双相抑郁伴自杀意念患者的认知功能与脑基底节、丘脑区磁共振质子波谱的相关性分析

Correlation between cognitive function and proton magnetic resonance spectroscopy in basal ganglia and thalamus in patients with bipolar depression and suicidal ideation

目的 探讨双相抑郁伴自杀意念患者的认知功能与脑基底节、丘脑区磁共振质子波谱的相关性,为临床治疗双相抑郁伴自杀意念提供参考依据。方法 回顾性分析2021年10月至2022年5月新疆维吾尔自治区人民医院收治的40例双相抑郁患者的临床资料,按照是否伴自杀意念分为A组(不伴有自杀意念)、B组(伴自杀意念),每组20例。比较两组患者的24项汉密尔顿抑郁量表(HAMD-24)、汉密尔顿焦虑量表(HAMA)、杨氏躁狂评定量表(YMRS)、蒙特利尔认知评估量表(MoCA)评分;采用磁共振检测脑基底节区、丘脑区N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、肌醇(MI)、乳酸(Lac)数值,并分析患者认知功能与脑基底节区、丘脑区NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr值的相关性。结果 与A组比,B组患者HAMD-24、HAMA、YMRS评分均显著升高,MoCA评分、左侧脑基底节区NAA/Cr值、右侧脑基底节区MI/Cr值及右侧丘脑区Cho/Cr值均显著降低(均P<0.05)。经Pearson相关性分析法结果显示,双相抑郁患者MoCA评分与左侧脑基底节区NAA/Cr、右侧脑基底节区MI/Cr值、右侧丘脑区Cho/Cr值呈正相关(均P<0.05)。结论 双相抑郁伴自杀意念患者存在明显的抑郁、焦虑、躁狂症状,且有认知功能障碍,脑基底节区、丘脑区均存在神经元功能紊乱,并且患者受到了比较严重的基底节神经损害,且与认知功能存在一定的关联,故临床可早期对患者进行认知功能评估与磁共振检查,以发现患者的自杀意念,降低不良预后的风险。

Objective To explore the correlation between cognitive function and proton magnetic resonance spectroscopy in basal ganglia and thalamus in patients with bipolar depression and suicidal ideation, and to provide reference for clinical treatment of bipolar depression and suicidal ideation. Methods Clinical data of 40 patients with bipolar depression admitted to People’s Hospital of Xinjiang Uygur Autonomous Region from October 2021 to May 2022 were retrospectively analyzed, according to whether accompanied by suicidal ideation, they were divided into group A(without suicidal ideation) and group B(with suicidal ideation), with 20 cases in each group. The hamilton depression scale-24(HAMD-24), hamilton anxiety scale(HAMA), Young’s mania rating scale(YMRS), montreal cognitive assessment(Mo CA) score were compared between the two groups, the values of N-acetylaspartate(NAA), creatine(Cr), choline(Cho), myo inositol(MI)and lactic acid(Lac) in basal ganglia and thalamus were detected by magnetic resonance imaging, the correlation between cognitive function and NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr values in basal ganglia region and thalamus region was analyzed. Results Compared with group A,HAMD-24, HAMA and YMRS scores significantly increased in group B, while MoCA scores, NAA/Cr value in left basal ganglia, MI/Cr value in right basal ganglia and Cho/Cr value in right thalamus region significantly decreased in group B(all P<0.05). Pearson correlation analysis showed that, MoCA score in patients with bipolar depression was positively correlated with NAA/Cr in the left basal ganglia, MI/Cr in the right basal ganglia and Cho/Cr in the right thalamus(all P<0.05). Conclusion Patients with bipolar depression and suicidal ideation have obvious symptoms of depression, anxiety and mania, as well as cognitive function, neuron dysfunction exists in both basal ganglia and thalamus, and the patients have suffered serious basal ganglia damage, which is associated with cognitive function to some extent, therefore, cognitive function assessment and magnetic resonance imaging examination can be conducted in early clinical stage, to detect suicidal ideation in patients and reduce the risk of poor prognosis.