中风后抑郁患者的区域性脑结构与功能变化研究

Strokes are the most common severe neurological disorder, with 15 million people worldwide suffering strokes annually, 5 million of whom are left permanently disabled. Depression is the most common and serious emotional disorder following a stroke, affecting one-third of all stroke survivors. Depression is associated with poor short-term recovery and long-term rehabilitation outcome, excess disability, cognitive impairment, and mortality in stroke survivors. Despite intensive research since the 1970s, the neuroanatomical model of poststroke depression (PSD), a depressive illness in patients with well-established cerebrovascular disease, remains unclear. There is no strong evidence for the hypothesis that there is a close relationship between lesion location and PSD. A new model proposes that chronic vascular burden is an important factor in the development of PSD, and there is also preliminary evidence to suggest that regional brain atrophy may be associated with PSD risk.We hypothesize that stroke subjects with PSD are more likely to have regional brain atrophy than those without PSD. In addition, among subjects with PSD, the regional brain atrophy is associated with more severe PSD. Finally, subjects with non-remitting PSD are more likely to have regional brain atrophy.This will be the first study that examines the role of regional brain atrophy in a large sample of consecutively admitted stroke survivors with PSD. MRI examination of brain will be conducted. Regional brain volumes will be measures using the regions of interest, Voxel based morphometry and cortical thickness changes. In addition, the functional MRI will also be utilized to examine the changes of functional connectivity. Its results will shed light on the impact of regional brain atrophy in PSD risk, symptom severity, and outcome. Our findings are thus likely to be applicable to a large population of older people at risk of depression and should also stimulate further research in this field.

中风是一种最常见的严重的神经疾病。抑郁症是中风后出现的最常见的严重的情感障碍，在所有中风后幸存的患者中，有三分之一受抑郁影响。抑郁症同中风后患者短期痊愈和长期康复的匮乏，过度残疾，认知缺陷以及死亡率都有关联。此外，中风后抑郁患者的区域性脑萎缩与中风后抑郁的严重程度相关。未缓解的中风后抑郁患者很可能存在区域性脑萎缩。这将是首个对区域性脑萎缩在被确诊的中风后抑郁患者的作用所进行的大样本研究。我们将进行脑磁共振检查，通过感兴趣区域法和基于体素的形态测量学，以及大脑皮层厚度变化等对区域性脑体积进行测量。此外，我们将应用功能磁共振检查，研究中风后抑郁患者的大脑功能连接的变化情况。此研究将会在区域性脑萎缩对中风后抑郁在患病风险，症状严重程度以及转归的影响等方面提供线索。因此，我们的研究发现也可适用于对中风后老年患者罹患抑郁风险的大样本研究，从而激发该领域的进一步研究。

本课题组按原定计划开展了研究，并取得了预期的研究成果，完成了预期的考核指标。本研究中，中风后抑郁定义为15-项老年抑郁量表评分大于或等于7分。所有入组病人均在入院的7天内接受核磁共振扫描。.本研究的第一部分主要探讨卒中后脑梗塞与中风后抑郁风险的关系。本部分发现位于额叶-皮质下环路的脑梗塞是中风后3月时抑郁发生的风险因素。结果提示，中风损伤通过破坏额叶-皮质下环路的完整性是其导致中风后抑郁发生的重要机制之一。.第二部分旨在探讨脑微出血在预测中风后抑郁的预后中的作用。135中风病人纳入本部分分析。中风后抑郁的缓解率是34.1%。校正混杂因素后，脑叶型的微出血是持续型中风后抑郁的预测因子。.第三部分重点探讨了扩大型血管外周间隙与中风后抑郁发生风险的关系。我们采用一个4分量表来评定扩大型血管外周间隙的严重程度。725名中风病人纳入本部分分析。结果显示，只有位于半卵圆中心的扩大型血管外周间隙可预测中风后抑郁的发生风险。.第四部分探讨了脑小血管病的总负担对中风后抑郁的效应。563名中风病人纳入本部分的分析。研究发现，较为严重的脑小血管病总负担显著增加中风病人在中风后15个月里中风后抑郁的发生风险。.最后，本研究采用病例对照设计以探讨中风后抑郁的大脑网络结构与功能的变化。我们筛选并匹配了34名中风后抑郁患者与34名中风后非抑郁的患者。研究发现，两组的功能网络属性无统计学差异；两组的结构网络的全局属性也无明显统计学差异，但中风后抑郁患者在左侧梭状回与左侧海马旁回，以及左侧梭状回与左侧腹中-枕叶皮层之间的网络连接强度相比于对照组明显下降。.综上所述，不同类型的脑血管损伤，包括脑梗塞病灶，中风前已合并的脑小血管病，以及与脑结构网络关键连接的破坏均为中风后抑郁发生发展的重要危险因素。本研究阐明，位于额叶-皮质下环路等某些特殊部位的脑血管损伤可预测中风后抑郁的发生和预后。以上所述关键部位的脑血管损伤可作为早期筛查中风后抑郁高危人群的影像学标志物。.本课题预期发表6篇期刊论文，12篇会议论文，并培养2名博士研究生及3名硕士研究生。实际上，已发表期刊论文4篇; 会议论文2篇, 会议报告及摘要15个;且培养了4名博士研究生及1名硕士研究生。.我们严格按照国家自然科学基金委的要求进行经费支出。总拨款70万，已花费41.8844万。