三维动脉自旋标记技术评价抑郁合并高血压患者脑血流灌注

doi:10.19723/j.issn.1671-167X.2019.02.011

摘要/Abstract

摘要：

目的: 应用三维伪连续动脉自旋标记技术(3D pseudocontinuous arterial spin labeling,3D pcASL), 探讨抑郁合并高血压患者脑血流灌注特点,并分析其与抑郁程度的相关性。方法: 16例临床诊断为抑郁的患者为抑郁组(男3例、女13例,年龄42~72岁),16例高血压患者为高血压组(男3例、女13例,年龄41~68岁),16例抑郁合并高血压患者为共病组(男3例、女13例,年龄45~74岁),16例健康者为对照组(男3例、女13例,年龄43~68岁)。使用GE 3.0T磁共振扫描3D pcASL序列并自动生成脑血流图,使用统计参数图(statistical parametric mapping,SPM8)软件对脑血流图进行预处理、空间标准化和平滑。使用方差分析比较4组之间脑血流灌注差异,提取脑血流灌注减低区的平均脑血流值与17项汉密尔顿抑郁量表(Hamilton depression scale,HAMD-17)进行相关分析。结果: 与对照组比较,共病组可见多个脑区出现脑血流灌注减低,包括双侧额上回、双侧额中回、双侧额下回、右侧顶上回、右侧顶下回、右侧缘上回、左侧尾状核、左侧岛叶,差异有统计学意义。与对照组比较,抑郁组脑血流灌注在双侧额中回出现下降趋势,但差异无统计学意义;高血压组未出现脑血流灌注异常。与抑郁组比较,共病组在双侧额叶和右侧缘上回脑血流灌注减低;与高血压组比较,共病组在左侧额中回脑血流灌注减低。相关分析显示各灌注减低区平均脑血流值与HAMD-17量表评分未见明显相关。结论: 尽管抑郁患者、高血压患者未见脑部脑血流灌注减低,但共病患者存在多个脑区脑血流灌注减低,提示高血压可能对脑血流低灌注有协同促进作用。

关键词: 抑郁症, 高血压, 动脉自旋标记, 脑血流

Abstract:

Objective: To evaluate cerebral blood flow (CBF) in patients with comorbid hypertension in depression using 3D pseudocontinuous arterial spin labeling (3D pcASL) and to compare the dif-ferences of CBF values in depression, hypertension, and comorbid hypertension between depression and healthy control groups. To investigate the correlation between CBF values and degrees of depression.Methods: Sixteen patients with depression (depression group, 3 males and 13 females, age range of 42-72 years old), sixteen patients with hypertension (hypertension group, 3 males and 13 females, age range of 41-68 years old), sixteen patients with comorbid hypertension in depression (comorbidity group, 3 males and 13 females, age range of 45-74 years old), and sixteen healthy controls (control group, 3 males and 13 females, age range of 43-68 years old) were recruited. 3D pcASL sequence was performed by GE 3.0T magnetic resonance scanner and CBF map was generated automatically. Statistical parametric mapping (SPM8) was performed to preprocess the CBF map, which was spatially normalized and smoothed. Comparison of the CBF values among the four groups was conducted by ANOVA. Correlation between the average CBF values in areas of decreased CBF and Hamilton depression scale (HAMD-17) was investigated.Results: The patients with comorbid hypertension in depression demonstrated lower CBF in bilateral superior frontal gyri, middle frontal gyri, inferior frontal gyri, right superior parietal gyrus, right inferior parietal gyrus, right supramarginal gyrus, left caudate nucleus and left insula lobe in comparison with the controls. Compared with control group, CBF values decreased in bilateral frontal lobes, but did not reach statistical significance. There were no significant differences of CBF values between the patients with hypertension and control subjects. Compared with depression, the patients with comorbid hypertension in depression showed lower CBF values in bilateral frontal lobes and right supramarginal gyrus. Compared with hypertension, lower CBF values in left middle frontal gyrus in the patients with comorbid hypertension in depression were shown. Correlation analysis indicated that no correlation between CBF values and scores of HAMD-17 was shown.Conclusion: Although there were no significant decreases of CBF values in patients with depression and hypertension, regional hypoperfusions were observed in patients with comorbid hypertension in depression. Hypertension might play a sy-nergistic action on cerebral hypoperfusion in patients with comorbid hypertension in depression.

Key words: Depressive disorder, Hypertension, Arterial spin labeling, Cerebral blood flow

中图分类号:

R814.46

刘颖,曾祥柱,王筝,张函,王希林,袁慧书. 三维动脉自旋标记技术评价抑郁合并高血压患者脑血流灌注[J]. 北京大学学报（医学版）, 2019, 51(2): 260-264.

Ying LIU,Xiang-zhu ZENG,Zheng WANG,Han ZHANG,Xi-lin WANG,Hui-shu YUAN. Cerebral blood flow measurements in patients with comorbid hypertension and depression using 3D arterial spin labeling[J]. Journal of Peking University(Health Sciences), 2019, 51(2): 260-264.

图/表 3

图1

表1

图2

参考文献 17

[1]	Nezamzadeh M, Matson GB, Young K , et al. Improved pseudo-continuous arterial spin labeling for mapping brain perfusion[J]. J Magn Reson Imaging, 2010,31(6):1419-1427. doi: 10.1002/jmri.22199
[2]	Shin DD, Liu TT, Wong EC , et al. Pseudocontinuous arterial spin labeling with optimized tagging efficiency[J]. Magn Reson Med, 2012,68(4):1135-1144. doi: 10.1002/mrm.v68.4
[3]	Chen Y, Wang DJ, Detre JA . Test-retest reliability of arterial spin labeling with common labeling strategies[J]. J Magn Reson Imaging, 2011,33(4):940-949. doi: 10.1002/jmri.v33.4
[4]	Gevers S, van Osch MJ, Bokkers RP , et al. Intra- and multicenter reproducibility of pulsed, continuous and pseudo-continuous arterial spin labeling methods for measuring cerebral perfusion[J]. J Cereb Blood Flow Metab, 2011,31(8):1706-1715. doi: 10.1038/jcbfm.2011.10
[5]	Arnone D, Mclntosh AM, Ebmeier KP , et al. Magnetic resonance imaging studies in unipolar depression: systematic review and meta-regression analyses[J]. Eur Neuropsychopharmacol, 2012,22(1):1-16. doi: 10.1016/j.euroneuro.2011.05.003
[6]	Bora E, Harrison BJ, Davey CG , et al. Meta-analysis of volumetric abnormalities in cortico-striatal-pallidal-thalamic circuits in major depressive disorder[J]. Psychol Med, 2012,42(4):671-681. doi: 10.1017/S0033291711001668
[7]	Colloby SJ, Firbank MJ, He J , et al. Regional cerebral blood flow in late-life depression: Arterial spin labelling magnetic resonance study[J]. Br J Psychiatry, 2012,200(2):150-155. doi: 10.1192/bjp.bp.111.092387
[8]	Ota M, Noda T, Sato N , et al. Characteristic distributions of regional cerebral blood flow changes in major depressive disorder patients: A pseudo-continuous arterial spin labeling (pCASL) study[J]. J Affect Disord, 2014,165:59-63. doi: 10.1016/j.jad.2014.04.032
[9]	Naismith SL, Norrie LM, Mowszowski L , et al. The neurobiology of depression in later-life: Clinical, neuropsychological, neuro-imaging and pathophysiological features[J]. Prog Neurobiol, 2012,98(1):99-143. doi: 10.1016/j.pneurobio.2012.05.009
[10]	Detre JA, Wang J, Wang Z , et al. Arterial spin-labeled perfusion MRI in basic and clinical neuroscience[J]. Curr Opin Neurol, 2009,22(4):348-355. doi: 10.1097/WCO.0b013e32832d9505
[11]	Järnum H, Eskildsen SF, Steffensen EG , et al. Longitudinal MRI study of cortical thickness, perfusion, and metabolite levels in major depressive disorder[J]. Acta Psychiatr Scand, 2011,124(6):435-446. doi: 10.1111/acps.2011.124.issue-6
[12]	Ho TC, Wu J, Shin DD , et al. Altered cerebral perfusion in exe-cutive, affective, and motor networks during adolescent depression[J]. J Am Acad Child Adolesc Psychiatry, 2013,52(10):1076-1091. doi: 10.1016/j.jaac.2013.07.008
[13]	Lui S, Parkes LM, Huang X , et al. Depressive disorders: focally altered cerebral perfusion measured with arterial spin-labeling MR imaging[J]. Radiology, 2009,251(2):476-484. doi: 10.1148/radiol.2512081548
[14]	Duhameau B, Ferré JC, Jannin P , et al. Chronic and treatment-resistant depression: a study using arterial spin labeling perfusion MRI at 3 Tesla[J]. Psychiatry Res, 2010,182(2):111-116. doi: 10.1016/j.pscychresns.2010.01.009
[15]	Walther S, Höfle O, Federspiel A , et al. Neural correlates of disbalanced motor control in major depression[J]. J Affect Disord, 2012,136(1/2):124-133. doi: 10.1016/j.jad.2011.08.020
[16]	吕粟, 黄晓琦, 孙学礼 , 等. 抑郁症患者脑MR血流灌注的图像特征[J]. 中华放射学杂志, 2009,43(3):244-248.
[17]	Alosco ML, Gunstad J, Xu X , et al. The impact of hypertension on cerebral perfusion and cortical thickness in older adults[J]. J Am Soc Hypertens, 2014,8(8):561-570. doi: 10.1016/j.jash.2014.04.002

相关文章 15

[1]	郑鸿尘,薛恩慈,王雪珩,陈曦,王斯悦,黄辉,江锦,叶莺,黄春兰,周筠,高文静,余灿清,吕筠,吴小玲,黄小明,曹卫华,严延生,吴涛,李立明. 基于大家系设计的静息心率与常见慢性病双表型遗传度估计[J]. 北京大学学报（医学版）, 2020, 52(3): 432-437.
[2]	杨航,杨林承,张瑞涛,凌云鹏,葛庆岗. 合并高血压、冠心病、糖尿病的新型冠状病毒肺炎患者发生病死的危险因素分析[J]. 北京大学学报（医学版）, 2020, 52(3): 420-424.
[3]	孟文颖,黄琬桐,张杰,焦明远,金蕾,靳蕾. 孕早期血清维生素E水平与妊娠期高血压疾病发病风险的关系[J]. 北京大学学报（医学版）, 2020, 52(3): 470-478.
[4]	李凡,王汉斌,彭清,孙云闯,张冉,庞博,方竞,张珏,黄一宁. 非线性动力学方法可预警直立倾斜试验中血管迷走性晕厥的发生[J]. 北京大学学报（医学版）, 2019, 51(3): 430-438.
[5]	刘雪芹, 闫辉, 邱建星, 张春雨, 齐建光, 张欣, 肖慧捷, 杨艳玲, 陈永红, 杜军保. 甲基丙二酸尿症相关肺高血压临床特点与基因突变[J]. 北京大学学报(医学版), 2017, 49(5): 768-777.
[6]	章湖洋，简伟研，方海. 新型农村合作医疗的高血压患者门诊费用对住院费用的替代效应[J]. 北京大学学报(医学版), 2016, 48(3): 472-477.
[7]	余灿清，陈怡平，吕筠，郭彧，Paul Sherliker，卞铮，周汇燕，谭云龙，陈君石，陈铮鸣，李立明. 中国30~79岁成人抑郁障碍与冠心病和脑卒中的关联[J]. 北京大学学报(医学版), 2016, 48(3): 465-471.
[8]	单娇，李宏宇，刘国峰，杨玄，董伟，简伟研，邓芙蓉，郭新彪. 大气污染对中老年高血压和心脑血管疾病患者卫生服务需求的影响：基于 CHARLS数据的分析[J]. 北京大学学报(医学版), 2016, 48(3): 460-464.
[9]	杨莹超，刘国莉，周敬伟，胡浩，沈丹华. 妊娠合并嗜铬细胞瘤1例[J]. 北京大学学报(医学版), 2016, 48(2): 370-372.
[10]	陈红涛，王文英，王津，梁亚平，王小婷，侯光敏，姬爱平. 不同高血压分级患者急性牙髓炎开髓治疗的风险评估[J]. 北京大学学报(医学版), 2016, 48(1): 89-93.
[11]	吴海燕, 梁耀先, 郑亦沐, 白琼, 庄震, 阿拉塔, 郑丹侠, 王悦. 高盐饮食上调肾局部肾素-血管紧张素系统参与大鼠高血压肾损害的发生[J]. 北京大学学报（医学版）, 2015, 47(1): 149-154.
[12]	王伟民. 肾交感神经消融治疗难治性高血压[J]. 北京大学学报（医学版）, 2014, 46(6): 836-837.
[13]	王方芳, 徐伟仙, 陈宝霞, 冯新恒, 李昭屏, 高炜. 心肌作功指数评价高血压患者左心室整体功能[J]. 北京大学学报（医学版）, 2014, 46(6): 863-867.
[14]	许文敏, 张新霞, 伍贵富. 深圳市福田区22家社区健康服务中心高血压患者现状分析[J]. 北京大学学报（医学版）, 2014, 46(6): 859-862.
[15]	杨颖, 张宝娓△, 齐丽彤, 马为, 孟磊, 霍勇. 斑点追踪技术评价高血压患者左心房时相功能变化[J]. 北京大学学报（医学版）, 2014, 46(4): 596-600.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Cerebral areas	CBF values/[mL/(100 g·min)]
Cerebral areas	Comorbidity group	Control group	P value	X	Y	Z	F value
Left superior frontal gyrus	46.7±5.7	56.1±11.0	0.004	-30	57	24	19.14
Right superior frontal gyrus	40.4±5.6	50.2±10.3	0.001	33	6	63	22.09
Left middle frontal gyrus	46.3±7.2	55.5±12.0	0.006	-33	54	24	29.89
Right middle frontal gyrus	43.9±6.1	55.4±11.3	0.001	36	3	63	21.69
Left inferior frontal gyrus	47.7±5.7	57.5±9.6	0.001	-48	27	30	23.45
Right inferior frontal gyrus	48.8±5.6	59.2±10.1	0.001	54	15	33	21.99
Right superior parietal gyrus	32.5±4.4	43.7±12.7	0.001	21	-72	54	16.12
Right inferior parietal gyrus	42.6±6.6	53.9±12.7	0.002	54	-30	54	15.59
Right supramarginal gyrus	47.3±5.6	56.8±9.8	0.002	63	-21	45	15.64
Left caudate nucleus	39.1±4.3	46.8±7.4	0.002	-3	9	3	17.47
Left insular lobe	49.3±5.9	62.3±8.7	<0.001	-36	12	6	20.72