摘要
目的 探讨磁共振(MRI)影像学及认知功能等指标对双相情感障碍的诊断预测效果.方法 选取2020年1月—2023年1月在佛山市第三人民医院住院或门诊治疗的65例双相情感障碍患者作为观察组,另以临床招募志愿者方式选取36例健康者作为对照组.两组均行磁共振(MRI)脑功能成像检查,观察并比较两组脑区不同部位低频振荡振幅(amplitude of low-frequency fluctuations,ALFF)值和局部一致性(regional homogeneity,ReHo)值.观察并比较两组重复性成套神经心理状态测验量表(repeatable battery for the assessment of neuropsychological status,RBANS)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、倍克-拉范森躁狂评定量表(Bech-rafaelsen mania rating scale,BRMS)、社会功能缺陷量表(social disability screening schedule,SDSS)评分.采用logistic回归分析各指标与双相情感障碍发生的相关性.采用受试者工作曲线(receiver operating characteristic curve,ROC)计算曲线下面积(area under the cure,AUC)判断各指标对双相情感障碍发生的预测价值.结果 观察组RBANS评分低于对照组,HAMA、HAMD、BRMS及SDSS评分高于对照组,差异有统计学意义(P＜0.05).观察组内侧额上回(右)和丘脑(左)ALFF值高于对照组,内侧额上回(右)、丘脑(左)及颞上回(右)ReHo值高于对照组,海马旁回(右)、舌回(右)、颞中回(右)ALFF值低于对照组,眼眶额上回(右)及后扣带回(右)ReHo值低于对照组,差异有统计学意义(P＜0.05).logistic结果显示,海马旁回(右)ALFF值低、丘脑(左)ALFF值高、眼眶额上回(右)ReHo值低、内侧额上回(右)ReHo值高及后扣带回(右)ReHo值低与双相情感障碍的发生有关.ROC曲线下AUC面积显示,海马旁回(右)ALFF值、丘脑(左)ALFF值、眼眶额上回(右)ReHo值、内侧额上回(右)ReHo值及后扣带回(右)ReHo值,均对预测双相情感障碍的发生有较高的敏感度及特异度,且各指标联合预测的AUC值为0.860、敏感度为0.738、特异度为0.833.结论 双相情感障碍患者除具有明显的焦虑和抑郁及躁狂表现外,还存在认知功能和社会功能受损,且患者脑区存在部分异常激活,其中海马旁回(右)ALFF值、丘脑(左)ALFF值、眼眶额上回(右)ReHo值、内侧额上回(右)ReHo值及后扣带回(右)ReHo值可用于辅助预测是否发生双相情感障碍.
Abstract
Objective To exploring the diagnostic and predictive effects of magnetic resonance imaging(MRI)imaging and cognitive function indicators in bipolar disorder.Methods A total of 65 patients with bipolar disorder who were hospitalized or outpatient treated at the Third People's Hospital of Foshan from January 2020 to January 2023 were selected as the observation group,and 36 healthy individuals were selected as the control group through clinical volunteer recruitment.Both groups underwent MRI brain functional imaging to observe and compare the amplitude of low-frequency fluctuations(ALFF)and regional homogeneity(ReHo)values in different brain regions.Observe and compare the scores of the repeatable battery for the assessment of neuropsychological status(RBANS),the Hamilton anxiety scale(HAMA),the Hamilton depression scale(HAMD),the Bech-rafaelsen mania rating scale(BRMS)and the social disability screening schedule(SDSS)between two groups.Use logistic regression to analyze the correlation between various indicators and the occurrence of bipolar disorder.The area under the receiver operating characteristic curve(AUROC)was used to assess the predictive value of each indicator for the occurrence of bipolar disorder.Results The RBANS score of the observation group was significantly lower than that of the control group,while the HAMA,HAMD,BRMS,and SDSS scores were all significantly higher than those of the control group(P<0.05).The ALFF values in the medial superior frontal gyrus(right)and thalamus(left)of the observation group were significantly higher than those in the control group,the ReHo values in the medial superior frontal gyrus(right),thalamus(left),and superior temporal gyrus(right)were significantly higher than those in the control group,the ALFF values in the parahippocampal gyrus(right),lingual gyrus(right),and middle temporal gyrus(right)were significantly lower than those in the control group,the ReHo values in the orbital superior frontal gyrus(right)and posterior cingulate gyrus(right)were significantly lower than those in the control group(P<0.05).The logistic regression results showed that low ALFF values in the parahippocampal gyrus(right),high ALFF values in the thalamus(left),low ReHo values in the orbitofrontal gyrus(right),high ReHo values in the medial superior frontal gyrus(right),and low ReHo values in the posterior cingulate gyrus(right)are associated with the occurrence of bipolar disorder.The AUROC shows that the parahippocampal gyrus(right)ALFF value,thalamic gyrus(left)ALFF value,orbitofrontal gyrus(right)ReHo value,medial superior frontal gyrus(right)ReHo value,and posterior cingulate gyrus(right)ReHo value all have high sensitivity and specificity in predicting the occurrence of bipolar disorder,and the combined prediction of all indicators has an AUC value of 0.860,a sensitivity of 0.738,and a specificity of 0.833.Conclusion In addition to obvious symptoms of anxiety,depression,and mania,patients with bipolar disorder also have impaired cognitive and social functions,and there is partial abnormal activation in their brain regions.Among them,the parahippocampal gyrus(right)ALFF value,thalamic(left)ALFF value,orbitofrontal gyrus(right)ReHo value,medial superior frontal gyrus(right)ReHo value,and posterior cingulate gyrus(right)ReHo value can be used to assist in predicting the occurrence of bipolar disorder.
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