卒中后抑郁患者小脑静息态功能磁共振改变的临床观察

Clinical Observation on the Alternations of Cerebellum by Resting-state Functional MRI in Patients with Post-stroke Depression

目的探讨卒中后抑郁(post-stroke depression,PSD)患者小脑静息态功能磁共振(rs-fMRI)相关参数的变化及其对患者抑郁状态的影响。方法对40例卒中患者及20例健康志愿者进行自评抑郁量表(SDS)和汉密尔顿抑郁量表(HAMD)评分。根据评分结果,分为3组:PSD组、N-PSD组和健康对照组,每组20例。每组患者均行小脑rs-fMRI扫描,测定小脑各部位的ReHo值(regional homogeneity),并对研究对象进行汉密尔顿抑郁量表(HAMD)评分,最后对结果进行统计分析。结果(1)与对照组及N-PSD组比较,PSD组右侧小脑前叶、后叶上部、后叶下部ReHo值均降低,差异均具有统计学意义(P<0.05);(2)PSD组右侧小脑前叶、小脑后叶上部及小脑后叶下部ReHo值与HAMD评分均呈显著负相关。结论病灶对侧小脑前叶、后叶上部、后叶下部神经元局部一致性的异常参与了PSD的发生发展,是PSD神经病理生理改变机制之一。

Objective To investigate the changes of related parameters of the cerebellum resting-state functional magnetic resonance(rs-fMRI)in patients with post-stroke depression(PSD)and its influence on the depression of patients.Methods Self-rated Depression Scale(SDS)and Hamilton Depression Scale(HAMD)scores were performed in 40 stroke patients and 20 healthy volunteers.According to the scoring results,the patients were divided into three groups:PSD group,N-PSD group and healthy control group,with 20 cases in each group.Rs-fMRI scan of each group of patients was performed to detect REGIONAL homoho(ReHo)value of each part of the cerebellum.The subjects were scored on the Hamilton Depression Scale(HAMD),and the results were statistically analyzed.Results(1)Compared with the control group and N-PSD group,ReHo values of right anterior cerebellar lobe,upper posterior lobe and lower posterior lobe in PSD group were decreased,with statistical significance(P<0.05).(2)The ReHo values of right anterior cerebellar,upper posterior cerebellar and lower posterior cerebellar in PSD group were significantly negatively correlated with HAMD score.Conclusion The abnormal local consistency of neurons in the contralateral anterior cerebellar lobe,upper posterior lobe and lower posterior lobe is involved in the occurrence and development of PSD,which is one of the neuropathophysiological mechanisms of PSD.