卒中后抑郁患者脑白质纤维束改变及其与抑郁程度的相关性研究  

Brain White Matter Fiber Bundle Alterations and Severity of Depression in Patients with Post-stroke Depression

作　　者：祁杰 张磊 邓丽君 段晓迪 董彬彬 隋汝波 QI Jie;ZHANG Lei;DENG Lijun;DUAN Xiaodi;DONG Binbin;SUI Rubo(Department of Neurology,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China;Nursing School,Jinzhou Medical University,Jinzhou 121000,China)

机构地区：[1]锦州医科大学附属第一医院神经内科,辽宁省锦州市121000 [2]锦州医科大学护理学院,辽宁省锦州市121000

出　　处：《中国全科医学》2022年第9期1123-1129,1135,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(81371461);辽宁省教育厅科技项目(JYTJCZR201903);辽宁省教育厅青年基金项目(JYTQN201707)。

摘　　要：背景卒中后抑郁(PSD)是卒中患者常见并发症之一,可增加卒中患者致残率、病死率,但其确切发病机制仍不明确。目的通过弥散张量纤维束成像(DTT)观察PSD患者脑白质纤维束改变并分析其与抑郁的相关性。方法选取2019年9月至2020年9月在锦州医科大学附属第一医院住院治疗的首发缺血性脑卒中患者40例,根据PSD发生情况分为PSD组和非PSD组,每组20例;选取同期在锦州医科大学附属第一医院体检的健康志愿者20例作为正常对照组。三组受试者均行DTT检查,比较三组受试者感兴趣区(ROI)各向异性分数(FA)、神经纤维数量;PSD组患者各ROI病灶侧FA、神经纤维数量与24项版汉密尔顿抑郁量表(HAMD-24)评分的相关性分析采用Pearson相关分析。结果PSD组患者下额枕束、皮质脊髓束、额桥束、扣带束、钩束病灶侧FA低于非PSD组、正常对照组及病灶对侧,下额枕束、皮质脊髓束、额桥束病灶侧神经纤维数量少于非PSD组、正常对照组及病灶对侧(P<0.05)。Pearson相关分析结果显示,PSD患者下额枕束、皮质脊髓束、额桥束、扣带束、钩束病灶侧FA与HAMD-24评分均呈负相关(r值分别为-0.469、-0.769、-0.728、-0.801、-0.839,P<0.05);PSD患者下额枕束、皮质脊髓束、额桥束病灶侧神经纤维数量与HAMD-24评分亦均呈负相关(r值分别为-0.858、-0.806、-0.694,P<0.01)。结论PSD患者病灶侧下额枕束、皮质脊髓束、额桥束、扣带束及钩束白质结构存在损伤且与抑郁程度相关,大脑部分白质纤维束改变可能在PSD的发生中具有重要作用。Background Post-stroke depression(PSD),a common complication in stroke patients,may increase the disability and mortality,however,its pathogenesis is unknown yet.Objective To observe the white matter fiber bundle alterations by diffusion tensor tractography(DTT),and to explore its correlation with depression in patients with PSD.Methods Participants were selected from the First Affiliated Hospital of Jinzhou Medical University from September 2019 to September 2020,involving 40 inpatients with first-episode ischemic stroke(20 were found with PSD,and 20 without),and 20 physical examinees as healthy controls.DTT was performed in all participants,fractional anisotropy(FA)and number of fiber bundles in regions of interest(ROIs)were compared across PSD and non-PSD inpatients and healthy controls.Pearson correlation analysis was performed to analyze the correlations of FA and number of fiber bundles on the side of stroke in the ROIs with 24-item Hamilton Rating Scale for Depression(HAMD-24)in PDS inpatients.Results In PSD inpatients,the FA of inferior fronto-occipital fascicles,corticospinal tract,frontopontine tract,cingulum bundle and uncinate fasciculus on the side of the stroke was significantly lower than those on the contralateral side(P<0.05).And the number of fiber bundle of inferior fronto-occipital fascicles,corticospinal tract and frontopontine tract on the side of the stroke was significantly less than those on the contralateral side(P<0.05).Compared to non-PSD inpatients or healthy controls,PSD inpatients demonstrated significantly lower FA of inferior fronto-occipital fascicles,corticospinal tract,frontopontine tract,cingulum bundle and uncinate fasciculus,and notable less number of fiber bundles of inferior fronto-occipital fascicles,corticospinal tract and frontopontine tract on the side of the stroke(P<0.05).Pearson correlation analysis revealed that,the FA of inferior fronto-occipital fascicles,corticospinal tract,frontopontine tract,cingulum bundle or uncinate fasciculus on the side of the stroke was

关 键 词：抑郁 卒中 白质 弥散张量纤维束成像 

分 类 号：R749.42[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]