抑郁症及抑郁高血压共病患者脑部基于体素的磁共振扩散峰度成像研究

Voxel-based analysis of diffusion kurtosis imaging for patients with depression and comorbid hypertension in depression

目的探讨磁共振扩散峰度成像(DKI)在评价抑郁症及抑郁高血压共病患者脑部微观结构损害中的应用价值。方法收集20例抑郁症患者(抑郁症组)、26例抑郁高血压共病患者(共病组)、26例高血压患者(高血压组)、23名健康志愿者(正常对照组),采用3.0T磁共振仪进行DKI扫描,使用DKE软件计算平均扩散峰度(MK)值;比较4组间MK值的差异;比较差异脑区平均MK值与17项汉密尔顿抑郁量表(HAMD-17)评分的相关性。结果相对于正常对照组,抑郁症组MK值减低的脑区包括右额中回、右梭状回、右前扣带回、左中扣带回、左后扣带回、右岛叶、右海马、右枕下回及左枕中回、双侧楔前叶、双侧壳核、两侧颞下回和颞中回(P<0.05),共病组MK值减低的脑区包括右额上回、右梭状回、右前扣带回、右中扣带回、左后扣带回、双侧海马、双侧海马旁回、左枕中下回、双侧楔前叶、右壳核、左舌回、双侧颞中回及颞下回及左侧丘脑(P<0.05),高血压组无MK减低区。相对于抑郁症组,共病组MK下降脑区为右额下回、右梭状回、右岛叶、右扣带前回(P<0.05)。右侧海马(r=0.421,P<0.001)及右侧额中回(r=0.400,P=0.001)的平均MK值与HAMD-17评分呈负相关。结论抑郁症和抑郁共病患者存在广泛的额叶-皮层下-边缘系统脑白质微观结构损害和功能异常;高血压可能对抑郁症有协同作用。

Objective To investigate the differences of cerebral microstructure impairment between patients of depression and comorbid depression and hypertension with diffusion kurtosis imaging （DKI）. Methods Twenty patients with depres- sion （depression group）, 26 comorbid hypertension in depression （comorbid group）, 26 hypertension （hypertension group） and 23 healthy control subjects （control group） were recruited. DKI examinations were performed using a 3.0T scanner. Mean kurtosis （MK） maps were compared among 4 groups. The relationship between MK and Hamilton depression scale （HAMD-17） were investigated using correlation analysis. Results Compared with control group, MK decreased in right middle frontal gyrus, the right fusiform gyrus, right anterior cingulate gyrus, left middle cingulate gyrus, left posterior cingulate gyrus, right insula, the right hippocampus, right occipital gyrus and left occipital gyrus, bilateral precuneus, bilateral putamen, bilateral inferior temporal gyrus and middle temporal gyrus significantly in comorbid group （P〈0.05）, MK reduced in more cerebaral areas, including the right superior frontal gyrus, the right fusiforrn gyrus, right anterior cingulate, the right of the cingulate gyrus, left posterior eingulate gyrus, bilateral hippocampus, parahippocampal gyrus bilat- erally, the left middle occipital gyrus, bilateral wedge anterior lobe, and right putamen, left lingual gyrus, bilateral middle temporal gyrus and inferior temporal gyrus and the left thalamus （P^0.05）, there was no cerebaral areas where MK decreased in hypertension group; compared with depression group, MK decreased in right inferior frontal gyrus, right fusiform gyrus, right insula and right anterior cingutate in comorbid group （P^0. 05）. MK in right hippocampus （r=0. 421, P〈0. 001） and the right middle frontal gyrus （r= 0. 400, P= 0. 001） were negatively correlated with HAMD-17 scores. Conclusion Depression patients with or without hypertension has extensive white matter impairments of frontal-subcorti- cal-limbic regions. Hypertension may have a synergistic effect on depression.