经一年治疗无效的晚发抑郁症认知功能及海马局部一致性研究

Regional Homogeneity of Hippocampus with Cognitive Impairment in Patients with Late-Onset Depression after One Year’s Invalid Treatment: A MRI Study on Blood Oxygenation-Level Dependent Function

摘要: 目的：探讨经一年治疗无效的晚发抑郁症(LOD)患者认知功能及海马局部一致性(ReHo)变化和两者相关性。方法：门诊随机选择LOD患者25例，分别在入组时和一年后进行简易智能状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)、修订后的成套神经心理测试(NTB)以及静息态磁共振检查，并用DPARSFA软件计算被试随访前后双侧海马ReHo值，一年后完成随访22例，并根据汉密尔顿抑郁量表(HAMD) 24项评分总减分率的50%为界，分为LOD治疗无效组(11例)和有效组(11例)，采用两配对样本t检验比较随访前后各项认知功能，双侧海马ReHo值差异。结果：LOD治疗无效组入组时和一年后在MMSE延迟回忆、MoCA持续注意、NTB视觉匹配和推理及左海马ReHo值比较差异有统计学意义(P < 0.05)，治疗有效组则在MMSE延迟回忆、NTB听觉学习测验3比较差异有统计学意义(P < 0.05)。相关分析显示LOD治疗无效组一年后左海马ReHo值与入组时MoCA持续注意呈负相关(P < 0.05)。结论：经一年治疗无效的LOD患者呈现出记忆、注意和执行功能全面下降趋势，其海马不仅参与情感调节中枢，且功能侧化，表现为左海马活性代偿性增高，并受持续注意障碍影响。

Abstract: Objective: To explore the changes of regional homogeneity (ReHo) of hippocampus with cognitive impairment in patients with late-onset depression (LOD) after one year’s invalid treatment and their correlation. Methods: 25 patients with LOD selected from outpatient department into the group. They were requested to determine mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), revised euro-psychological test battery (NTB) and resting-state function magnetic resonance imaging (rs-fMRI) in the group and one year later. Finally 22 cases were completed. The values of ReHo of hippocampus on both sides before and after the follow-up were calculated with the software of DPARSFA. After a year of follow-up, the invalid treatment group and the valid treatment group were determined by rate of 50% points in Hamilton Depression Scale (HAMD) 24. The values of cognitive function and ReHo of hippocampus on both sides before and after the follow-up were compared with two-paired sample t-test. Results: The differences in the invalid treatment group were statistically significant before and after the follow-up in the delayed recall of MMSE, the sustained attention of MoCA, the visual matching and reasoning of NTB, ReHo in left Hippocampus (P < 0.05). There were statistically significant differences between MMSE delayed recall and NTB auditory learning test 3 (P < 0.05) in the other group. The correlation analysis showed negative correlation in the invalid treatment group between ReHo in left Hippocampus after a year and the sustained attention of MoCA in the group (P < 0.05). Conclusion: The patients with LOD after one year’s invalid treatment showed a general decline in memory, attention, and executive function. The hippocampus is not only involved in emotional regulation centers, but also functional lateralization being shown as the left hippocampal activity increased compensatory which was affected by the sustained attention disorders.