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目的:应用磁共振波谱(MRS)技术探讨脑卒中后不同时段发生脑卒中后抑郁(PSD)脑N-天冬氨酸盐/肌苷(NAA/Cr)和胆碱/肌酐(Cho/Cr)的代谢改变。方法:急性脑卒中住院病例223例,脑卒中后72h予汉密顿抑郁量表(24项版)评分,≥8分者(PSD患者)根据病例编号,采用随机数字表法分为干预组(第1组)和对照组(第2组);<8分者1个月时再次评分,≥8分者再分为干预组(第3组)和对照组(第4组);<8分者2个月时再评分,≥8分者再分为干预组(第5组)和对照组(第6组);<8分者3个月再评分,≥8分组(第7组)、<8分组(第8组)。干预组(1、3、5、7组)给予帕罗西汀20mg·d-1治疗。分别在72h、3个月对PSD患者行MRS(双侧颞叶海马、丘脑)检测。结果:①在NAA/Cr比值中:72h和3个月时,第4、6组颞叶海马、丘脑ROINAA/Cr比值低于第2组(P<0.05);而与第7组相比,P<0.01;第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;各组患者各ROINAA/Cr比值72h与3个月比较,均差异无统计学意义。Cho/Cr比值中:第4、6组海马和丘脑ROICho/Cr比值高于第2、7组,且以海马更为显著(P<0.01);而第4组与第6组比较和第7组与第2组比较,均差异无统计学意义;第4、6组右侧丘脑ROICho/Cr比值3个月较72h时增高。②3个月时第4、6组右颞叶ROICho/Cr高于第5组(P<0.05)。③第7组72h、3个月时右海马ROICho/Cr比值高于第8组(P<0.05)。结论:MRS在PSD早期诊断中价值有限,但对病程1和2个月时PSD的发生有较为肯定的预示意义;针对该人群进行早期干预对改善脑代谢具有积极意义。
Objective: To investigate the effects of cerebral hemorrhage (PSD) on cerebral natriuretic peptide (NAA / Cr) and choline / creatinine (Cho / Cr) after stroke at different time points by using magnetic resonance spectroscopy (MRS) Metabolic changes. Methods: A total of 223 hospitalized cases of acute stroke and 72 hours after stroke were divided into two groups: the Hamilton Depression Rating Scale (24 items) and the patients with ≥8 points (PSD) according to the case number, (Group 1) and control group (group 2); those with score <8 were re-rated at 1 month and were divided into intervention group (group 3) and control group (group 4) Who were scored again at 2 months and were further divided into intervention group (group 5) and control group (group 6) <8 group (group 8). Intervention group (1,3,5,7 group) was given paroxetine 20mg · d-1 treatment. MRS (bilateral temporal lobe hippocampus, thalamus) were detected in PSD patients at 72 h and 3 months respectively. Results: ① In the NAA / Cr ratio, ROINAA / Cr ratio in hippocampus and thalamus of the 4th and 6th groups was lower than that of the 2nd group at 72h and 3 months (P <0.05) P <0.01. There was no significant difference between group 4 and group 6 and between group 7 and group 2. There was no significant difference in each ROINAA / Cr ratio between 72h and 3 months . In the Cho / Cr ratio, the ratio of ROICho / Cr in hippocampus and hippocampus in groups 4 and 6 was higher than that in groups 2 and 7, and more significantly in hippocampus (P <0.01). However, in group 4 and group 6, There was no significant difference between group 2 and group 2; the right thalamus ROICho / Cr ratio in groups 4 and 6 increased at 3 months compared with 72 hours. At 3 months, ROICho / Cr in the right temporal lobe of the 4th and 6th groups was higher than that of the fifth group (P <0.05). ③ In group 7, the ratio of ROICho / Cr in right hippocampus was higher than that in group 8 at 72h and 3 months (P <0.05). CONCLUSIONS: MRS is of limited value in the early diagnosis of PSD, but it has certain predictive significance for the occurrence of PSD at 1 and 2 months of disease duration. Early intervention in this population is of positive significance for improving cerebral metabolism.