伴轻度认知障碍的恢复期老年抑郁症患者静息态功能磁共振研究

发布时间：2018-06-08 13:01

本文选题：恢复期老年抑郁症 + 轻度认知障碍　；参考：《广州医科大学》2017年硕士论文

【摘要】：背景:老年抑郁症患者(late life depression,LLD)存在情绪障碍及认知损害。抑郁发作和认知损害共病时会加速老年人的认知下降以及增加痴呆发生风险,其中伴轻度认知障碍(mild cognitive impairment,MCI)的恢复期LLD患者其抑郁病史和认知损害可能存在相互作用,引起整体功能脑网络的紊乱,促进认知的恶化。而目前关于伴MCI的恢复期LLD患者抑郁病史和认知损害相互作用的神经影像学机制以及对功能脑网络属性的影响尚未清晰。目的:本研究拟采用静息态功能磁共振(Resting state functional magnetic resonance imaging,rs-fMRI)技术,分析伴MCI的恢复期LLD患者功能脑网络属性特点,以及抑郁病史和认知损害在脑区功能活动上的交互效应,探讨抑郁病史和认知损害交互效应与功能脑网络属性、认知表现的关系。方法:本研究纳入恢复期LLD患者32例(其中伴MCI的恢复期LLD患者13例,不伴MCI的恢复期LLD患者19例),MCI患者26例,正常对照(normal control,NC)27例。所有被试进行详细神经心理评估及rs-fMRI扫描。一方面基于rs-fMRI数据提取全脑各个脑区平均时间信号序列进行相关性分析,构建各个被试功能脑区连接网络,再采用图论法计算功能脑网络属性;另一方面基于分数低频振幅(fractional amplitude of low-frequency fluctuation,fALFF)的rs-fMRI技术,构建各个被试功能脑区活动fALFF图。各组被试的功能脑网络属性比较采用灰质体积校正后的协方差分析,进一步组间两两比较采用LSD-t检验;各组被试的功能脑区活动fALFF值采用灰质体积校正后的2(恢复期LLD)×2(MCI)析因分析以获得抑郁病史和MCI在功能脑区活动上的主效应和交互效应;恢复期LLD组功能脑网络属性值、存在抑郁病史和MCI交互效应的脑区活动fALFF值与认知量表得分相关分析采用Pearson相关分析及多重线性回归分析。结果:1、rs-fMRI分析:(1)功能脑网络属性指标:四组间集群系数(clustering coefficient,aCp)(P=0.036)、特征路径长度(shortest path length,aLp)(P=0.005)、全局效率(global efficiency,aEgloble)(P=0.008)、局部效率(local efficiency,aEloc)(P=0.006)的差异有统计学意义。进一步组间两两比较发现,不伴MCI恢复期LLD组aLp值大于NC组(P=0.032),aEglobe值(P=0.027)及aEloc值(P=0.034)低于NC组;伴MCI的恢复期LLD组aCp值小于不伴MCI的恢复期LLD组(P=0.039)、MCI组(P=0.017)和NC组(P=0.004),aLp值大于MCI组(P=0.013)和NC组(P=0.001),aEglobe值低于MCI组(P=0.023)和NC组(P=0.001),aEloc值低于MCI组(P=0.026)和NC组(P=0.001)。(2)功能脑区活动fALFF值:抑郁病史和MCI的交互效应表现为左侧额上回、左侧额中回、左侧顶下小叶、左侧顶上小叶的活动下降(P0.05,GRF校正),右侧海马旁回的活动增加(P0.05,GRF校正);抑郁病史的主效应表现为左侧壳核、左侧岛叶、左侧眶部额下回、左侧眶部额上回、左侧直回的活动下降(P0.05,GRF校正);MCI的主效应表现为左侧颞中回、左侧颞下回、双侧下丘脑活动增加(P0.05,GRF校正),双侧额中回、双侧额下回、双侧额上回、双侧楔前叶、左侧中央后回、右侧角回、右侧顶下小叶、右侧顶上小叶的活动下降(P0.05,GRF校正)。2、相关分析:(1)恢复期LLD患者记忆综合得分与功能脑网络属性a Lp(r=-0.409,P=0.038)、aEgloble(r=0.458,P=0.019)及aEloc(r=0.507,P=0.008)均相关,经多重线性回归进一步分析,依然发现记忆综合得分与功能脑网络属性参数a Lp(标准系数β=-0.645,P=0.022)、aEgloble(标准系数β=2.617,P=0.016)及aEloc(标准系数β=2.447,P=0.023)存在相关;(2)恢复期LLD组右侧海马旁回fALFF值与功能脑网络属性参数aLp(r=0.451,P=0.011)、aEgloble(r=-0.476,P=0.007)及aEloc(r=-0.425,P=0.017)相关,经多重线性回归进一步分析,依然发现右侧海马旁回fALFF值与功能脑网络属性参数aLp(标准系数β=0.501,P=0.030)、aEgloble(标准系数β=-0.559,P=0.014)及aEloc(标准系数β=-0.531,P=0.019)相关。此外还发现右侧海马旁回fALFF值与记忆综合得分相关(标准系数β=-0.810,P=0.002)。结论:1、恢复期LLD患者存在功能脑网络整合能力和分工效率的下降,其中伴MCI的恢复期LLD患者功能脑网络属性改变程度最明显。2、伴MCI的恢复期LLD患者存在抑郁病史和认知损害的交互效应,表现为额顶皮层-边缘系统的脑区功能活动异常。3、存在抑郁病史和认知损害交互效应的脑区中,右侧海马旁回的功能活动增加与恢复期LLD患者的功能网络效率下降有关,并且与恢复期LLD患者记忆表现相关。
[Abstract]:Background: late life depression (LLD) has emotional disorders and cognitive impairment. Depression and cognitive impairment can accelerate cognitive decline in elderly people and increase the risk of dementia, with the history of depression and cognitive impairment in patients with mild cognitive impairment (mild cognitive impairment, MCI) in the recovery period of LLD. There may be interactions that cause disorders of the overall functional brain network and promote cognitive deterioration. At present, the neuroimaging mechanism of the history of depression and the interaction of cognitive impairment in the convalescent LLD patients with the convalescent period of MCI and the effects on the functional brain network are not yet clear. State functional magnetic resonance imaging, rs-fMRI) technology, analysis of the functional brain network properties of LLD patients with MCI in the recovery period, and the interaction effects of depression history and cognitive impairment on functional activity of the brain area, and explore the relationship between the history of depression and the cognitive impairment and the relationship between the ability of the brain network and the cognitive performance. 32 cases of LLD patients were included in the recovery period (13 cases of LLD patients with MCI, 19 cases of LLD without MCI), 26 cases of MCI patients, 27 cases of normal control (normal control, NC). All subjects performed detailed neuropsychological assessment and rs-fMRI scan. On the one hand, the average time signal sequence of the whole brain regions was extracted based on rs-fMRI data. On the basis of correlation analysis, each functional brain area connection network is constructed, and then graph theory is used to calculate functional brain network properties. On the other hand, based on the rs-fMRI technology of fractional amplitude of low-frequency fluctuation (fALFF), the activity fALFF of each test work can be constructed. The functional brain network attributes of each group are tested. The covariance analysis was compared with gray matter volume correction, and 22 of the further groups were compared with the LSD-t test. The fALFF values of the functional brain areas of each group were analyzed by 2 (recovery period LLD) x 2 (MCI) analysis to obtain the main and interaction effects of MCI in the functional brain region, and the LLD group in the recovery period. Functional brain network attribute value, the brain area activity fALFF value of depression history and MCI interaction effect and cognitive scale score correlation analysis using Pearson correlation analysis and multiple linear regression analysis. Results: 1, rs-fMRI analysis: (1) functional brain network attribute index: four groups of cluster coefficient (clustering coefficient, aCp) (P=0.036), characteristic path length Shortest path length (aLp) (P=0.005), global efficiency (global efficiency, aEgloble) (P=0.008), local efficiency (local efficiency, aEloc) have statistical significance. The value of aCp in group LLD with MCI was less than that of LLD group (P=0.039), MCI group (P=0.017) and NC group (P=0.004), MCI group (P=0.017) and NC group (P=0.004). The interaction effect was the left upper frontal gyrus, the left middle frontal gyrus, the left apical lobule, the left parietal lobule movement (P0.05, GRF correction), the activity of the right paraphippocampal gyrus increased (P0.05, GRF correction). The main effects of the history of depression were the left putamen, left insula, the left orbital frontal gyrus, the left orbital frontal gyrus, and left direct gyrus. Decrease (P0.05, GRF correction); the main effect of MCI was left temporal gyrus, left temporal gyrus, bilateral hypothalamic activity increased (P0.05, GRF correction), bilateral middle frontal gyrus, bilateral inferior frontal gyrus, bilateral frontal gyrus, bilateral anterior lobe, left central posterior gyrus, right angular gyrus, right apical lobule, and right apical lobule (P0.05, GRF corrected).2. Analysis: (1) the memory comprehensive score of LLD patients in the recovery period was related to the functional brain network attribute a Lp (r=-0.409, P=0.038), aEgloble (r=0.458, P=0.019) and aEloc (r=0.507, P=0.008), and further analyzed by multiple linear regression, still found the memory comprehensive score and the functional brain network attribute parameters a (standard coefficient beta). There is a correlation between quasi coefficient beta =2.617, P=0.016) and aEloc (standard coefficient beta =2.447, P=0.023). (2) the fALFF value of the right parahippocampal gyrus in group LLD is related to functional brain network attribute parameter aLp (r=0.451, P=0.011), aEgloble (r=-0.476, 0.017), and is further analyzed by multiple linear regression, still finding the right side hippocampal gyrus. ALFF values are related to functional brain network attribute parameters aLp (standard coefficient beta =0.501, P=0.030), aEgloble (standard coefficient beta =-0.559, P=0.014) and aEloc (standard coefficient beta =-0.531, P=0.019). Furthermore, the fALFF value of the lateral parahippocampal gyrus is related to the memory comprehensive score (standard coefficient beta =-0.810). Conclusion: 1, functional brain exists in the recovery period. The ability of network integration and division of labor decreased, in which the functional brain network properties of LLD patients with MCI's recovery period were most obvious.2, and the patients with LLD had the interaction effect of depression history and cognitive impairment in the convalescent period of MCI, which showed the functional active abnormal.3 in the frontal cortex marginal system, and the history of depression and cognitive impairment. The increased functional activity of the right parahippocampal gyrus in the brain region of the right side is related to the decline in the functional network efficiency of LLD patients in the recovery period and the memory performance of patients with LLD in the recovery period.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R749.4

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