自主神经功能对卒中后抑郁患者运动功能的影响

Impact of autonomic nerve function on motor function in patients with post-stroke depression

目的 从脑局部一致性(ReHo)的角度探讨自主神经功能对卒中后抑郁(PSD)患者运动功能的影响。方法 2020年1月至12月,选取南京医科大学附属脑科医院住院和门诊脑梗死患者60例,分为对照组(n=30)和PSD组(n=30),采用Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)和汉密尔顿抑郁量表(HAMD)进行评定,并观测心率变异性(HRV)。两组各随机选取10例行静息态磁共振(rs-f MRI)扫描,计算Re Ho。结果 PSD组HRV各指标均低于对照组(|t|>2.092,P<0.05)。PSD组FMA和MBI评分与24 h正常R-R间期标准差(SDNN)、24 h相邻R-R间期差值的均方根值(RMSSD)、24 h相邻正常R-R间期差值>50 ms的心搏数占心搏数的百分比(PNN50)、总功率(TP)、极低频功率(VLF)、低频功率(LF)呈正相关(r>0.394,P<0.05),与HAMD呈负相关(|r|>0.919,P<0.001)。PSD组HAMD与SDNN、RMSSD、PNN50、TP、VLF呈负相关(|r|>0.769,P<0.001)。与对照组相比,PSD组的右侧直回(142体素,t=6.575)、左侧内侧和旁扣带脑回(204体素,t=4.925)的Re Ho增加(GRF校正,P_(-Voxel)<0.005,P_(-Cluster)<0.05);右侧小脑(191体素,t=-6.487)、左侧颞中回(140体素,t=-5.516)以及左侧中央前回(119体素,t=-4.764) Re Ho降低(GRF校正,P_(-Voxel)<0.005,P_(-Cluster)<0.05)。结论 PSD患者自主神经功能与运动功能障碍相关,自主神经对情绪、认知和运动脑区的调节可能是影响PSD患者运动功能的机制。

Objective To explore the impact of autonomic nerve function on motor function in patients with post-stroke depression(PSD)from the perspective of regional homogeneity(ReHo).Methods From January to December,2020,a total of 60 inpatients and outpatients with cerebral infarction in the Affiliated Brain Hospital of Nanjing Medical University were divided into control group(n=30)and PSD group(n=30).Two groups were assessed using Fugl-Meyer Assessment(FMA),modified Barthel Index(MBI)and Hamilton Depression Scale(HAMD).Heart rate variability(HRV)was measured.Ten patients in each group were selected randomly to undergo resting state functional magnetic resonance imaging(rs-fMRI)to calculate ReHo.Results All HRV indices were lower in PSD group than in the control group(|t|>2.092,P<0.05).In PSD group,FMA and MBI scores showed positive correlations with 24-hour standard deviation of normal-to-normal R-R intervals(SDNN),the root mean square of successive differences between normal heartbeats over 24 hours(RMSSD),the percentage of differences between adjacent normal R-R intervals over 24 hours that were greater than 50 ms(PNN50),total power(TP),very low frequency power(VLF)and low frequency power(LF)(r>0.394,P<0.05),and showed negative correlations with HAMD scores(|r|>0.919,P<0.001).HAMD scores in PSD group were negatively correlated with SDNN,RMSSD,PNN50,TP and VLF(|r|>0.769,P<0.001).Compared with the control group,the ReHo increased in PSD group in the right rectus gyrus(142 voxels,t=6.575),the left medial and paracingulate gyri(204 voxels,t=4.925)(GRF correction,P_(-Voxel)<0.005,P_(-Cluster)<0.05);and reduced in the right cerebellum(191 voxels,t=-6.487),the left middle temporal gyrus(140 voxels,t=-5.516),and the left precentral gyrus(119 voxels,t=-4.764)(GRF correction,P_(-Voxel)<0.005,P_(-Cluster)<0.05)in PSD group.Conclusion Autonomic nerve function is related to motor dysfunction in patients with PSD.The modulation of emotional,cognitive and motor brain regions by the autonomic nervous system may play a role in influencing the motor function in patients with PSD.