不同睡眠质量抑郁症患者前额叶低频振幅特征及其与记忆功能的关系  

Characteristics of amplitude of low frequency fluctuations in the frontal lobe in depression patients with different sleep quality and its relationship with memory function

作　　者：陈志璐 阎锐[1,2] 田水 王强[5] 朱荣鑫[1] 王旭苗 赵帅 汤浩[1] 卢青[3,4] 姚志剑 Chen Zhilu;Yan Rui;Tian Shui;Wang Qiang;Zhu Rongxin;Wang Xumiao;Zhao Shuai;Tang Hao;Lu Qing;Yao Zhijian(Department of Psychiatry,the Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China;Medical School of Nanjing University,Nanjing 210093,China;School of Biological Sciences&Medical Engineering,Southeast University,Nanjing 210096,China;Child Development and Learning Science,Key Laboratory of Ministry of Education,Southeast University,Nanjing 210096,China;Department of Medical Psychology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学附属脑科医院心境障碍科,210029 [2]南京大学医学院,210093 [3]东南大学生物科学与医学工程学院,南京210096 [4]东南大学儿童发展与学习科学教育部重点实验室,南京210096 [5]南京大学医学院附属鼓楼医院医学心理科,210008

出　　处：《中华行为医学与脑科学杂志》2020年第10期892-897,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金项目(81871066);国家重点研发计划项目(2018YFC1314601);江苏省重点研发计划专项(BE2018609,BE2019675);江苏省科教强卫工程省市共建医学创新团队项目(CXTDC2016004);江苏省医学科研重点项目(K2019011);南京市科技发展计划项目(201803030)。

摘　　要：目的:探讨睡眠质量对抑郁症患者脑局部自发神经活动的改变及其与记忆功能的相关性。方法:招募58例抑郁症患者和58例性别、年龄及受教育年限均匹配的健康对照,进行3.0 T静息态磁共振扫描,并使用韦氏记忆量表、汉密尔顿抑郁量表和匹兹堡睡眠质量指数对被试进行评估。根据匹兹堡睡眠质量指数得分,将患者分为低睡眠质量组(n=38)、高睡眠质量组(n=20)。比较三组受试记忆功能及脑区低频振幅(amplitude of low frequency fluctuations,ALFF)值,在方差分析的基础上进行两独立样本t检验,所得差异脑区ALFF值与两患者组韦氏记忆得分进行相关分析。结果:三组受试韦氏记忆商数存在差异(F=14.163,P<0.01),低睡眠质量患者组分值最低;左内侧额上回(MNI:x=-10,y=30,z=58;K=56),右眶部额下回(MNI:x=26,y=20,z=-26;K=24),左侧额中回(MNI:x=-40 y=32,z=42;K=25)的ALFF值在三组间存在差异(体素水平P<0.001,团块水平P<0.05,GRF矫正)。与高睡眠质量患者组相比,低睡眠质量患者组左内侧额上回ALFF值升高,且与低睡眠质量组的韦氏记忆商数(r=-0.327,P=0.045)和短时记忆(r=-0.388,P=0.016)呈负相关。与健康对照组相比,低睡眠质量患者组左内侧额上回、左额中回ALFF值升高;高睡眠质量组右眶部额下回ALFF值升高。结论:低睡眠质量抑郁症患者记忆功能受损更为严重,前额叶活动异常升高,与记忆功能存在一定相关性,可能与抑郁症患者长期的睡眠问题导致前额叶神经可塑性及突触改变有关。Objective:To explore the association between the spontaneous neural activity and memory function in depressive patients with different sleep quality.Methods:Totally 58 patients with depressive disorder and 58 gender-,age-,education-matched healthy controls(HC)completed 3.0 T MRI Scanning and clinical assessment including Wechsler memory scale(WMS),24 Hamilton depression scale(HAMD-24)and Pittsburgh sleep quality index(PSQI).According to the score of PSQI,patients were divided into poor sleep quality group(PS,n=38)and good sleep quality group(GS,n=20).Amplitude of low frequency fluctuations(ALFF)were calculated and compared among three groups.Correlation analyses between the brain activity and the score of WMS were conducted as well.Results:Memory quotient of WMS showed differences among three groups(F=14.163,P<0.01),and the lowest score was found in patients with low sleep quality.The brain areas showed significant differences among three groups located in the left medial superior frontal gyrus(lmSFG,MNI:x=-10,y=30,z=58;K=56),right orbital inferior frontal gyrus(roIFG,MNI:x=26,y=20,z=-26;K=24)and left middle frontal gyrus(lMFG,MNI:x=-40 y=32,z=42;K=25)(voxel size P<0.001,cluster size P<0.05,GRF corrected).Compared with GS group,the ALFF of PS group showed significantly increased in the lmSFG,which was negatively correlated with memory quotient(r=-0.327,P=0.045)and short term memory(r=-0.388,P=0.016).Compared with HC group,the ALFF of PS group showed increased in the lmSFG and lMFG,GS group showed increased ALFF in the roIFG.Conclusion:The impairment of memory function is more serious in patients with depression of low sleep quality,and the activity of frontal lobe is abnormally increased,which is related to memory function.Their association suggests that poor sleep quality in depressive patients may impair memory function by disrupting neural plasticity and synaptic pruning in the frontal lobes.

关 键 词：抑郁症 睡眠质量 低频振幅 记忆功能 

分 类 号：R749.4[医药卫生—神经病学与精神病学]