脑卒中后抑郁患者基于背外侧前额叶种子点的静息态功能连接及低频振幅变化

The changes in resting-state functional connectivity in stroke survivors with depression

目的分析基于前额叶背外侧区(DLPFC)种子点到全脑的功能连接、低频振幅变化,探讨脑卒中后抑郁(PSD)患者功能成像与临床量表、炎性指标(hs-CRP、IL-6、IL-2、IL-10、IL-17a及IFN-γ)的关联。方法纳入2016年至2020年新乡医学院第一附属医院收治的67例缺血性脑卒中患者,剔除12例头动较大和数据不完整的患者,最终纳入55例。收集基线数据,将汉密尔顿抑郁量表17项(HAMD-17)得分≧7分的患者分为PSD组(28例),HAMD-17得分<7分的患者分为对照组(27例)。收集功能磁共振成像数据进行分析,并测定血清炎症指标。结果与对照组比较,PSD组以L-DLPFC为种子点时1个差异团块内功能连接降低,体素129 mm^(3),MNI坐标(x=9,y=30,z=33),对应AAL脑区左前扣带回、右内侧扣带回、左内侧额上回;以R-DLPFC为种子点时1个差异团块内功能连接降低,体素44 mm^(3),MNI坐标(x=-27,y=12,z=47),对应AAL脑区左额中回。PSD组以R-DLPFC为种子点的异常脑区功能连接值与卒中时间呈正相关(r=0.433,P=0.027)。对照组以L-DLPFC为种子点的差异脑区功能连接值与MoCA呈负相关(r=-0.417,P=0.038),以R-DLPFC为种子点的功能连接值与IFN-γ呈正相关(r=0.620,P=0.001),异常脑区功能连接值与其他临床量表、炎症指标、病灶体积无显著相关性。结论执行控制网络内部及其与突显网络之间的功能连接异常可能参与PSD的发生机制,且可能与脑卒中时间、认知功能、IFN-γ有关。

Objective To analyze any changes in the functional connectivity between the seed points of the dorsolateral prefrontal cortex(DLPFC)and the whole brain,as well as any fluctuations in the low-frequency amplitude among persons with post-stroke depression(PSD).The aim was to develop correlations among functional imaging results,clinical scales,and inflammation indicators including high-sensitivity C-reactive protein(hs-CRP),interleukin 6(IL-6),interleukin 2(IL-2),interleukin 10(IL-10),interleukin 17a(IL-17a)and interferon-γ(IFN-γ).Methods Between 2016 and 2020,55 ischemic stroke survivors were tested.The 28 scoring 7 or more on the Hamilton Depression Scale(HAMD-17)formed the PSD group,while the 27 others formed the control group.Functional magnetic resonance images were collected,and serum inflammation indicators were determined.Results When seed points in the left DLPFC were used,in the PSD group the frontal cortex(FC)decreased in one cluster,with a voxel of 129mm^(3) and the MNI coordinates(x=9,y=30,z=33)indicating that the anatomical automatic labeling(AAL)brain regions were the Cingulum_Ant_L,Cingulum_Mid_R and the frontal_Sup_Medial_L.When the right DLPFC was used as the seed point the FC again decreased in one cluster,with voxels of 44mm^(3) and the MNI coordinates(x=-27,y=12,z=47)referring to the AAL brain region of the frontal_Mid_L.In the PSD group,the FC value of abnormal brain areas with the R-DLPFC as the seed point was positively correlated with time since stroke.In the control group,the FC value of abnormal brain areas with L-DLPFC as the seed point was negatively correlated with MoCA,while with R-DLPFC as the seed point it was positively correlated with IFN-γ.The FC values of abnormal areas of the brain showed no significant correlation with other clinical scales,inflammation indicators or lesion volume.Conclusion Abnormal functional connections within the executive control network and between the salience networks may participate in the mechanism of PSD,and may be related to the time since stroke,cognitive functioning,and IFN-γlevels.