Raring Scale(HDRS).National Institute of Health Stroke Scale(NIHSS)was used to collect the fractional anisotropy(FA)of the anatomical structure of the brain.Plasma glutamate(Glu),γ-aminobutyric acid(γ-GABA),norepinephrine(NE)and serotonin(5-HT)level were measure by the use of high performance liquid chromatography-fluorescence detection. Results The results of single factor analysis showed that the FA value of right inferior frontal gyrus,genu and splenium of corpus callosum was significantly lower than that of NPSD group,the difference was statistically significant( P <0.05).The HDRS scores of PSD group were significantly negatively correlated with FA value of right inferior frontal gyrus,genu and splenium of corpus callosum and plasma Glu and 5-HT level.Multivariate logistic regression analysis showed that PSD in the acute phase after stroke was independently associated with FA of right inferior frontal gyrus,genu and splenium of corpus callosum. Conclusion The decrease of FA value of right inferior frontal gyrus,genu and splenium of corpus callosum in acute phase of ischemic stroke may be an independent risk factor for PSD.Combined with plasma Glu and 5-HT detection may contribute to the early recognition of PSD.

关 键 词：卒中后抑郁 磁共振弥散张量成像 神经递质 急性缺血性卒中 

分 类 号：R445.2[医药卫生—影像医学与核医学]