血脑屏障损害与脑小血管病患者抑郁的相关性

Correlation between blood-brain barrier damage and depression in patients with cerebral small vessel disease

目的探讨血脑屏障（blood-brainbarrier，BBB）损害与脑小血管病（cerebralsmallvesseldisease，CSVD）患者抑郁的相关性。方法前瞻性连续纳入住院治疗的CSVD患者，入院后完成头颅MRI和脑脊液检查，应用脑脊液恤清白蛋白比值（albumin CSF／serum ratio，Q-AIb）评估BBB损害程度，在发病3个月后根据汉密尔顿抑郁量表（HamiltonDepression Scale，HAMD）和《美国精神障碍诊断与统计手册（第4版）》诊断标准进行抑郁评定。分析BBB损害与CSVD患者抑郁的相关性。结果共纳入130例连续的CSVD患者，其中58例（44．62％）在3个月内发生抑郁。抑郁组腔隙性梗死（43．10％对26．39％；x2=4．008，P=0．045）、脑白质疏松（75．86％对58．33％；x2=4．408，P=0．036）和脑微出血（27．59％对12．50％x2=4．707，P=0．030）的构成比以及基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分[（5．02±2．51）分对（3．60±2．43）分；t=3．256，P=0．001]、深部白质Fazekas评分[（2．35±1．00）分对（1．56±1．05）分；t=4．358，P〈0．001]和Q-Alb分类构成比（x2=6．852，P=0．033）与非抑郁组存在显著性统计学差异。多变量logistic回归分析显示，基线NIHSS评分[优势比（oddratio，OR）1．248，95％可信区间（ confidence interval, CI）1．027～1．517；p=0．026]、脑白质疏松（OR14．786，95％CI 1．776～123．111；P=0．013）、深部白质Fazekas评分（OR 1．847，95％CI 1．210～2．819；P=0．004）和Q-Aib（OR30．417，95％CI3．662～252．643；P=0．004）与抑郁存在显著独立相关性。结论BBB损害与CSVD患者的抑郁独立相关。

Objective To investigate the correlation of blood-brain barrier （BBB） damage and depression in patients with cerebral small vessel disease （CSVD）. Methods Consecutive patients with CSVD admitted to hospital were enrolled prospectively. The patients completed head MRI and cerebrospinal fluid （CSF） examination after admission. The BBB damage degree was evaluated by using albumin CSF/serum ratio （Q-AIb）. At 3 months after onset, the depression was assessed according to the Hamilton depression scale （HAMD） and the American Diagnostic and Statistical Manual of mental disorders, 4th edition （DSM- IV）. The correlation between the BBB damage and depression in patients with CSVD was analyzed. Results A total of 130 consecutive patients with CSVD were enrolled, including 58 （44. 62%） had depression within 3 months. There were significant differences in the proportions of patients with lacunar infarction （43.10% vs. 26. 39% ; X2 = 4. 008, P = 0. 045）, leukoaraiosis （75.86% vs. 58.33% ; X2 = 4. 408, P = 0. 036）, and cerebral microbleed （27. 59% vs. 12. 50% ; X2 = 4. 707, P = 0. 030）, and baseline National Institutes of Health Stroke Scale （NIHSS） scores （5.02 ±2. 51 vs. 3.60±2.43; t = 3.256, P = 0. 001 ）, Fazekas scales of deep white matter （2. 35 ± 1.00 vs. 1.56 ± 1.05; t =4. 358, P 〈0. 001） and the proportion of Q-AIb category （x2 = 6. 852, P = 0. 033） between the depression group and the non-depression group. Multivariate logistic regression analysis showed that the baseline NIHSS scores （odds ratio [ OR ] 1. 248, 95% confidence interval [ CI] 1. 027- 1. 517; P = 0. 026）, leukoaraiosis （OR 14. 786, 95% CI 1. 776- 123. 111; P =0. 013）, Fazekas scales of deep white matter （OR 1. 847, 95% CI 1. 210-2. 819; P =0. 004）, and Q-Alb （OR 30. 417, 95% CI 3.662-252. 643; P =0. 004） had significant independent correlation with depression.Conclusions The BBB damage is indeoendentlv associated with depression in oatients with CSVD.