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

doi:10.12114/j.issn.1007-9572.2021.02.079

摘要/Abstract

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。

关键词: 抑郁, 卒中, 白质, 弥散张量纤维束成像

Abstract: 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 negatively correlated with HAMD-24 score in PSD inpatients (r=-0.469, -0.769, -0.728, -0.801, -0.839, P<0.05) ; the number of fiber bundle of inferior fronto-occipital fascicles, corticospinal tract or frontopontine tract on the side of the stroke was negatively correlated with HAMD-24 score in PSD inpatients (r=-0.858, -0.806, -0.694, P<0.01) .

Conclusion

There were impairment changes of structure of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle and uncinate fasciculus in patients with PSD, and these changes may be significantly correlated with the severity of depression, indicating that some white matter fiber bundle alterations may be involved in the onset of PSD.

Key words: Depression, Stroke, White matter, Diffusion tensor tractography

中图分类号:

R749.42R743

祁杰,张磊,邓丽君,等. 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[J]. 中国全科医学, 2022, 25(09): 1123-1129. DOI: 10.12114/j.issn.1007-9572.2021.02.079.

QI Jie, ZHANG Lei, DENG Lijun, DUAN Xiaodi, DONG Binbin, SUI Rubo.

Brain White Matter Fiber Bundle Alterations and Severity of Depression in Patients with Post-stroke Depression [J]. Chinese General Practice, 2022, 25(09): 1123-1129.

图/表 9

表1 三组受试者一般资料比较

Table 1 Comparison of general information among first-episode ischemic stroke inpatients with and without post-stroke depression，and healthy physical examinees

组别	例数	性别（男/女）	年龄（±s，岁）	受教育年限（±s，年）	冠心病〔n（%）〕	LDL（±s，mmol/L）	HDL（±s，mmol/L）	血糖（±s，mmol/L）	NIHSS评分（±s，分）
正常对照组	20	10/10	53.8±8.4	9.3±3.2	10（50.0）	3.06±1.12	1.13±0.34	7.4±1.7	-
非PSD组	20	10/10	55.1±8.8	8.8±3.2	10（50.0）	3.11±1.01	1.28±0.32	7.4±1.8	6.8±3.0
PSD组	20	10/10	54.6±7.5	9.1±3.2	9（45.0）	3.03±1.06	1.20±0.24	7.4±2.1	6.9±4.3
检验统计量值		0^a	0.182	0.130	0.133	0.033	1.138	0.012	0.016^b
P值		1.00	0.83	0.88	0.94	0.97	0.33	0.99	0.90

表2 三组受试者SDS标准分、HAMD-24评分比较（±s，分）

Table 2 Comparison of standard score of SDS and HAMD-24 score among first-episode ischemic stroke inpatients with and without post-stroke depression，and healthy physical examinees

组别	例数	SDS标准分	HAMD-24评分
正常对照组	20	26.80±7.47^a	2.45±1.50^a
非PSD组	20	29.20±10.74^a	2.60±1.39^a
PSD组	20	57.85±5.04	17.65±4.37
F值		92.085	194.912
P值		<0.01	<0.01

表3 三组受试者各ROI病灶侧、病灶对侧FA比较（±s）

Table 3 Comparison of fractional anisotropy in regions of interest among first-episode ischemic stroke inpatients with and without post-stroke depression，and healthy physical examinees

组别	例数	下额枕束				皮质脊髓束
组别	例数	病灶侧	病灶对侧	t_配对值	P值	病灶侧	病灶对侧	t_配对值	P值
正常对照组	20	0.574±0.059^a	0.583±0.067	1.156	0.26	0.575±0.049^a	0.573±0.052	0.322	0.75
非PSD组	20	0.575±0.047^a	0.578±0.049	0.993	0.33	0.565±0.033^a	0.571±0.039	1.602	0.13
PSD组	20	0.475±0.055	0.572±0.071	-8.622	<0.01	0.459±0.038	0.576±0.077	-6.153	<0.01
F（χ²）值		22.868	0.165			50.404	0.035
P值		<0.01	0.85			<0.01	0.97

表4 三组受试者各ROI病灶侧、病灶对侧神经纤维数量比较（±s）

Table 4 Comparison of number of fiber bundles in regions of interest among first-episode ischemic stroke inpatients with and without post-stroke depression，and healthy physical examinees

组别	例数	下额枕束				皮质脊髓束
组别	例数	病灶侧	病灶对侧	t_配对值	P值	病灶侧	病灶对侧	t_配对值	P值
正常对照组	20	1 235.90±207.09^a	1 246.95±213.17	1.381	0.18	1 348.85±152.50^a	1 376.65±108.78	1.391	0.18
非PSD组	20	1 162.00±217.06^a	1 173.25±219.02	1.093	0.29	1 347.15±218.66^a	1 357.15±215.53	1.900	0.07
PSD组	20	888.75±144.07	1 297.40±157.94	10.812	<0.01	946.15±210.66	1 379.65±152.42	8.270	<0.01
F（χ²）值		18.115	1.976			27.976	0.110
P值		<0.01	0.15			<0.01	0.90

图1 PSD组患者各ROI病灶侧FA与HAMD-24评分的相关性

Figure 1 Correlation of fiber bundles on the side of stroke with HAMD-24 score in first-episode ischemic stroke inpatients with post-stroke depression

图2 PSD组患者各ROI病灶侧神经纤维数量与HAMD-24评分的相关性

Figure 2 Correlation between number of fiber bundles on the side of stroke and HAMD-24 score in first-episode ischemic stroke inpatients with post-stroke depression

图3 PSD患者下额枕束DTT检查结果

Figure 3 Diffusion tensor tractography imaging of inferior fronto-occipital fasciculus of a first-episode ischemic stroke inpatient with post-stroke depression

图4 PSD患者皮质脊髓束DTT检查结果

Figure 4 Diffusion tensor tractography imaging of corticospinal tract of a first-episode ischemic stroke inpatient with post-stroke depression

图5 PSD患者额桥束DTT检查结果

Figure 5 Diffusion tensor tractography imaging of frontopontine tract of a first-episode ischemic stroke inpatient with post-stroke depression

参考文献 28

[1]	MIR H，SIEMIENIUK R A C，GE L，et al. Patent foramen ovale closure，antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke：a systematic review and network meta-analysis incorporating complementary external evidence[J]. BMJ Open，2018，8(7):e023761. DOI：10.1136/bmjopen-2018-023761.
[2]	VOLZ M，LADWIG S，WERHEID K. Gender differences in post-stroke depression：a longitudinal analysis of prevalence，persistence and predictive value of known risk factors[J]. Neuropsychol Rehabil，2021，31(1):1-17. DOI：10.1080/09602011.2019.1648301.
[3]	SHI Y Z，XIANG Y T，YANG Y，et al. Depression after minor stroke：prevalence and predictors[J]. J Psychosom Res，2015，79(2):143-147. DOI：10.1016/j.jpsychores.2015.03.012.
[5]	KIM J S. Post-stroke mood and emotional disturbances：pharmacological therapy based on mechanisms[J]. J Stroke，2016，18(3):244-255. DOI：10.5853/jos.2016.01144.
[6]	许孝南，吴军，陈旭辉，等. 卒中后抑郁的扩散张量成像研究进展[J]. 中国脑血管病杂志，2015，12(6):321-324. DOI：10.3969/j.issn.1672-5921.2015.06.010.
[7]	NIIDA R，YAMAGATA B，NIIDA A，et al. Aberrant anterior thalamic radiation structure in bipolar disorder：a diffusion tensor tractography study[J]. Front Psychiatry，2018，9:522. DOI：10.3389/fpsyt.2018.00522.
[8]	JANG S H，KWON H G. Relationship between depression and dorsolateral prefronto-thalamic tract injury in patients with mild traumatic brain injury[J]. Sci Rep，2020，10(1):19728. DOI：10.1038/s41598-020-76889-3.
[9]	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志，2015，48(4):246-257. DOI：10.3760/cma.j.issn.1006-7876.2015.04.002.
[10]	中华医学会精神科分会. CCMD-3中国精神障碍分类与诊断标准[M]. 3版. 济南：山东科学技术出版社，2001.
[11]	GBD 2015 Mortality and Causes of Death Collaborators. Global，regional，and national life expectancy，all-cause mortality，and cause-specific mortality for 249 causes of death，1980—2015：a systematic analysis for the Global Burden of Disease Study 2015[J]. Lancet，2016，388(10053):1459-1544. DOI：10.1016/S0140-6736(16)31012-1.
[12]	LI L J，YAO X M，GUAN B Y，et al. Persistent depression is a predictor of quality of life in stroke survivors：results from a 5-year follow-up study of a Chinese cohort[J]. Chin Med J（Engl），2019，132(18):2206-2212. DOI：10.1097/CM9.0000000000000400.
[13]	WANG C X，LUO B Y，WU J，et al. Diagnosis and treatment of post-stroke depression in China：a cross-sectional survey of 350 senior clinicians in neurology，geriatrics，and rehabilitation departments[J]. Int Psychogeriatr，2020，32(1):151-153. DOI：10.1017/S1041610218001254.
[14]	SHI Y，YANG D，ZENG Y，et al. Risk factors for post-stroke depression：a Meta-analysis[J]. Front Aging Neurosci，2017，9:218.
[15]	李晶雪，王天俊. 卒中后抑郁发病机制及治疗研究进展[J]. 临床荟萃，2019，34(6):572-576. DOI：10.3969/j.issn.1004-583X.2019.06.018.
[16]	POLETTI S，AGGIO V，BRIOSCHI S，et al. Impact of early and recent stress on white matter microstructure in major depressive disorder[J]. J Affect Disord，2017，225:289-297. DOI：10.1016/j.jad.2017.08.017.
[17]	SHEN X Y，FAN Z X，WANG L，et al. Altered white matter microstructure in patients with post-stroke depression detected by diffusion kurtosis imaging[J]. Neurol Sci，2019，40(10):2097-2103. DOI：10.1007/s10072-019-03947-8.
[18]	苑杰，姜伟时，刘颖，等. 卒中后抑郁与病灶分布关系的研究进展[J]. 世界最新医学信息文摘（连续型电子期刊），2019，19(80):103-104. DOI：10.19613/j.cnki.1671-3141.2019.80.047.
[19]	FERRIS J K，EDWARDS J D，MA J A，et al. Changes to white matter microstructure in transient ischemic attack：a longitudinal diffusion tensor imaging study[J]. Hum Brain Mapp，2017，38(11):5795-5803. DOI：10.1002/hbm.23768.
[20]	QIN L，GUO Z，MCCLURE M A，et al. White matter changes from mild cognitive impairment to Alzheimer's disease：a meta-analysis[J]. Acta Neurol Belg，2021，121(6):1435-1447. DOI：10.1007/s13760-020-01322-5.
[21]	SHELINE Y I，PRICE J L，VAISHNAVI S N，et al. Regional white matter hyperintensity burden in automated segmentation distinguishes late-life depressed subjects from comparison subjects matched for vascular risk factors[J]. Am J Psychiatry，2008，165(4):524-532. DOI：10.1176/appi.ajp.2007.07010175.
[22]	GOZDAS E，FINGERHUT H，CHROMIK L C，et al. Focal white matter disruptions along the cingulum tract explain cognitive decline in amnestic mild cognitive impairment（aMCI）[J]. Sci Rep，2020，10(1):10213. DOI：10.1038/s41598-020-66796-y.
[23]	SANTOS J P L，BRENT D，BERTOCCI M，et al. White matter correlates of suicidality in adults with bipolar disorder who have been prospectively characterized since childhood[J]. Biol Psychiatry Cogn Neurosci Neuroimaging，2021，6(1):107-116. DOI：10.1016/j.bpsc.2020.07.007.
[24]	JUNG S，KIM J H，SUNG G，et al. Uncinate fasciculus white matter connectivity related to impaired social perception and cross-sectional and longitudinal symptoms in patients with schizophrenia spectrum psychosis[J]. Neurosci Lett，2020，737:135144. DOI：10.1016/j.neulet.2020.135144.
[25]	OESTREICH L K L，WRIGHT P，O'SULLIVAN M J. Microstructural changes in the reward system are associated with post-stroke depression[J]. Neuroimage Clin，2020，28:102360. DOI：10.1016/j.nicl.2020.102360.
[26]	DRESANG H C，HULA W D，YEH F C，et al. White matter neuroanatomical predictors of aphasic verb retrieval[J]. Brain Connect，2021，11(4):319-330. DOI：10.1089/brain.2020.0921.
[27]	KAKEDA S，WATANABE K，KATSUKI A，et al. Genetic effects on white matter integrity in drug-naive patients with major depressive disorder：a diffusion tensor imaging study of 17 genetic loci associated with depressive symptoms[J]. Neuropsychiatr Dis Treat，2019，15:375-383. DOI：10.2147/NDT.S190268.
[28]	单苏民，王雁，宫本强. 以高级智能减退为首发症状的基底节区梗死1例报告[J]. 中风与神经疾病杂志，2002，19(2):126. DOI：10.3969/j.issn.1003-2754.2002.02.029.

[1]	秦凤银, 张绮珊, 赖锦佳, 黄奕敏, 韩郭茵, 孙兴兰, 王芬, 谭益冰. 广东省社区居民脑卒中高危筛查意向的现状及影响因素研究[J]. 中国全科医学, 2023, 26(34): 4283-4289.
[2]	王越, 陈晴, 刘鲁蓉. 中国老年人抑郁检出率及影响因素的Meta分析[J]. 中国全科医学, 2023, 26(34): 4329-4335.
[3]	苏凯奇, 吕转, 吴明莉, 罗萌, 高静, 聂晨晨, 刘昊, 冯晓东. 电针对缺血再灌注后学习记忆障碍大鼠BDNF/TrkB/PI3K/Akt通路的影响及对海马神经元保护作用研究[J]. 中国全科医学, 2023, 26(33): 4187-4193.
[4]	余新连, 代欣月, 赵习存, 徐莹. 阴虚质与初中生抑郁情绪的关系：应激性生活事件和入睡时长的链式中介作用[J]. 中国全科医学, 2023, 26(33): 4159-4166.
[5]	尹苗苗, 崔立玲, 李雅晴, 王利群, 张玥, 巫嘉陵. 双任务对后循环缺血性脑卒中伴前庭症状患者步行能力的影响研究[J]. 中国全科医学, 2023, 26(33): 4207-4212.
[6]	杨宇轩, 张晗, 杜娟, 王玲玲, 谢玉磊, 尹开明, 张波. 眼动追踪的动态任务评估脑卒中后单侧空间忽略的价值研究[J]. 中国全科医学, 2023, 26(32): 4020-4025.
[7]	蹇秋枫, 徐荣华, 姚倩, 周媛媛. 中国老年脑卒中患者认知障碍患病率和影响因素的Meta分析[J]. 中国全科医学, 2023, 26(32): 4070-4079.
[8]	朱琳, 郭闫葵, 高琛, 陈学志, 王法帅. 单纯西药、中成药及其联合治疗卒中后失眠疗效的网状Meta分析[J]. 中国全科医学, 2023, 26(30): 3823-3832.
[9]	肖雨倩, 白艳杰, 王岩, 陈淑颖, 陈丽敏, 孙可心, 万俊. 线粒体转移在脑卒中后认知障碍中的研究进展[J]. 中国全科医学, 2023, 26(30): 3833-3840.
[10]	任延峰, 刘世蒙, 陶颖, 陈英耀. 抑郁症患者药物治疗偏好的系统综述：基于离散选择实验和优劣尺度法[J]. 中国全科医学, 2023, 26(28): 3559-3564.
[11]	梁雪梅, 王睿, 赵玉环, 徐天娇, 王伟, 孙伟东. 经颅低水平激光：一种治疗抑郁症的新方法[J]. 中国全科医学, 2023, 26(27): 3335-3341.
[12]	刘月, 刘琦, 董惠, 刘亚玲. 基于蒙特利尔认知评定量表双阈值定义的卒中后认知"恢复者"神经心理学变化研究[J]. 中国全科医学, 2023, 26(27): 3417-3422.
[13]	郑思婷, 何春渝, 周均, 孔叶, 杨薪瑶, 周海英, 魏晓霏. 脑卒中运动功能障碍患者自我管理的最佳证据总结[J]. 中国全科医学, 2023, 26(26): 3230-3237.
[14]	王晓雯, 肖统领, 王祎, 杨莹, 夏晓爽, 李新. 急性缺血性脑卒中患者同型半胱氨酸水平与急性肾损伤的关系研究[J]. 中国全科医学, 2023, 26(26): 3290-3296.
[15]	杨璐, 宗占红, 易莹莹. 中国农村中老年女性抑郁状况及影响因素研究[J]. 中国全科医学, 2023, 26(25): 3091-3095.