皮质下缺血性抑郁患者的血管危险因素、认知损害和脑白质微结构损害

发布时间：2019-05-21 17:53

【摘要】：目的探讨皮质下缺血性抑郁（subcortical ischemic depression, SID）患者的血管危险因素与认知损害，为临床实施个体化治疗提供Pq证依据。方法选择35例SID患者（SID组）、37例皮质下缺血性血管病不伴抑郁患者（subcortical ischemic vascular disease，SIVD组）、40名正常对照（normal control，NC组）为研究对象。SID组和SIVD组来自2010年10月至2011年9月安徽医科大学第一附属医院神经内科就诊患者，NC组来自同期健康体检老年人。使用Framingham评分对血管危险因素进行评定；采用老年抑郁量表（geriatricdepression scale，GDS）、汉密尔顿抑郁量表（Hamilton depression sclae，HAMD）（17项）、简易智能精神状态检查量表（mini-mental state examination，MMSE）、蒙特利尔认知评估量表（Montreal CognitiveAssessment，，MoCA）、剑桥老年认知量表中文版（Cambridge Cognitive Examination-Chinese version, CAMCOG-C）、画钟试验（clock drawing task, CDT）等对抑郁症状和认知功能进行评定。结果SID组（12.3±4.7）和SIVD组（13.5±3.4）的Framingham评分均显著高于NC组（8.6±1.8）（F=20.850，P=0.000）。SID组（26.7±2.5；20.0±4.0；5.2±2.7）和SIVD组（26.8±1.9；20.7±3.0；6.1±2.1）MMSE、MoCA、CDT评分均显著低于NC组（28.3±1.8；23.1±3.4；8.0±1.8）（均P0.05）；SID组（82.7±9.0）和SIVD组（86.2±6.9）的CAMCOG-C量表评分均显著低于NC组（92.3±6.2）（均P0.05），SID组的CAMCOG-C量表评分显著低于SIVD组（P 0.05）。从CAMCOG-C子项来看，SID组（9.0±1.4；24.7±4.0；19.5±3.4）和SIVD组（9.4±0.9；25.5±2.1；20.3±2.3）的定向、语言、记忆评分均显著低于NC组（9.9±0.4；27.4±1.9；22.1±2.4）（均P0.05）；SID组（9.4±1.9）执行评分低于NC组（10.4±1.5）（P0.05），思维、知觉评分（5.4±1.7；6.3±1.4）低于SIVD组（6.2±1.3；7.0±1.4）和NC组（6.6±1.3；7.2±1.4）（均P0.05）。SID组的Framingham评分与各项抑郁及认知评分无显著相关，但GDS和HAMD评分均与MMSE、MoCA、CAMCOG-C、CDT评分呈显著性负相关（P均0.05）。结论SID患者存在多区域认知损害，尤其以思维、知觉和执行功能损害为主；SID患者的血管危险因素与SID的抑郁症状无直接联系。目的在全面控制血管危险因素后应用弥散张量成像技术（diffusion tensorimaging, DTI）比较晚发抑郁（late-onset depression, LOD）患者与正常老年人脑区域多部位白质微结构完整性的差异。方法选择18例LOD患者（LOD组）和18例正常对照（normal control, NC组）为研究对象。LOD组来自2010年10月至2011年9月安徽医科大学第一附属医院神经内科就诊患者，NC组来自同期健康体检老年人。使用Framingham评分对血管危险因素进行评定；采用简易智能状态检查量表（mini-mental stateexamination, MMSE）、汉密尔顿抑郁量表（Hamilton depression scale, HAMD）（17项）对认知功能和抑郁症状进行评定。两组在性别、年龄、受教育程度等方面无显著差异（P＞0.05）。应用GE公司的Signa3.0T超导磁共振行常规MRI检查以排除脑内疾病，随后行DTI扫描，在DTI图像上选取额上回（superior frontal gyrus,SFG）、额中回（middle frontal gyrus, MFG）、内囊前肢（anterior limb internal capsule,ALIC）、上纵束（superior longitudinal fasciculus, SLF）、岛叶（insula）、胼胝体（corpus callosum, CC）为感兴趣区（regions of interest, ROI），并分别对部分各向异性（fractional anisotropy, FA）、平均扩散系数（mean diffusion, MD）进行测量。运用统计学软件比较LOD组和NC组各ROI的参数值有无差异。结果LOD组左侧大脑半球MFG、SLF、ALIC(0.223±0.037,0.262±0.036,0.334±0.067)的FA值显著低于NC组（0.252±0.042,0.290±0.043,0.394±0.097）（P＜0.05），余ROI的FA值无统计学意义（P＞0.05）。此外，两组之间的MD值差异无统计学意义（P＞0.05）。结论1）在控制了年龄、性别、教育程度、血管危险因素和总体认知功能的情况下，同NC组相比较，LOD组表现出MFG、SLF、ALIC的白质微结构完整性损害。2）皮质-皮质下环路白质是调节情绪和认知的重要环路，该环路内白质微结构连接的改变可能影响情绪调节的过程，增加抑郁发生的风险。
[Abstract]:Objective To study the risk factors and cognitive impairment of the patients with subcortical ischemic depression (SID) and to provide the basis for the individual treatment of the clinical practice. Methods 35 patients with SID (SID group),37 cases of subcortical ischemic heart disease (SIVD) and 40 normal controls (NC group) were selected as the study group. Like. SID group and SIVD group from October 2010 to September 2011, from the neurology department of the First Affiliated Hospital of the University of China Medical University, the NC group was from the elderly in the same period of health examination The risk factors of blood vessels were assessed using the Framingham score; the elderly depression scale (GDS), the Hamilton depression score (HAMD) (17 items), the mini-mental state examination (MMSE) and the Montreal Cognitive Assessment Scale (MoCA) were used. The depressive symptoms and cognitive function were evaluated by the Chinese version of Cambridge, the Chinese version, the CAMCOG-C, the clock drawing task, and the CDT. The Framingham score was significantly higher in the results SID group (12.3% 4.7) and in the SIVD group (13.5% 3.4) than in the NC group (8.6% 1.8) (F = 20.850, P = 0.0 00). SID group (26.7-2.5; 20.0-4.0; 5.2-2.7) and SIVD group (26.8-1.9; 20.7-3.0; 6.1-2.1) MMSE, MoCA and CDT scores were significantly lower than in NC group (28.3-1.8; 23.1-3.4; 8.0-1.8) (all P0. The scores of CAMCOG-C scale in SID group (82.7-9.0) and SIVD group (86.2-6.9) were significantly lower than that in NC group (92.3-6.2) (all P0.05), and the CAMCOG-C scale score of SID group was significantly lower than that of SIVD group (P 0. 05). From the CAMCOG-C sub-item, the orientation, language and memory scores of the SID group (9.0-1.4; 24.7-4.0; 19.5-3.4) and the SIVD group (9.4-0.9; 25.5-2.1; 20.3-2.3) were significantly lower than that of the NC group (9.9-0.4; 27.4-1.9; 22.1-2.4) (all P0. 05); SID group (9.4% 1.9) performance score was lower than that of NC group (10.4% 1.5) (P0.05), thinking, perception score (5.4% 1.7; 6.3% 1.4) was lower than that of SIVD group (6.2% 1.3; 7.0% 1.4) and NC group (6.6% 1.3; 7.2% 1.4) (all P0. The Framingham score of SID group was not related to the scores of depression and cognition, but the scores of GDS and HAMD were negatively correlated with the scores of MMSE, MoCA, CAMCOG-C and CDT (P <0. 05). Conclusion There are multi-area cognitive impairment in SID patients, especially in the form of thinking, perception and executive function, and the risk factors of the patients with SID and the depressive symptoms of SID Objective To control the risk factors of blood vessels and to use the diffusion tensor imaging (DTI) to compare the late-onset depression (LOD) with the multi-part white matter microjunction in the brain of the normal old people. The difference in structural integrity was selected in 18 LOD patients (LOD group) and 18 normal controls (normal control, The study object was the NC group. The LOD group was from the Neurology Department of the First Affiliated Hospital of the University of China Medical University from October 2010 to September 2011, and the NC group was from the NC group. The risk factors of the blood vessel were assessed by using the Framingham score, and the cognitive function was assessed by using the mini-mental state examination (MMSE), the Hamilton depression scale (HAMD) and the Hamilton depression scale (HAMD) (17). And the two groups have no significant difference in terms of sex, age, degree of education, etc. (P> 0.05). Conventional MRI of the Signa3.0 T superconducting magnetic resonance line of GE company was applied to eliminate the brain disease, and then the DTI scan was performed, and the upper anterior fascicle (MFG), the inner capsule front limb (ALIC) and the upper longitudinal fascicle were selected on the DTI image. Ulus, SLF, insula, corus callosum, and CC are regions of interest (ROI), and partial anisotropy (FA) and mean diffusion coefficient (mean diffusion coefficient) are respectively obtained. n, MD) for measurement. Comparison of the LOD and NC groups of RO with statistical software The value of FA in the left cerebral hemisphere MFG, SLF, ALIC (0.223, 0.037, 0.262, 0.036, 0.334 and 0.067) of the LOD group was significantly lower than that of the NC group (0.252, 0.042, 0.290, 0.043, 0.394 and 0.097) (P <0.05), and the FA value of the residual ROI was not statistically significant. The difference of MD between the two groups was not statistically significant (P> 0.05). Conclusion 1) In the case of control of age, sex, degree of education, risk factors and general cognitive function, we compare with NC group, L In the OD group, the white matter microstructural integrity of the MFG, SLF, and ALIC is impaired.2) The white matter of the subcortical white matter is an important loop for regulating the mood and the cognition, and the change of the white matter microstructure connection in the loop may affect the mood regulation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.1

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