脑卒中后抑郁患者SSR与单胺类神经递质的相关性研究

发布时间：2018-04-23 18:16

本文选题：脑卒中后抑郁 + 皮肤交感反应　；参考：《延边大学》2017年硕士论文

【摘要】：目的:深入研究脑卒中后抑郁(Post-stroke depression,PSD)患者经检测交感神经皮肤反应(skin sympathetic response,SSR)结合测定血浆中 5-羟色胺(5-hydroxy tryptamine,5-HT)、多巴胺(dopamine,DA)等单胺类神经递质含量及汉密尔顿量表评分,评价PSD患者的抑郁程度,为临床供科学诊断依据。方法:采用美国Medtronic公司Keypoint肌电图机对经汉密尔顿抑郁量表分组后的正常对照组(健康人),单纯脑卒中组(stroke,S),脑卒中后抑郁组(post-stroke depression,PSD),各20例进行皮肤交感反应(SSR)检查,测定上肢及下肢潜伏期和波幅,用于对比各组之间潜伏期及波幅有无差异,从而推断大脑神经功能损害后的自主神经功能有无变化。同时检测受试者血浆中5-HT及DA的含量,对比各组之间有无差异,并进一步研究脑卒中后抑郁程度、SSr测定结果及血浆中单胺类神经质之间有无相关性。结果:1.脑卒中后抑郁组与正常对照组对比上肢、下肢SSR的潜伏期及波幅均有显著差异(P0.01);脑卒中后抑郁组与单纯脑卒中组对比上肢、下肢SSR的潜伏期有显著差异(P0.01),其波幅差异不显著,没有统计学意义(P0.05);单纯脑卒中组与正常对照组对比上肢SSR的伏期及波幅、下肢SSR的波幅均有显著差异(P0.05),与下肢SSR的潜伏期差异不显著没有统计学意义(P0.05)。2.脑卒中后抑郁组患者血浆当中5-HT、DA含量较正常对照组和单纯脑卒中组下降明显(P0.01);单纯脑卒中组和正常对照组血浆中5-HT、DA含量进行比较,无明显差异,不具有统计学意义(P0.05)。3.脑卒中后抑郁组汉密尔顿抑郁量表评分与上肢、下肢潜伏期正相关,与波幅无相关;单纯脑卒中组的汉密尔顿抑郁量表评分与下肢SSR的潜伏期正相关,正常对照组的汉密尔顿抑郁量表评分与各项SSR结果无相关。4.脑卒中后抑郁组血浆中5-HT、DA含量与HAMD评分、SSR上、下肢的潜伏潜呈负相关。结论:1.脑卒中后抑郁患者SSR检查结果与正常组及单纯脑卒中患者比较,潜伏期明显延长,且与抑郁程度正相关,故检测SSR异常变化可以作为一种客观指标判断脑损伤后自主神经功能有无异常。2.正常对照组或单纯脑卒中患者血浆中5-羟色胺、多巴胺含量明显高于脑卒中后抑郁组,故检测血浆中单胺类神经递质含量可有助于支持PSD诊断。3.在检测患者SSR基础上,结合血浆中单胺类神经递质含量测定及HAMD评分,可以对脑卒中后抑郁做出更加准确、严谨的诊断,为将来临床工作提供可靠的诊断依据。
[Abstract]:Objective: to study the contents of monoamine neurotransmitters such as 5-hydroxytryptamine 5-HT (5-hydroxytryptamine 5-HT), dopamine dopamine (DA) and Hamilton scale (Hamilton scale) in patients with post-stroke depression after stroke (Post-stroke depression) by detecting sympathetic skin skin sympathetic response (SSRs) and plasma serotonin 5-hydrotryptamine 5-HT (5-HT). To evaluate the degree of depression in patients with PSD and to provide scientific basis for clinical diagnosis. Methods: the normal control group (healthy controls, simple stroke group, post-stroke depression group) and post-stroke depression group (20 patients with post-stroke depression) were examined by Keypoint electromyography machine of Medtronic Company, USA. The latencies and amplitudes of upper and lower limbs were measured to compare whether there were differences in latency and amplitudes among the groups, so as to infer the changes of autonomic nerve function after cerebral nerve function damage. At the same time, the plasma 5-HT and DA levels in the subjects were measured, and the differences among the groups were compared, and the correlation between the level of depression after stroke and the monoamine neuroticism was further studied. The result is 1: 1. There were significant differences in the latency and amplitude of lower limb SSR between the depression group and the normal control group (P 0.01), the latency of lower extremity SSR was significantly different between the depression group and the simple stroke group (P 0.01), and the amplitude of SSR was not significantly different between the depression group and the simple stroke group. There was no significant difference in the amplitude and latency of SSR in upper limb and lower extremity between simple stroke group and normal control group (P 0.05), but there was no significant difference in latency of SSR between stroke group and normal control group (P 0.05). There was no significant difference in incubation period between stroke group and lower extremity SSR (P 0.05 路2), but there was no significant difference in the amplitude of lower extremity SSR between simple stroke group and normal control group. The levels of 5-HTDA in the patients with post-stroke depression were significantly lower than those in the normal control group and the simple stroke group, but there was no significant difference in the plasma 5-HTDA level between the stroke group and the normal control group. The scores of Hamilton Depression scale (Hamd) in post-stroke depression group were positively correlated with the latency of upper limb and lower extremity, but not with the amplitude of wave, and the scores of Hamilton Depression scale in simple stroke group were positively correlated with the latency of lower extremity SSR. There was no correlation between the scores of Hamilton Depression scale and the results of SSR in normal control group. 4. 4. There was a negative correlation between the level of 5 HT DA in plasma and the latent potential of lower extremity in HAMD score. Conclusion 1. The results of SSR examination in patients with post-stroke depression were significantly longer than those in the normal group and the patients with simple stroke, and were positively correlated with the degree of depression. Therefore, the detection of abnormal changes of SSR can be used as an objective index to determine the autonomic nervous function after brain injury. The levels of 5-hydroxytryptamine and dopamine in normal control group or simple stroke group were significantly higher than those in post-stroke depression group, so the detection of monoamine neurotransmitters in plasma could be helpful to support the diagnosis of PSD. 3. On the basis of the detection of SSR, combined with the determination of monoamine neurotransmitters in plasma and HAMD score, we can make a more accurate and rigorous diagnosis of post-stroke depression, and provide a reliable diagnostic basis for future clinical work.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.13

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