帕金森病伴抑郁患者静息态下脑活动的局部一致性改变

Objective To explore the changes of regional homogeneity (ReHo) in the brains of patients with Parkinson's disease (PD) accompanied by depression and its relationship with depression using resting-state functional magnetic resonance imaging (fMRI). Methods The resting-state fMRI data of 62 PD patients (42 without depression and 20 with depression) who visited the outpatient clinic of Nanjing Medical University Affiliated Brain Hospital from June to October 2017, 20 patients with depression, and 47 healthy controls were collected. A 2×2 analysis of covariance was performed to compare the differences in ReHo among the four groups, and the ReHo values of the brain regions with inter-group differences were correlated with the Hamilton Depression Scale (HAMD), the Unified Parkinson's Disease Rating Scale Part III (UPDRS - Ⅲ) scores, and Hoehn - Yahr staging. Results Under the main effect of PD, the brain regions with increased ReHo in the PD group were mainly located in the left ventrolateral prefrontal cortex and the right precuneus, and the brain regions with decreased ReHo were mainly located in the bilateral supplementary motor areas and the left angular gyrus. Under the main effect of depression, ReHo in the depression group was increased in the bilateral cerebellum, while decreased in the bilateral precentral gyrus, postcentral gyrus, left inferior frontal gyrus, left posterior cingulate gyrus, left supplementary motor area, right dorsolateral prefrontal cortex, right inferior parietal lobe, and right calcarine fissure. The brain regions with an interaction between PD and depression included the bilateral middle frontal gyrus, left inferior frontal gyrus, and right supramarginal gyrus. Under the main effect of depression, there were significant negative correlations between the ReHo values in the right dorsolateral prefrontal cortex (r = -0.526, P < 0.01) and inferior parietal lobe (r = -0.456, P < 0.01) and the HAMD scores. Conclusion There are abnormal brain functions in patients with PD accompanied by depression at rest, and the occurrence of depression in PD patients is not a superposition of PD and depression.

目的 运用静息态功能磁共振探讨帕金森病伴抑郁患者脑局部一致性（ＲｅＨｏ）的变化及其与抑郁之间的关系。方法 收集２０１７ 年６ 月至１０ 月于南京医科大学附属脑科医院门诊就诊的６２ 例帕金森病患者（不伴抑郁组４２ 例、伴抑郁组２０ 例）、２０ 例抑郁症患者及４７ 名健康对照的静息态功能磁共振成像数据，进行２ ×２ 的协方差分析，比较４ 组间的ＲｅＨｏ 差异，并将存在组间差异的脑区的ＲｅＨｏ 值与汉密尔顿抑郁量表（ＨＡＭＤ）、统一帕金森病评定量表第三部分（ＵＰＤＲＳ－Ⅲ）评分以及Ｈｏｅｈｎ－Ｙａｈｒ 分期进行相关分析。结果 帕金森病主效应作用下，帕金森病组ＲｅＨｏ 增高的脑区主要位于左侧腹外侧前额叶和右侧楔前叶，降低的脑区主要位于两侧辅助运动区、左侧角回。抑郁主效应作用下，抑郁组ＲｅＨｏ 在两侧小脑增高，而在两侧中央前回、中央后回、左侧额下回、左侧后扣带回、左侧辅助运动区、右侧背外侧前额叶、右侧顶下叶、右侧距状裂降低。帕金森病与抑郁交互作用的脑区包括双侧额中回、左侧额下回及右侧缘上回。抑郁主效应下差异脑区右侧背外侧前额叶（r ＝.－０．５２６，P ＜０．０１）、顶下叶（r ＝－０．４５６，P ＜０．０１） ＲｅＨｏ 值与ＨＡＭＤ 评分均存在明显的负相关。结论 伴抑郁的帕金森病患者静息状态下存在脑功能异常，且帕金森病患者出现抑郁并不是帕金森病及抑郁症两者的叠加。.