卒中后抑郁患者小脑弥散张量改变的临床研究

Clinical study on the diffusion tensor imaging of cerebellum in patients with post-stroke depression

目的利用弥散张量成像(diffusion tensor imaging,DTI)探讨卒中后抑郁(post-stroke depression PSD)患者小脑形态结构改变并分析其与抑郁状态的关系。方法将研究对象分为3组(每组20例),分别为卒中后抑郁组(PSD组),卒中后无抑郁组(CONT组)及对照组(NORM组)。利用多模式磁共振成像(包括磁共振常规序列及弥散张量成像)对60例研究对象的小脑各部分体积的改变和各向异性分数(fractional anisotropy,FA)进行检测,并且对每1例研究对象均进行HAMD量表评定,最后对小脑的结构改变与抑郁量表评分之间进行相关性分析。结果 PSD组患者小脑后叶下部的体积和小脑中、下脚的FA值较CONT组及NORM组均有显著降低(P<0.05);CONT组与健康对照组小脑各部分的体积和FA值比较无统计学差异(P>0.05);PSD组患者小脑后叶下部的体积减小与HAMD评分成显著负相关,相关系数为-0.896,P<0.05;同样,PSD组患者小脑中、下脚FA值的降低与HAMD评分均成显著负相关,相关系数分别为-0.704和-0.916,均P<0.05。结论 PSD患者小脑形态结构发生了改变且这种改变与抑郁状态呈显著相关性,进而从临床上初步证实了小脑可能参与了卒中后抑郁的发生。

Objective To conform clinically the morphological structure changes of cerebellar in PSD by technology of diffusion tensor imaging and to investigate the relationship between the changes and depression states. Methods Patients with PSD,without PSD,and healthy volunteers were enrolled,20 in each group. The alterations of the 60 ones＇ cerebellar structures were detected by diffusion tensor imaging,and the correlation between these changes and depression scale scoring were analyzed. Results In PSD group,the volume of cerebellar posterior lobe and the FA values of the middle and inferior cerebellar peduncle were significantly reduced compared with stroke without depression group and control group.However,no significant difference of volume change and FA value of cerebellum were found in both the control and CONT groups（ P〈0. 05）. The result found significant negative correlation between the score of HAMD and the decreases of the volume in cerebellar posterior lobe（ r =- 0. 896,P〈0. 05）. In addition,significant negative correlation was also found between the score of HAMD and the reductions in the middle and inferior cerebellar peduncle of the FA values（ r =- 0. 704,r =- 0. 916,both P〈0. 05）. Conclusion The cerebellar morphological structure in patients with PSD has changed,and this change significant correlated with depression state. And then these findings preliminarily confirmed in clinical that the strcture of the cerebellar may be involved in the pathogensis of PSD.