抑郁症患者抗抑郁剂治疗前后脑动脉血流速度的改变及与认知功能的关系

摘要

Objective:To find out the cerebral blood flow velocity changes and its relationship with the attention and executive function in major depression(MD)after short-term treatment. Method:A total of 70 MD patients(MD group)and 65 healthy controls(healthy control group)were assessed with a self-developed general state of health questionnaire,Hamilton depression rating scale(HAMD),cancellation test(CT),Wiscon-sin card sorting test (WCST)and transcranial doppler ultrasonography (TCD)after enrolled,and MD group was tested again after a treatment for 4 to 8 weeks. Results:After short-term treatment,MD showed signifi-cantly faster average blood flow velocity in basilar artery(t=2. 45,P<0. 05). Compared with healthy controls, MD still showed lower blood flow velocity in left and right middle cerebral artery,left and right anterior cerebral artery after short-term treatment(t= -6. 07--12. 14;P<0. 01). Compared with before treatment,MD showed better performance in CT,but still lower than healthy controls in CT except net IV(t= -2. 54--17. 33;P<0. 05or P<0. 01). Compared with those before treatment,MD showed fewer response errors and perseverative errors after short-term treatment,but were still higher than healthy controls (t=9. 33-15. 13;P<0. 01). The cerebral artery average blood flow velocity shows significant correlations with the CT and WCST performance(P<0. 05 or P<0. 01). There were significant positive correlation between vertebral artery blood flow reduction and total CT net score reduction,response errors reduction and perseverative errors reduction in MD after short-term treatment(r=0. 454,0. 270,0. 378;P<0. 01). Conclusion:The slower average blood flow velocity in cere-bral arteries and impaired attention and executive function are improved in MD after short-term treatment,but are still lower than healthy controls. There are close relationship between the average cerebral artery blood flow velocity changes and impaired attention,executive function in MD after short-term treatment.%目的:探讨短期治疗后抑郁症患者脑动脉血流速度的变化及其与注意力、执行功能的关系.方法:采用汉密尔顿抑郁量表(HAMD)评估70例抑郁症患者(抑郁症组)抑郁情绪,采用划销测验、威斯康星卡片分类测验(WCST)测试抑郁症组和65名健康对照者(健康对照组)的认知功能;运用经颅多普勒超声检测两组脑动脉血流速度,抑郁症组在抗抑郁治疗4~8周后再次重测.结果:短期治疗后抑郁症组基底动脉血流速度较治疗前增快(t=2.45,P<0.05),但左、右大脑中动脉、左、右大脑前动脉血流速度仍低于健康对照组(t=-6.07~-12.14;P均<0.01);治疗后抑郁症组划销测验成绩较治疗前明显提高,但除净分IV外仍低于健康对照组(t=-2.54~-17.33;P<0.05或P<0.01);WCST错误应答数、持续性错误数均较治疗前减少,但仍多于健康对照组(t=9.33~15.13;P均<0.01).相关分析显示,治疗后大脑动脉平均血流速度与划销测验、WCST成绩显著相关(P<0.05或P<0.01);椎动脉血流速度差值与划销测验总净分差值、WCST错误应答数差值及持续性错误数差值呈正相关(r=0.454,0.270,0.378;P均<0.01).结论:短期治疗后抑郁症患者脑动脉平均血流速度与注意力、执行功能均得到一定程度的改善,但仍未恢复到正常状态;注意力与执行功能受损可能与脑动脉平均血流速度的改变有关.