冠心病伴抑郁患者脑结构磁共振成像特点及与情绪认知的相关性研究

Study on brain structural magnetic resonance imaging characteristics and correlation with emotion and cognition in patients with coronary heart disease and depression

目的探究冠心病伴抑郁(coronary heart disease with depression,CHDD)患者脑结构磁共振成像(structure magnetic resonance imaging,sMRI)特点,并分析其与情绪、认知能力的相关性。材料与方法采用病例对照设计,共纳入22例CHDD患者,44例冠心病不伴抑郁(coronary heart disease without depression,CHD-nD)患者,以及30例健康对照(healthy control,HC)组。所有受试者的T1加权图像均通过MR脑结构分割辅助分析系统进行数据处理,并利用SPSS 26.0软件进行统计分析。首先对所有数据进行正态性检验。对符合正态分布的数据,使用One-way ANOVA进行三组间比较,并通过最小显著差异检验(least significant difference test,LSD)进行事后组间的比较。对于非正态分布数据进行Kruskal Wallis H非参数检验,并使用Mann-Whitney U检验进行事后比较,同时应用Bonferroni校正以控制多重比较的误差。此外,采用相关性分析来探究脑结构变化与情绪认知评分的相关性。结果(1)与HC组相比,CHDD组患者在右侧额中回前部、颞下回、枕外侧回皮层曲率显著降低(P<0.05),在左侧颞上回坡部的皮层表面积显著增加(P<0.05)。(2)与HC组相比,CHD-nD患者在胼胝体后部体积显著增加,在左侧后扣带回、左侧盖部、右侧中央旁小叶、左侧海马下托、左侧海马伞的全脑体积占比以及左侧内嗅皮质的皮层曲率均显著降低(P均<0.05)。(3)与HC组相比,CHDD组、CHD-nD组在双侧眶额叶内侧部、左侧楔叶的全脑体积占比及右侧中央前回皮层曲率均显著降低,在右侧海马裂的体积均显著增高(P<0.05)。(4)相关性分析的结果显示,汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分与左侧眶额叶内侧部全脑体积占比(r=−0.228,P=0.025)、右侧中央前回(r=−0.239,P=0.019)及右侧枕外侧回皮层曲率(r=−0.256,P=0.012)呈负相关,与左侧颞上回坡部皮层表面积呈正相关(r=0.254,P=0.013);蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评分与左侧眶额叶内侧部全脑体积占比呈正相关(r=0.342,P=0.007)。结论CHDD患者在前额叶(额中回前部和中央前回)、颞叶(颞下回和颞上回坡部)、枕叶(枕外侧回和楔叶),以及海马裂的结构异常可能是CHDD患者的神经解剖基础,这些脑区与患者的情绪、认知障碍有关。

Objective:To explore the MRI characteristics of brain structure in patients with coronary heart disease and depression(CHDD)and analyze their correlation with emotion and cognitive ability.Materials and Methods:A case-control design was adopted,including 22 CHDD patients,44 coronary heart disease without depression(CHD-nD)patients,and 30 healthy controls(HC).T1-weighted images of all subjects were processed using a MR brain structure segmentation auxiliary analysis system,and statistical analysis was performed using SPSS 26.0 software.Firstly,all data were tested for normality.For data conforming to a normal distribution,one-way ANOVA was used to compare the three groups,followed by post-hoc comparisons using the least significant difference(LSD)test.For non-normally distributed data,the Kruskal Wallis H nonparametric test was applied,with post-hoc comparisons performed using the Mann-Whitney U test and Bonferroni correction to control for errors in multiple comparisons.Additionally,correlation analysis was conducted to explore the relationship between brain structural changes and emotional and cognitive scores.Results:(1)Compared to the HC group,the CHDD group showed significantly reduced cortical curvature in the right anterior middle frontal gyrus,inferior temporal gyrus,and lateral occipital cortex(P<0.05),and a significant increase in cortical surface area in the left superior temporal gyrus(P<0.05).(2)Compared to the HC group,CHD-nD patients exhibited a significant increase in the volume of the posterior corpus callosum and significant decreases in the proportion of whole brain volume in the left posterior cingulate gyrus,left operculum,right paracentral lobule,left hippocampal subiculum,left hippocampal fissure,and cortical curvature of the left entorhinal cortex(all P<0.05).(3)Compared to the HC group,the CHDD and CHD-nD groups showed significantly reduced proportions of whole brain volume in the bilateral medial orbitofrontal cortex.They left cuneus and reduced cortical curvature in the right precentral gyrus.Additionally,volume significantly increased in the right hippocampal fissure(all P<0.05).(4)Correlation analysis revealed that the Hamilton Depression Scale(HAMD)score was negatively correlated with the proportion of whole brain volume in the left medial orbitofrontal cortex(r=−0.228,P=0.025),right precentral gyrus(r=−0.239,P=0.019),and cortical curvature of the right lateral occipital cortex(r=−0.256,P=0.012),and positively correlated with the cortical surface area of the left superior temporal gyrus(r=0.254,P=0.013).The Montreal Cognitive Assessment(MoCA)score was positively correlated with the proportion of whole brain volume in the left medial orbitofrontal cortex(r=0.342,P=0.007).Conclusions:Structural abnormalities in the frontal lobe(precentral gyrus anterior and precentral gyrus),temporal lobe(inferior temporal gyrus and superior temporal gyrus slope),occipital lobe(lateral occipital gyrus and cuneus),and hippocampal fissure of CHDD patients may be the neuroanatomical basis of CHDD.These brain regions are related to patients'emotional,and cognitive impairments.