血清25-羟基维生素D₃浓度与腰椎间盘突出症患者情绪障碍的神经机制研究

Study on the Neural Mechanism of Serum 25-Hydroxyvitamin D₃ Concentration and Emotional Disorders in Patients with Lumbar Disc Herniation

摘要: 目的：探究血清25-羟基维生素D₃[25(OH)D₃)]浓度与腰椎间盘突出症(LDH)患者情绪障碍的关联神经机制，为临床干预LDH患者情绪问题提供理论依据。方法：选取2023年8月~2025年8月安徽医科大学第一附属医院收治的64例LDH患者设为LDH组，同期选取64例年龄、性别匹配的健康志愿者设为健康对照(HC)组。收集两组受试者临床资料，采用汉密尔顿抑郁、焦虑量表(HAMD、HAMA)评估情绪状态，视觉模拟评分法(VAS)评估疼痛程度，Oswestry功能障碍指数(ODI)、日本骨科协会腰椎功能评分(JOA)评估腰椎功能；采集空腹静脉血，通过化学发光免疫分析法检测血清25(OH)D₃浓度，行高分辨率3D-T1结构磁共振扫描获取全脑灰质体积(GMV)。运用独立样本t检验对比两组各项指标差异，通过Pearson相关、多元线性回归分析，校正混杂因素后探究血清25(OH)D₃浓度、差异脑区GMV与情绪评分的相关性。结果：1) 两组年龄、性别、BMI基线资料无统计学差异(P > 0.05)；相较于HC组，LDH组血清25(OH)D₃浓度、JOA评分显著降低，HAMD、HAMA、VAS、ODI评分均显著升高，差异均有统计学意义(P < 0.001)。2) LDH患者血清25(OH)D₃浓度与HAMD、HAMA、VAS、ODI评分呈显著负相关，与JOA评分呈显著正相关(均P < 0.001)；校正年龄、性别、BMI后，该独立负相关关系依然成立(均P < 0.001)。3) 相较于HC组，LDH患者左侧颞极部颞上回、左侧颞中回、右侧颞中回等情绪调节相关脑区GMV显著减小(P < 0.05)。4) LDH患者HAMD评分与左侧颞极部颞上回GMV呈负相关，且血清25(OH)D₃浓度与该脑区GMV呈显著正相关(均P < 0.05)。结论：LDH患者普遍存在维生素D缺乏(VDD)，且伴随明显焦虑、抑郁情绪，此类情绪障碍或与血清25(OH)D₃浓度降低、颞叶皮层等情绪调节关键脑区体积减小相关。维生素D (VD)可通过调控特定脑区结构可塑性，对LDH患者情绪障碍起到保护作用，本研究为阐释LDH合并情绪障碍的神经机制提供了影像学依据，也为临床VD筛查、心理评估及补充VD辅助治疗提供了科学支撑。

Abstract: Objective: To explore the neural mechanism underlying the correlation between serum 25-hydroxyvitamin D₃ [25(OH)D₃] concentration and emotional disorders in patients with lumbar disc herniation (LDH), so as to provide a theoretical basis for the clinical intervention of emotional problems in LDH patients. Methods: Sixty-four LDH patients admitted to the First Affiliated Hospital of Anhui Medical University from August 2023 to August 2025 were selected as the LDH group, and 64 healthy volunteers matched for age and gender were enrolled as the healthy control (HC) group in the same period. Clinical data of all subjects were collected. Emotional status was assessed using the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), pain severity was evaluated via the Visual Analogue Scale (VAS), and lumbar function was rated with the Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) Lumbar Function Score. Fasting venous blood samples were collected, and serum 25(OH)D₃ concentration was detected by chemiluminescent immunoassay. High-resolution 3D-T1 structural magnetic resonance imaging was performed to obtain the whole-brain gray matter volume (GMV). The independent-sample t-test was used to compare differences in various indicators between the two groups. Pearson correlation analysis and multiple linear regression analysis were applied to explore the correlations among serum 25(OH)D₃ concentration, GMV of differential brain regions and emotional scores after adjusting for confounding factors. Results: 1) There were no statistically significant differences in baseline data including age, gender and BMI between the two groups (P > 0.05). Compared with the HC group, the LDH group presented significantly lower serum 25(OH)D₃ concentration and JOA score, and remarkably higher HAMD, HAMA, VAS and ODI scores, with extremely significant differences (P < 0.001). 2) Serum 25(OH)D₃ concentration in LDH patients was significantly negatively correlated with HAMD, HAMA, VAS and ODI scores, and positively correlated with JOA score (all P < 0.001). After adjusting for age, gender and BMI, this independent negative correlation still remained (all P < 0.001). 3) Compared with the HC group, LDH patients showed significantly decreased GMV in multiple emotion regulation-related brain regions, such as the left temporal pole superior temporal gyrus, left middle temporal gyrus and right middle temporal gyrus (P < 0.05). 4) In the LDH group, HAMD score was negatively correlated with GMV of the left temporal pole superior temporal gyrus, and serum 25(OH)D₃ concentration was significantly positively correlated with GMV of this brain region (both P < 0.05). Conclusions: Vitamin D deficiency (VDD) is prevalent in LDH patients, accompanied by obvious anxiety and depression. Such emotional disorders may be related to decreased serum 25(OH)D₃ concentration and reduced volume of key emotion regulation brain regions such as the temporal cortex. Vitamin D (VD) can exert a protective effect on emotional disorders in LDH patients by regulating the structural plasticity of specific brain regions. This study provides imaging evidence for clarifying the neural mechanism of LDH complicated with emotional disorders, and also offers scientific support for clinical VD screening, psychological evaluation and adjuvant therapy with VD supplementation.