前额叶Oxy-Hb峰值浓度与达峰时间在不同程度脑卒中后抑郁状态病人中的变化

摘要

Objective To investigate the change of oxygenate hemoglobin (Oxy-Hb)peak concentration and the time to peak in prefrontal brain lobe in post stroke depression patients with different degrees and to move forward a single step for discussing whether can use functional near-infrared spectroscopy to assist in early diagnosis of depression after stroke.Methods Via functional near-infrared spectroscopy to test 93 patients with PSD (mild depression group 27 cases,moderate depression group 19 cases,major depression group 18 cases) and 29 controls.All subjects completed verbal fluency test in which they were asked to make words as many as possible according to one of three words.The peak level of Oxy-Hb and the time to peak was analyzed in patients with PSD and the control when they completed baseline and verbal fluency test.Results The peak level of Oxy-Hb was (0.29 ± 0.17) mmol · L-1 · mm and the time to peak was (74.27 ±24.12) s in mild depression group patients with PSD.In moderate depression group,the peak level of Oxy-Hb was (0.17 ± 0.11) mmol · L-1 · mm and the time to peak was (95.14 ± 70.35) s.And in major depression group,the peak level of Oxy-Hb was (0.16 ±0.30)mmol · L-1 · mm and the time to peak was (125.95 ±25.68)s.The controls were (0.32 ±0.10)mmol · L-1 · mm and (69.23 ± 41.78)s.The peak level and the time to peak in mild depression group had no statistically significant difference compared with the control group.Patients with moderate depression group and the control group were different significantly only in Oxy-Hb peak concentration.Only patients with major depression group and control group patients were statistically significant both in the peak level and the time to peak.Conclusion Oxy-Hb peak concentration is one of the more sensitive biological indexes which can be used for the observation of moderate and major patients with PSD.The time to peak applied only to patients with major depression.For patients with mild depression these two indexes were not applicable.%目的 通过对不同程度的脑卒中后抑郁(post stroke depression,PSD)病人脑部前额叶功能激活变化特点的观察,进一步探讨能否利用近红外光脑成像技术(functional near-infrared spectroscopy,fNIRS)协助早期识别及辅助诊断脑卒中后抑郁状态奠定一定的研究基础.方法 应用近红外光脑成像系统对脑卒中后抑郁状态病人(轻度抑郁组27例,中度抑郁组19例,重度抑郁组18例)和脑卒中后未出现抑郁或情绪不稳的病人(对照组29例)在执行语义言语流畅任务(verbal fluency task,VFTr)时,测定前额叶脑组织氧合血红蛋白(oxygenate hemoglobin,Oxy-Hb)峰值浓度和达峰时间,并进行比较分析,对相关结果进行统计学分析.结果 轻度抑郁组病人Oxy-Hb峰值浓度为(0.29±0.17) mmol·L-1·mm,达峰时间为(74.27±24.12)s,中度抑郁组病人Oxy-Hb峰值浓度为(0.17±0.11) mmol·L-1·mm,达峰时间为(95.14±70.35)s,重度抑郁组病人Oxy-Hb峰值浓度为(0.16 ±0.30) mmol·L-1·mm,达峰时间为(125.95 ±25.68)s;轻度抑郁组病人两方面与对照组差异均无统计学意义(P＞0.05);中度抑郁组病人仅在Oxy-Hb峰值浓度方面与对照组差异有统计学意义(P＜0.05);只有重度抑郁组病人在以上两方面与对照组差异均有统计学意义(P＜0.05).结论 Oxy-Hb峰值浓度是一个较为敏感的指标,可用于中度、重度PSD病人的观察,达峰时间只对重度病人适用,对于轻度病人上述两个指标均不适用;PSD后抑郁程度不同的病人,具有的抑郁情绪症状不同,而呈现出前额叶功能激活下降状态的生物学特征也有差异,重度抑郁状态的病人前额叶有氧代谢功能失调情况更严重,表现更为典型,这将为进一步研究将近红外光脑成像检查作为PSD早期识别及辅助诊断的一种检查方法奠定一定的研究基础.