老年单相抑郁障碍与双相抑郁障碍患者脑白质变性程度比较

Study on the degree of white matter hyperintensity between unipolar depression and bipolar depression in elderly

目的:探讨脑白质高信号(WMH)在老年单相抑郁障碍(UPD)与双相抑郁障碍(BPD)患者差异及其与临床相关性。方法:收集30例UPD患者(UPD组)、23例BPD患者(BPD组)及年龄、性别等相匹配的23名健康对照者(HC组)人口学资料、脑血管病危险因素,并给予17项汉密尔顿抑郁量表(HAMD-17)、简易智力状态检查(MMSE)评估,应用Fazekas量表对头颅MRI的WMH程度评分;分析WMH评分与临床相关性。结果:3组间脑室旁WMH(PWMH)评分差异具有统计学意义(F=3.161,P=0.048),UPD组PWMH评分显著高于HC组(P=0.016);将年龄作为协变量后差异仍有统计学意义(F=3.440;P=0.037)。深部WMH(DWMH)评分及Fazekas量表总分3组比较差异无统计学意义。Logistic回归分析显示,PWMH评分对是否患有UPD具有贡献,在考虑高血压、糖尿病、年龄的影响后仍有统计学意义(OR=2.968,95%CI:1.283~6.865,P=0.011)。结论:PWMH作为重要的脑小血管损害因素,是引起老年期UPD的危险因素。

Objective： To compare the difference of white matter hyperintensity（WMH） between unipolar depression（UPD） and bipolar depression（BPD） and their clinical relationship in elderly. Method： The data of general demographic information and risk factors for cerebrovascular disease of 30 UPD patients（UPD group）,23 BPD patients（BPD group） and 23 age-and sex-matched health controls（HC group） were collected.And they were administered by Hamilton depression scale 17 item（HAMD-17） and mini-mental state examinatlon（MMSE）; the degree of white matter hyperintensity（WMH） were measured by Fazekas score on MRI;the relationship between the WMH score and clinical data amongthe groups were analyzed. Results： The difference among the 3 groups of periventricular WMH（PWMH） was significant（F = 3. 161,P = 0. 048）,the PWMH score in the UPD group was significant higher than the HC group（P = 0. 016）. There were still remarkable differences after controlling age（F = 3. 440; P = 0. 037）. The scores of deep WMH（DWMH） and Fazekas were no significant difference amonge the 3 groups. Logistic regression analysis results showed that the contribution of PWMH to UPD was still statistically significant after adjusting other confounding factors（including hypertension,diabetes mellitus,age）（OR = 2. 968,95% CI： 1. 283-6. 865,P = 0. 011）. Conclusion： As an important factor of cerebral small vessel disease,PWMH is the risk factor of UPD in the elderly.