晚发抑郁症患者词语流畅性测验下前额叶氧合血红蛋白浓度变化的近红外线光谱成像研究

Prefrontal cortex hemoglobin concentration changes during a verbal fluency test in late-onset depression： a multi-channel near-infrared spectroscopy study

目的 应用近红外光谱成像技术分析晚发抑郁症（late-onset depression,LOD）患者执行词语流畅性测验（verbal fluency test,VFT）时前额叶功能及执行功能特点.方法 应用近红外光谱成像技术检测29例LOD患者（LOD组）和30名健康对照者（对照组）VFT时前额叶氧合血红蛋白浓度的改变并进行比较,采用17项汉密尔顿抑郁量表（17-item Hamilton Depression Scale,HAMD17）测定抑郁严重程度.采用独立样本t检验分析LOD组与对照组的VFT任务期44个通道的平均氧合血红蛋白浓度改变值的差异.采用Spearman相关分析分析LOD组HAMD17分值与VFT结果、VFT任务期44个通道的平均氧合血红蛋白浓度改变值之间的相关性.结果 （1）LOD组VFT平均数低于对照组,差异具有统计学意义[（9.6±2.4）个与（11.3±2.2）个,t=-2.89,P＜0.01].（2）VFT任务期LOD组双侧前额叶部分区域（16个通道）激活程度低于对照组,差异具有统计学意义（t=-3.54～-2.02,均P＜0.05）.（3）LOD组HAMD17阻滞因子与VFT平均数呈负相关（r=-0.52,P＜0.01）;LOD组VFr任务期,前额叶部分脑区激活程度与HAMD总分呈负相关（右侧CH4：r=-0.44,P＜0.01）,与HAMD17阻滞因子呈负相关（右侧CH7：r=-0.53,P＜0.01;右侧CHI2：r=-0.48,P＜0.01;右侧CH17：r=-0.40,P＜0.05;右侧CH18：r=-0.48,P＜0.01;右侧CH22：r=-0.46,P＜0.01;左侧CH10：r=-0.41,P＜0.05;左侧CH11：r=-0.57,P＜0.01;左侧CH15：r=-0.45,P＜0.05）,与激越因子呈负相关（右侧CH11：r=-0.38,P＜0.05;左侧CH 19：r=-0.38,P＜0.05）,与HAMD焦虑/躯体化因子呈负相关（左侧CH11：r=-0.44,P＜0.05;左侧CH15：r=-0.45,P＜0.01）.结论 LOD存在执行功能损害,与其前额叶功能下降相关;抑郁症状严重程度与前额叶功能下降正相关.

Objective To investigate executive function in late-onset depression （LOD）,to assess activation characteristics of prefrontal cortex and to examine the relationship between cognitive deficits and activation in the prefrontal regions.Methods Twenty-nine patients with LOD and 30 normal controls were included in this study.The severity of depression was evaluated by the 17-item Hamilton Depression Scale （HAMD17）.Hemoglobin concentration changes in bilateral prefrontal areas were measured during verbal fluency test （VFT） using 44-channel near infrared spectroscopy （NIRS）.Results （1） In LOD group,the correct scores of VFT were significantly lower than that of the control group（9.6±2.4 vs.11.3±2.2,t=-2.89,P＜0.01）.（2） In VFT,the part of right prefrontal,left inferior frontal gyrus regions in LOD patients were significantly lower than controls （t=-3.54 to-2.02,all P＜0.05）.（3） The score of VFT was negatively correlated with retardation factor score （r=-0.52,P＜0.01）.In LOD group,the spearman correlation analysis showed that the part of prefrontal regions in the VFT was correlated with HAMD17 total score （right,CH4：r=-0.44,P＜0.01）,retardation factor score （right,CH7：r=-0.53,P＜0.01;CH12：r=-0.48,P＜0.01;CH17：r=-0.40,P＜0.05,CH18：r=-0.48,P＜0.01;CH22：r=-0.46,P＜0.01;left,CH10：r=-0.41,P＜0.05;CH11：r=-0.57,P＜0.01;CH15：r=-0.45,P＜0.05）,anxiety/somatization factor score （left,CH11：r=-0.44,P＜0.05;CH15：r=-0.45,P＜0.01） and agitata factor score （right,CH11：r=-0.38,P＜0.05;left,CH19：r=-0.38,P＜0.05）.Conclusion LOD patients may have executive dysfunction and prefrontal dysfunction,which be positively related to severity of depressive symptoms.