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

doi:10.3969/j.issn.1006-7795.2017.01.020

摘要/Abstract

摘要： 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，VFT）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。

关键词: 脑卒中, 抑郁, Oxy-Hb峰值浓度, 达峰时间

Abstract: 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.

Key words: stroke, depression, Oxy-Hb peak concentration, time to peak

中图分类号:

R743.3

杨智权, 刘爱贤, 聂忆秋. 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[J]. 首都医科大学学报, 2017, 38(1): 97-102.

Yang Zhiquan, Liu Aixian, Nie Yiqiu. The change of prefrontal Oxy-Hb peak concentration and the time to peak in patients with different degree depression after stroke[J]. Journal of Capital Medical University, 2017, 38(1): 97-102.

参考文献

[1] 张庆元,王耀光,黄建平,等. 103例脑卒中病人急性期心理障碍的研究[J]. 中国神经精神疾病杂志, 2006, 32(1):79-80.
[2] 张小芊,刘晓敏,刘破资.近红外光谱分析仪在精神疾病中的应用[J].国际精神病学杂志,2012,39(2):133-136.
[3] Ferrari M,Quaresima V.A brief review on the history of human functional near-infrared spectroscopy(fNIRS) development and fields of application[J].Neuroimage,2012,63(2):921-935.
[4] Dieler A C,Tupak S V,Fallgatter A J.Functional near-infrared spectroscopy for the assessment of speech related tasks[J].Brain Lang,2012,121(2):90-109.
[5] 李增勇,代世勋,张小印,等.驾驶员疲劳态下脑氧饱和度的近红外光谱法检测及其分析[J].光谱学与光谱分析,2010,30(1):58-61.
[6] Henry J D,Crawford J R. A meta-analytic review of verbal fluency performance following focal cortical lesions[J].Neuropsychology,2004,18(2):284-295.
[7] Herrmann M J,Ehlis A C,Fallgatter A J. Frontal activation during a verbal-fluency task as measured by near-infrared spectroscopy[J].Brain Res Bull,2003,61(1):51-56.
[8] Kinou M, Takizawa R, Marumo K, et al. Differential spatiotemporal characteristics of the prefrontal hemodynamic response and their association with functional impairment in schizophrenia and major depression[J].Schizophr Res,2013,150(2-3):459-467.
[9] Jae G K, Xia M N, Liu H L. Extinction coefficients of hemoglobin for near-infrared spectroscopy of tissue[J].IEEE Eng Med Biol Mag, 2005, 4(3):118-121.
[10] Matcher S J,Elwell C E,Cooper C E,el al.Performance comparison of several published tissue near-infrared spectroscopy algorithms[J].Anal Biochem,1995,227(1):54-68.
[11] Villringer A, Chance B.Non-invasive optical spectroscopy and imaging of human brain function[J].Trends Neurosci,1997,20(10):435-442.
[12] Hock C, Villringer K, Müller-Spahn F,et al.Decrease in parietal cerebral hemoglobin oxygenation during performance of a verbal fluency task in patients with Alzheimer's disease monitored by means of near-infrared spectroscopy (NIRS)-correlation with simultaneous rCBF-PET measurements[J].Brain Res,1997,755(2):293-303.
[13] Hoshi Y, Kobayashi N, Tamura M.Interpretation of near-infrared spectroscopy signals:a study with a newly developed perfused rat brain model[J].J Appl Physiol,2001,90(5):1657-1662.
[14] Nakahachi T,Ishii R, Iwase M,et al.Frontal activity during the digit symbol substitution test determined by multichannel near-infrared spectroscopy[J].Neuropsychobiology, 2008,57(4):151-158.
[15] Suto T, Fukuda M, Ito M, et al.Multichannel near-infrared spectroscopy in depression and schizophrenia:cognitive brain activation study[J].Biol Psychiatry, 2004,55(5):501-511.
[16] 张小芊,宾光宇,史璐洁,等.抑郁症病人言语流畅性任务下近红外光谱脑激活特征的初步研究[J].中华精神科杂志,2014,47(1):7-11.
[17] Hanry J D,Crawford J R.A meta-analytic review of verbal fluency performance following focal cortical lesions[J].Neuropsychology,2004,18(2):284-295.
[18] 刘琳琳,王惠玲,王熇生,等.精神分裂症病人等级伦敦塔任务的近红外光谱成像研究[J].中华精神科杂志,2012,45(6):321-326.
[19] Alvarez J A,Emory E.Executive function and the frontal lobes:a meta-analytic review[J].Neuropsychol Rev,2006,16(1):17-42.
[20] 权文香,白云峰,董问天,等.近红外光成像技术检测认知任务期间正常人额叶氧合血红蛋自水平变化[J].中国医科大学学报,2012,41(11):1044-1046.
[21] Pu S, Nakagome K,Yamada T,el al.The relationship between the prefrontal activation during a verbal fluency task and stress-coping style in major depressive disorder:a near-infrared spectroscopy study[J].J Psychiatr Res,2012,46(11):1427-1434.
[22] Noda T,Yoshida S, Matsuda T,el al.Frontal and right temporal activations correlate negatively with depression severity during verbal fluency task:a multi-channel near-infrared spectroscopy study[J].J Psychiatr Res,2012,46(7):905-912.
[23] Chaudhary U,Hall M,DeCerce J,et al.Frontal activation and connectivity using near-infrared spectroscopy:verbal fluency language study[J].Brain Res Bull,2011,84(3):197-205.
[24] 符晓艳, 赵秋菊,刘文伟,等. 心理干预对脑卒中后抑郁患者康复的作用[J]. 解放军医药杂志, 2014,26(8):99-101.
[25] 张亚芳, 刘海娟. 自我效能训练联合药物对老年脑卒中后抑郁的影响[J]. 中国煤炭工业医学杂志,2014,17(10):1697-1700.
[26] 王允琴, 戴秀珍,孙轩翔. 卒中后抑郁与血清单胺氧化酶活性及5-羟色胺水平相关性研究[J]. 中国煤炭工业医学杂志, 2014,17(4):562-564.