磁共振弥散张量成像对基底节区梗死后抑郁状况的评估

Evaluation of depression status following basal ganglia infarction by diffusion tensor magnetic resonance imaging

目的利用磁共振弥散张量成像（DTI）技术研究基底节区梗死患者相关解剖结构的异常改变，评估卒中后抑郁（PSD）的状况。方法选取基底节区梗死患者，依汉密尔顿抑郁量表（HAMD-24）评分分为PSD组（n=7）、对照组（n=19），完成NIHSS评分。后行DTI检测患者双侧尾状核、苍白球、壳核和背侧丘脑的各向异性（FA）值、表观弥散系数（ADC）值、神经纤维数量。结果PSD组NIHSS评分（6．29±3．45）明显高于对照组（3．95±1．90；t=2．219，P=0．036），各神经核团的DTI数据与对照组比较差异无统计学意义，左侧壳核的FA值（0．37±0．03）明显低于右侧（0．40±0．02；t=2．243，P=0．045）。经Spearman相关分析，卒中后患者的HAMD评分与NIHSS评分呈正相关（r=0．464，P=0．017），与左侧苍白球FA值（r=-0．563，P=0．005）、右侧苍白球FA值（r=-0．416，P=0．035）、左侧壳核FA值（r=-0．428，P=0．029）呈负相关。结论严重的神经功能缺损与缺血性PSD的发生有关，而抑郁程度与NIHSS评分增高、双侧苍白球和左侧壳核的FA值下降有关。相关信息有助于我们对基底节区梗死患者PSD的状况进行评估。

Objective To study the anatomical abnormalities of basal ganglia and research their influence on depression status in patients with post stroke depression （PSD）by diffusion tensor imaging （DTI） of MRI. Methods Patients with basal ganglia infarction were recruited, and divided into groups of PSD and non depression control group by Hamilton Depression Rating Scale （HAMD） assessment. All the patients were evaluated with National Institute of Health Stroke Scale （ NIHSS ）. And the patients were checked by DTI sequence. Fractional anisotropy （FA） , average diffusion coefficient （ADC） values and the number of nerve fiber were measured in bilateral caudatum, pallidum, putamen and thalamus. Results The score of NIHSS （ 6. 29 ± 3.45 ） was significantly higher in PSD group than that in non-depression group （3. 95±1.90 ;t = 2. 219, P = 0. 036 ）. No significant difference was found between the two groups for the DTI data of the basal ganglia nuclei （ t = 0. 056--1. 618, all P 〉 0. 05 ） . Compared with contralateral construction（0. 40 ± 0. 02）, the FA value decreased in the left putamen（0. 37 ± 0.03） in the PSD group （t = 2. 243 ,P = 0. 045 ）. By Spearman correlations analysis, the HAMD score was positively correlated with NIHSS score （ r = 0. 464, P = 0. 017 ）, and negatively correlated with the FA values of left pallidum （r = -0. 563 ,P = 0. 005 ）, right pallidum （ r = - 0. 416, P = 0. 035 ） and left putamen （ r = - 0. 428, P =0. 029）. Conclusions The occurrence of PSD was associated with neurological functional deficit following basal ganglia infarction. The depression level was correlated with the increasing of NIHSS score, the reductions in bilateral pallidum and left putamen FA values. This research contributes to evaluation of the PSD status in patients with basal ganglia infarction.