急性脑梗死后不同部位脑白质病变与抑郁的关系

The relation between white matter lesions of different parts of brain after acute cerebral infarction and de- pressive disorder

目的探讨急性脑梗死后不同部位的脑白质病变（WML）对抑郁发生的影响。方法纳入大连市第三人民医院神经内科2012年3月至2013年4月住院的急性脑梗死患者97例，根据有无脑白质病变分为2组，比较2组间汉密尔顿焦虑量表（HAMA）评分及汉密尔顿抑郁量表（HAMD）评分有无差异。对有WML组行改良Scheltens评分，并将改良Scheltens评分与HAMD评分进行直线相关分析，了解额叶、颞叶、顶叶、枕叶、基底节、侧脑室旁及小脑、脑干等不同部位的白质损害程度与抑郁严重程度的相关性。结果有WML组HAMD评分（10±6）分，HAMA评分（11±4）分，无WML组HAMD评分（6±4）分，HAMA评分（9±3）分，2组之间HAMD及HAMA评分比较差异均有统计学意义（均P〈0.05）；有WML组59例患者HAMD评分（10±6）分与改良Scheltens评分总分（4.39±0.49）分及额叶（2.76±0.43）分、枕叶白质（1.61±0.49）分、额部脑室旁白质（2.85±0.36）分，病变呈明显正相关 （r=0.395,P=0.002;r=0.438,P=0.001;r=0.247,P=0.005;r=0.385,P=0.003）。结论急性脑梗死后不同部位的WML与抑郁障碍相关，主要以额部白质病变为主，额部白质病变越严重，抑郁程度越重。

ObjectiveTo evaluate the relationship between white matter lesions（WML） of different parts of brain after acute cerebral infarction and depressive disorder.MethodsThe clinical data of 97 patients with acute cerebral infarction were analyzed. All patients were divided into 2 groups according to with or without WML.The differences of Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale （HAMD） between 2 groups were analyzed. The WML group was scored using the semiquatitative rating scale of Scheltens Rating Scale（Scheltens）. The correlation between the scheltens of lateral ventricle, frontal lobe, parietal lobe, temporal lobe, occipital lobe, basal ganglia, cerebella, brainstem and HAMD were observed.ResultsIn WML group, the scale of HAMD was 10±6 and HAMA was 11±4. In without WML group, the scale of HAMD was 6±4 and HAMA was 9±3. There were significant differences of HAMA and HAMD between WML group and without WML group. HAMD was positively correlated with total scores of total Scheltens scales（4.39±0.49）, frontal（2.76±0.43）, occipital white matter（1.61±0.49） and frontal periventricular hyperintensities（2.85±0.36）（r=0.395,P=0.002;r=0.439,P=0.001;r=0.247,P=0.005;r=0.385,P=0.003）.ConclusionWML of different parts after acute cerebral infarction is positively correlated with depressive disorder, especially in frontal white matter.