Brain White Matter Fiber Bundle Alterations
and Severity of Depression in Patients with Post-stroke Depression

doi:10.12114/j.issn.1007-9572.2021.02.079

Abstract

Abstract: Background

Post-stroke depression (PSD) , a common complication in stroke patients, may increase the disability and mortality, however, its pathogenesis is unknown yet.

Objective

To observe the white matter fiber bundle alterations by diffusion tensor tractography (DTT) , and to explore its correlation with depression in patients with PSD.

Methods

Participants were selected from the First Affiliated Hospital of Jinzhou Medical University from September 2019 to September 2020, involving 40 inpatients with first-episode ischemic stroke (20 were found with PSD, and 20 without) , and 20 physical examinees as healthy controls. DTT was performed in all participants, fractional anisotropy (FA) and number of fiber bundles in regions of interest (ROIs) were compared across PSD and non-PSD inpatients and healthy controls. Pearson correlation analysis was performed to analyze the correlations of FA and number of fiber bundles on the side of stroke in the ROIs with 24-item Hamilton Rating Scale for Depression (HAMD-24) in PDS inpatients.

Results

In PSD inpatients, the FA of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle and uncinate fasciculus on the side of the stroke was significantly lower than those on the contralateral side (P<0.05) . And the number of fiber bundle of inferior fronto-occipital fascicles, corticospinal tract and frontopontine tract on the side of the stroke was significantly less than those on the contralateral side (P<0.05) . Compared to non-PSD inpatients or healthy controls, PSD inpatients demonstrated significantly lower FA of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle and uncinate fasciculus, and notable less number of fiber bundles of inferior fronto-occipital fascicles, corticospinal tract and frontopontine tract on the side of the stroke (P<0.05) . Pearson correlation analysis revealed that, the FA of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle or uncinate fasciculus on the side of the stroke was negatively correlated with HAMD-24 score in PSD inpatients (r=-0.469, -0.769, -0.728, -0.801, -0.839, P<0.05) ; the number of fiber bundle of inferior fronto-occipital fascicles, corticospinal tract or frontopontine tract on the side of the stroke was negatively correlated with HAMD-24 score in PSD inpatients (r=-0.858, -0.806, -0.694, P<0.01) .

Conclusion

There were impairment changes of structure of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle and uncinate fasciculus in patients with PSD, and these changes may be significantly correlated with the severity of depression, indicating that some white matter fiber bundle alterations may be involved in the onset of PSD.

Key words: Depression, Stroke, White matter, Diffusion tensor tractography

摘要： 背景

卒中后抑郁（PSD）是卒中患者常见并发症之一，可增加卒中患者致残率、病死率，但其确切发病机制仍不明确。

目的

通过弥散张量纤维束成像（DTT）观察PSD患者脑白质纤维束改变并分析其与抑郁的相关性。

方法

选取2019年9月至2020年9月在锦州医科大学附属第一医院住院治疗的首发缺血性脑卒中患者40例，根据PSD发生情况分为PSD组和非PSD组，每组20例；选取同期在锦州医科大学附属第一医院体检的健康志愿者20例作为正常对照组。三组受试者均行DTT检查，比较三组受试者感兴趣区（ROI）各向异性分数（FA）、神经纤维数量；PSD组患者各ROI病灶侧FA、神经纤维数量与24项版汉密尔顿抑郁量表（HAMD-24）评分的相关性分析采用Pearson相关分析。

结果

PSD组患者下额枕束、皮质脊髓束、额桥束、扣带束、钩束病灶侧FA低于非PSD组、正常对照组及病灶对侧，下额枕束、皮质脊髓束、额桥束病灶侧神经纤维数量少于非PSD组、正常对照组及病灶对侧（P<0.05）。Pearson相关分析结果显示，PSD患者下额枕束、皮质脊髓束、额桥束、扣带束、钩束病灶侧FA与HAMD-24评分均呈负相关（r值分别为-0.469、-0.769、-0.728、-0.801、-0.839，P<0.05）；PSD患者下额枕束、皮质脊髓束、额桥束病灶侧神经纤维数量与HAMD-24评分亦均呈负相关（r值分别为-0.858、-0.806、-0.694，P<0.01）。

结论

PSD患者病灶侧下额枕束、皮质脊髓束、额桥束、扣带束及钩束白质结构存在损伤且与抑郁程度相关，大脑部分白质纤维束改变可能在PSD的发生中具有重要作用。

关键词: 抑郁, 卒中, 白质, 弥散张量纤维束成像

CLC Number:

R749.42R743

QI Jie, ZHANG Lei, DENG Lijun, DUAN Xiaodi, DONG Binbin, SUI Rubo.

Brain White Matter Fiber Bundle Alterations and Severity of Depression in Patients with Post-stroke Depression [J]. Chinese General Practice, 2022, 25(09): 1123-1129.

祁杰,张磊,邓丽君等. 卒中后抑郁患者脑白质纤维束改变及其与抑郁程度的相关性研究[J]. 中国全科医学, 2022, 25(09): 1123-1129. DOI: 10.12114/j.issn.1007-9572.2021.02.079.

Figures/Tables 9

References 28

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组别	例数	性别（男/女）	年龄（±s，岁）	受教育年限（±s，年）	冠心病〔n（%）〕	LDL（±s，mmol/L）	HDL（±s，mmol/L）	血糖（±s，mmol/L）	NIHSS评分（±s，分）
正常对照组	20	10/10	53.8±8.4	9.3±3.2	10（50.0）	3.06±1.12	1.13±0.34	7.4±1.7	-
非PSD组	20	10/10	55.1±8.8	8.8±3.2	10（50.0）	3.11±1.01	1.28±0.32	7.4±1.8	6.8±3.0
PSD组	20	10/10	54.6±7.5	9.1±3.2	9（45.0）	3.03±1.06	1.20±0.24	7.4±2.1	6.9±4.3
检验统计量值		0^a	0.182	0.130	0.133	0.033	1.138	0.012	0.016^b
P值		1.00	0.83	0.88	0.94	0.97	0.33	0.99	0.90

组别	例数	性别（男/女）	年龄（±s，岁）	受教育年限（±s，年）	冠心病〔n（%）〕	LDL（±s，mmol/L）	HDL（±s，mmol/L）	血糖（±s，mmol/L）	NIHSS评分（±s，分）
正常对照组	20	10/10	53.8±8.4	9.3±3.2	10（50.0）	3.06±1.12	1.13±0.34	7.4±1.7	-
非PSD组	20	10/10	55.1±8.8	8.8±3.2	10（50.0）	3.11±1.01	1.28±0.32	7.4±1.8	6.8±3.0
PSD组	20	10/10	54.6±7.5	9.1±3.2	9（45.0）	3.03±1.06	1.20±0.24	7.4±2.1	6.9±4.3
检验统计量值		0^a	0.182	0.130	0.133	0.033	1.138	0.012	0.016^b
P值		1.00	0.83	0.88	0.94	0.97	0.33	0.99	0.90

组别	例数	SDS标准分	HAMD-24评分
正常对照组	20	26.80±7.47^a	2.45±1.50^a
非PSD组	20	29.20±10.74^a	2.60±1.39^a
PSD组	20	57.85±5.04	17.65±4.37
F值		92.085	194.912
P值		<0.01	<0.01

组别	例数	SDS标准分	HAMD-24评分
正常对照组	20	26.80±7.47^a	2.45±1.50^a
非PSD组	20	29.20±10.74^a	2.60±1.39^a
PSD组	20	57.85±5.04	17.65±4.37
F值		92.085	194.912
P值		<0.01	<0.01

组别	例数	下额枕束				皮质脊髓束
组别	例数	病灶侧	病灶对侧	t_配对值	P值	病灶侧	病灶对侧	t_配对值	P值
正常对照组	20	0.574±0.059^a	0.583±0.067	1.156	0.26	0.575±0.049^a	0.573±0.052	0.322	0.75
非PSD组	20	0.575±0.047^a	0.578±0.049	0.993	0.33	0.565±0.033^a	0.571±0.039	1.602	0.13
PSD组	20	0.475±0.055	0.572±0.071	-8.622	<0.01	0.459±0.038	0.576±0.077	-6.153	<0.01
F（χ²）值		22.868	0.165			50.404	0.035
P值		<0.01	0.85			<0.01	0.97