基于体素的病灶行为学图谱分析卒中病灶分布与缺血性卒中后抑郁的关联研究  

Association between lesion location and depressive symptoms in acute ischemic stroke patients using voxel-based lesion-symptom mapping

作　　者：王金晶 谷蒙蒙 蒋诗忆 音大为 王朋 孙文 刘新峰 Wang Jinjing;Gu Mengmeng;Jiang Shiyi;Yin Dawei;Wang Peng;Sun Wen;Liu Xinfeng(Department of Neurology,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China;Stroke Center&Department of Neurology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China;Department of Neurology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210002,China;Department of Radiology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)神经内科,南京210002 [2]中国科技大学附属第一医院(安徽省立医院)脑血管病中心神经内科,合肥230001 [3]南京医科大学附属南京第一医院神经内科,南京210002 [4]中国科技大学附属第一医院(安徽省立医院)南区影像中心,合肥230001

出　　处：《中华内科杂志》2023年第1期70-75,共6页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金(81870946);安徽省自然科学基金(2108085MH271);安徽省重点研发计划(202104j07020049)。

摘　　要：目的探讨急性缺血性卒中病灶分布与卒中后抑郁(PSD)的相关性。方法病例对照研究。数据来自2020年9月至2021年6月在中国科技大学附属第一医院神经内科住院治疗的急性缺血性卒中患者243例, 年龄23~86岁, 平均年龄为59岁;其中男性153例, 女性90例。根据精神障碍诊断和统计手册第5版(DSM-5)标准, 将患者分为PSD组和卒中后非抑郁(non-PSD)组。采用24项汉密尔顿抑郁量表对患者抑郁程度进行评估。运用t检验、秩和检验、χ2检验对PSD组和non-PSD组的临床基线特征进行对比。另外, 采用基于体素的病灶行为学图谱(VLSM)的统计方法分析梗死病灶与PSD发生和严重程度之间的相关性。结果本研究纳入PSD组患者70例, 非PSD组患者173例。单因素分析结果提示PSD组和non-PSD组相比, 除汉密尔顿焦虑评分(P=0.025)和抑郁评分(P<0.001)之外, 其他指标差异均无统计学意义(均P>0.05)。经VLSM分析后, 与PSD的发生相关的区域为前扣回(Z=-3.05, P<0.001)、左侧海马(Z=-3.15, P<0.001)、左侧舌叶(Z=-3.08, P<0.001);与PSD严重程度相关的区域为前扣回(Z=-3.64, P<0.001)、左侧海马(Z=-3.51, P<0.001)、左侧舌叶(Z=-4.18, P<0.001)、左侧距状裂皮层(Z=-3.65, P<0.001)。结论急性脑梗死患者的病灶部位可以预测PSD的发生。Objective The study aimed to investigate the association between lesion location and post-stroke depression(PSD)in acute ischemic stroke patients.Methods In this case-control study,acute ischemic stroke patients were recruited from the Department of Neurology,First Affiliated Hospital of the University of Science and Technology of China(USTC),between September 2020 and June 2021.According to the Diagnostic and Statistical Manual of Mental Disorders(DSM-5)criteria,the patients were divided into the PSD and non-PSD groups.The 24-item Hamilton Rating Scale(HAMD)was used to evaluate the severity of depression.The Student′s t-test,Mann-Whitney test,and Chi-square test were used to compare the clinical baseline characteristics of PSD and non-PSD groups.Voxel-based lesion-symptom mapping(VLSM)was applied to investigate the association between lesion location and depression occurrence and severity.Results A total of 70 and 173 patients were admitted to the PSD and non-PSD groups,respectively.The mean age of patients was 59 years(23-86).There were 153 males and 90 females.Univariate analysis showed a significant difference only in Hamilton Anxiety(P=0.025)and Depression(P<0.001)scores between the PSD and non-PSD groups.VLSM analysis identified clusters within the anterior cingulate gyrus(Z=-3.05,P<0.001),left hippocampus(Z=-3.15,P<0.001),and left lingual lobe(Z=-3.08,P<0.001)where lesions were significantly associated with PSD.Additionally,the severity of PSD was associated with damage in the anterior cingulate gyrus(Z=-3.64,P<0.001),left hippocampus(Z=-3.51,P<0.001),left lingual lobe(Z=-4.18,P<0.001),and pericalcarine cortex(Z=-3.65,P<0.001).Conclusion VLSM demonstrated that lesion location could be used to predict the occurrence of PSD in patients with acute ischemic stroke.

关 键 词：卒中 抑郁 危险因素 病例对照研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]