自主神经功能对卒中后抑郁患者运动功能的影响
Impact of autonomic nerve function on motor function in patients with post-stroke depression
张明兰 1张玲玲 2王丽莎 1刘莉 2高润 2饶江 2刘婉 2夏子安 2张传文 2程欣欣2
作者信息
- 1. 南京医科大学附属脑科医院物理诊断科心电图室,江苏南京市 210029
- 2. 南京医科大学附属脑科医院康复医学科,江苏南京市 210029
- 折叠
摘要
目的 从脑局部一致性(ReHo)的角度探讨自主神经功能对卒中后抑郁(PSD)患者运动功能的影响.方法 2020年1月至12月,选取南京医科大学附属脑科医院住院和门诊脑梗死患者60例,分为对照组(n = 30)和PSD组(n = 30),采用Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)和汉密尔顿抑郁量表(HAMD)进行评定,并观测心率变异性(HRV).两组各随机选取10例行静息态磁共振(rs-fMRI)扫描,计算ReHo.结果 PSD组HRV各指标均低于对照组(|t|>2.092,P<0.05).PSD组FMA和MBI评分与24 h正常R-R间期标准差(SDNN)、24 h相邻R-R间期差值的均方根值(RMSSD)、24 h相邻正常R-R间期差值>50 ms的心搏数占心搏数的百分比(PNN50)、总功率(TP)、极低频功率(VLF)、低频功率(LF)呈正相关(r>0.394,P<0.05),与HAMD呈负相关(|r|>0.919,P<0.001).PSD组HAMD与SDNN、RMSSD、PNN50、TP、VLF呈负相关(|r|>0.769,P<0.001).与对照组相比,PSD组的右侧直回(142体素,t = 6.575)、左侧内侧和旁扣带脑回(204体素,t = 4.925)的ReHo增加(GRF校正,P-Voxel<0.005,P-Cluster<0.05);右侧小脑(191体素,t =-6.487)、左侧颞中回(140体素,t =-5.516)以及左侧中央前回(119体素,t =-4.764)ReHo降低(GRF 校正,P-Voxel<0.005,P-Cluster<0.05).结论 PSD患者自主神经功能与运动功能障碍相关,自主神经对情绪、认知和运动脑区的调节可能是影响PSD患者运动功能的机制.
Abstract
Objective To explore the impact of autonomic nerve function on motor function in patients with post-stroke depression(PSD)from the perspective of regional homogeneity(ReHo).Methods From January to December,2020,a total of 60 inpatients and outpatients with cerebral infarction in the Affiliat-ed Brain Hospital of Nanjing Medical University were divided into control group(n = 30)and PSD group(n =30).Two groups were assessed using Fugl-Meyer Assessment(FMA),modified Barthel Index(MBI)and Hamil-ton Depression Scale(HAMD).Heart rate variability(HRV)was measured.Ten patients in each group were se-lected randomly to undergo resting state functional magnetic resonance imaging(rs-fMRI)to calculate ReHo.Results All HRV indices were lower in PSD group than in the control group(|t|>2.092,P<0.05).In PSD group,FMA and MBI scores showed positive correlations with 24-hour standard deviation of normal-to-normal R-R intervals(SDNN),the root mean square of successive differences between normal heartbeats over 24 hours(RMSSD),the percentage of differences between adjacent normal R-R intervals over 24 hours that were greater than 50 ms(PNN50),total power(TP),very low frequency power(VLF)and low frequency power(LF)(r>0.394,P<0.05),and showed negative correlations with HAMD scores(|r|>0.919,P<0.001).HAMD scores in PSD group were negatively correlated with SDNN,RMSSD,PNN50,TP and VLF(|r|>0.769,P<0.001).Compared with the control group,the ReHo increased in PSD group in the right rectus gyrus(142 voxels,t = 6.575),the left me-dial and paracingulate gyri(204 voxels,t = 4.925)(GRF correction,P-Voxel<0.005,P-Cluster<0.05);and reduced in the right cerebellum(191 voxels,t =-6.487),the left middle temporal gyrus(140 voxels,t =-5.516),and the left precentral gyrus(119 voxels,t =-4.764)(GRF correction,P-Voxel<0.005,P-Cluster<0.05)in PSD group.Conclusion Autonomic nerve function is related to motor dysfunction in patients with PSD.The modulation of emo-tional,cognitive and motor brain regions by the autonomic nervous system may play a role in influencing the mo-tor function in patients with PSD.
关键词
卒中后抑郁/心率变异性/自主神经/功能磁共振/局部一致性Key words
post-stroke depression/heart rate variability/autonomic nerve/functional magnetic resonance imaging/regional homogeneity引用本文复制引用
基金项目
江苏省卫健委重点项目(ZD2022030)
江苏省哲学社会科学项目(21TYB013)
南京市医学科技发展重点项目(ZKX17029)
南京市卫生科技发展重点项目(ZKX22042)
南京医科大学校基金(NMUB20210232)
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据