脑卒中后不同时段发生抑郁患者的头颅磁共振波谱分析

The Research of Magnetic Resonance Spectroscopy Analysis to Different Period in Post Stroke Depression Patients

目的:应用磁共振波谱(MRS)技术探讨脑卒中后不同时段发生脑卒中后抑郁(PSD)脑N-天冬氨酸盐/肌苷(NAA/Cr)和胆碱/肌酐(Cho/Cr)的代谢改变。方法:急性脑卒中住院病例223例,脑卒中后72h予汉密顿抑郁量表(24项版)评分,≥8分者(PSD患者)根据病例编号,采用随机数字表法分为干预组(第1组)和对照组(第2组);<8分者1个月时再次评分,≥8分者再分为干预组(第3组)和对照组(第4组);<8分者2个月时再评分,≥8分者再分为干预组(第5组)和对照组(第6组);<8分者3个月再评分,≥8分组(第7组)、<8分组(第8组)。干预组(1、3、5、7组)给予帕罗西汀20mg·d-1治疗。分别在72h、3个月对PSD患者行MRS(双侧颞叶海马、丘脑)检测。结果:①在NAA/Cr比值中:72h和3个月时,第4、6组颞叶海马、丘脑ROINAA/Cr比值低于第2组(P<0.05);而与第7组相比,P<0.01;第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;各组患者各ROINAA/Cr比值72h与3个月比较,均差异无统计学意义。Cho/Cr比值中:第4、6组海马和丘脑ROICho/Cr比值高于第2、7组,且以海马更为显著(P<0.01);而第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;第4、6组右侧丘脑ROICho/Cr比值3个月较72h时增高。②3个月时第4、6组右颞叶ROICho/Cr高于第5组(P<0.05)。③第7组72h、3个月时右海马ROICho/Cr比值高于第8组(P<0.05)。结论:MRS在PSD早期诊断中价值有限,但对病程1和2个月时PSD的发生有较为肯定的预示意义;针对该人群进行早期干预对改善脑代谢具有积极意义。

Aim：To explore the neurobilchemical changes in patients of post stroke depression（PSD） developed in different periods with magnetic resonance spectroscopy（MRS）.Methods：223 patients attacked by acute stroke hospitalized in succession were enrolled in our project.They were all diagnosed with intracranial hemorrhage（48 cases） or brain ischemic（175 cases） by brain computed tomography（CT） or magnetic resonance imaging（MRI） within 72 hours after admission to the hospital.There were 113 male whose age range from 41 years old to 75 years old and the average age is（62.8？à5.8） years old and 110 female whose age range from 37 years old to 75 years old and the average age is（64.1？à6.1） years old.Hamilton depression rating scale（edition of HAMD 24 items） was used to assess on 72 hours time point after stroke.The cases whose scores ？Y8 were divided into 2 groups according to the case number randomly.Group 1 was treated with anti-depression medicine and Group 2 was the control.The rest cases were assessed with HAMD again 1 month after stroke.Those whose scores ？Y8 were divided into 2 groups randomly：group 3（treatment group） and group 4（the control）.The rest was assessed with HAMD again 2 months after stroke.Those whose scores ？Y8 were divided into 2 groups randomly：group 5（treatment group） and group 6（the control）.3 months after stroke,the rest cases whose scores 8 in 2 months were assessed again and divided into group 7（scores ？Y8） and group 8（scores 8）.20 mg·d-1 paroxetine hydrochloride were used in the treatment groups（group 1,3,5,7）.All cases enrolled were scored on 72 hours and 3 months with HAMD and detected with MRS.There were 7 cases quitted for failing to take medicine and 8 cases dropped out.No serious adverse reaction appeared in the research project.Results：￠ùThe comparison of metabolites in both sides of hippocampus sclerosis in temporal lobes and thalamus on 72 hours and 3 months time point in PSD patients during different periods analyzed by MRS：for N-acetyl aspartate/creatine（NAA/Cr）value,each region of interest（ROI￡？value in group 4 and group 6 were lower than that in group 2 and group 7.For choline/creatine（Cho/Cr）value,the ROI value in group 4 and group 6 were higher than that in group 2 and group 7,especially in temporal（P0.01）.￠úIn group 4 and group 6,the ROI value of right thalamus on 3 months time point were higher than that on 72 hours time point.￠？The comparison of metabolites analyzed by MRS in PSD patients in the end of 3 months：For Cho/Cr value,the ROI value in right side of temporal lobe in group 7 was higher than that in group 8（P0.05）.For NAA/Cr value￡？there was no difference between group 7 and group 8.Conclusion：MRS has some limitations in early diagnosis of PSD while it could be relatively predictable for PSD attacked 1 month and 2 months after stroke.It is positive to intervene earlier for those PSD patients in improving the brain metabolism.