Relationship between chronic stress and neuroimaging and prognosis in patients with depression
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摘要:
目的 探索慢性应激与抑郁症患者脑影像学改变及预后的关系。 方法 选取2019年2月~2021年2月120例抑郁症患者，采用生活事件量表（LES）评估患者慢性应激状态，根据评分结果分为慢性应激组（n=78）和非慢性应激组（n=42），另选取同期30例健康志愿者作为对照组。受试者均行头颅MRI扫描，采集得到的3DT1数据采用FreeSurfer自动化处理，计算并比较全脑脑区皮层厚度，并采用17项汉密尔顿抑郁量表（HAMD-17）评估抑郁症状，分别比较慢性应激组、非慢性应激组、对照组全脑皮层厚度及HAMD-17评分，并采用Pearson相关系数分析LES评分与全脑皮层厚度、HAMD-17评分的相关性；抑郁症患者出院后随访6~12月，比较慢性应激组、非慢性应激组抑郁症发作时间及6月内临床治愈率。 结果 对照组、非慢性应激组、慢性应激组左侧额叶三角部、双侧额上回、左侧额缘、双侧楔前叶、双侧颞中回、左侧顶下缘上回、左侧扣带回、右侧额叶岛盖部、右侧额下回及皮层平均厚度均呈下降趋势，组间差异均有统计学意义（P<0.05），未见皮层厚度增加脑区；对照组、非慢性应激组、慢性应激组HAMD-17评分呈升高趋势，组间差异均有统计学意义（P<0.05）；Pearson相关性分析显示，LES评分与大脑皮层平均厚度呈负相关关系（P<0.05），与HAMD-17评分呈正相关关系（P<0.05）；慢性应激组6月临床治愈低于非慢性应激组（P<0.05），抑郁发作时间长于非慢性应激组（P<0.05）。 结论 慢性应激可加剧抑郁症患者大脑皮层萎缩，且与患者病情程度及预后密切相关。 Abstract:Objective To explore the relationship between chronic stress and neuroimaging and prognosis in patients with depression. Methods A total of 120 patients with depression were selected from February 2019 to February 2021, chronic stress was assessed by life events scale (LES). They were classified into chronic stress group (n=78) and non-chronic stress group (n= 42) according to the score of LES. Thirty healthy volunteers were selected in control group. The subjects underwent cranial MRI scans, FreeSurfer automatic processing was used to calculate and compare the cortical thickness of the whole brain region. Depressive symptoms were assessed with the 17-item hamilton depression scale (HAMD-17). The total cortical thickness and HAMD-17 scores were compared among the three groups. Pearson correlation analysis was used to analyze the correlation between LES scores and the total cortical thickness, HAMD-17 scores. Patients with depression were followed up for 6-12 months after discharge. Time of depressive episode was counted, the depressive episode time and clinical cure rate within 6 months were compared between chronic stress group and non-chronic stress group. Results The thickness of left frontal triangle, bilateral superior frontal gyrus, left frontal margin, bilateral precuneus, bilateral middle temporal gyrus, left superior parietal margin gyrus, left cingulate margin cortex, right insular lid of frontal lobe and right inferior frontal gyrus in control group, non-chronic stress group, chronic stress group showed a decreasing trend, the difference between the groups was significant (P<0.05), no increase in cortical thickness was observed in brain regions. HAMD-17 scores in control group, non-chronic stress group, chronic stress group showed a decreasing trend (P<0.05). Pearson correlation analysis showed that LES scores was negatively correlated with the total cortical thickness (P<0.05), and positively correlated with HAMD-17 scores (P<0.05). The 6-month clinical cure of chronic stress group was lower than that of non-chronic stress group (P<0.05). Depressive episodes lasted longer than those in the non-chronic stress group (P<0.05). Conclusion Chronic stress exacerbates cortical atrophy in patients with depression. It is closely related to the degree of disease and prognosis of patients. -
Key words:
- depression /
- chronic stress /
- magnetic resonance imaging /
- cortical thickness /
- prognosis
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图 1 抑郁症患者影像学表现
A~B：患者女，31岁，确诊为抑郁症，有早期应激事件史，皮层平均厚度为2.05 mm；C~D：患者女，22岁，确诊为抑郁症，无早期应激事件史，皮层平均厚度为2.42 mm.
Figure 1. Imaging findings of patients with depression.
表 1 受试者一般资料比较
Table 1. Comparison of general data of subjects[n(%)]
指标 慢性应激组(n=78) 非慢性应激组(n=42) 对照组(n=30) χ2/Z/F P 性别 0.09 0.954 男 31(39.74) 16(38.10) 11(36.67) 女 47(60.26) 26(61.90) 19(63.33) 年龄（岁，Mean±SD) 39.36士8.52 38.42±7.21 38.79±6.24 0.212 0.809 文化程度 0.41 0.814 初中及以下 14(19.75) 8(19.05) 4(13.33) 高中/中专 38(48.72) 22(52.38) 16(53.33) 大专及以上 26(33.33) 12(28.57) 10(33.33) 
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表 2 三组大脑皮层厚度差异脑区比较
Table 2. Comparison of cerebral cortex thickness differences among the three groups (mm, Mean±SD)
指标 慢性应激组(n=78) 非慢性应激组(n=42) 对照组(n=30) F P 左侧额叶三角部 2.04±0.42ab 2.38±0.35a 2.63±0.29 29.618 <0.001 左侧额上回 2.11±0.3ab 2.44±0.23a 2.69±0.25 54.907 <0.001 左侧额缘 1.93±0.32ab 2.25±0.29a 2.52士0.23 47.293 <0.001 左侧楔前叶 2.09±0.35ab 2.35±0.30a 2.64士0.27 33.294 <0.001 左侧颞中回 2.35±0.24ab 2.56±0.28a 2.79±0.22 35.947 <0.001 左侧顶下叶缘上回 2.33±0.29 2.54±0.24 2.72±0.19 26.830 <0.001 左侧扣带回 1.97±0.14ab 2.16±0.25a 2.31±0.19 39.930 <0.001 右侧额叶岛盖部 2.35±0.29 2.60±0.22 2.73±0.14 30.606 <0.001 右侧额上回 2.43±0.29ab 2.66±0.17a 2.85±0.20 35.084 <0.001 右侧楔前叶 2.25±0.27ab 2.47±0.19a 2.65±0.14 36.695 <0.001 右侧颞中回 2.62±0.43 2.88±0.20 3.09±0.18 23.133 <0.001 右侧额下回 1.79±0.21ab 1.94±0.17a 2.17±0.15 44.782 <0.001 平均皮层厚度 1.96±0.34ab 2.27±0.24a 2.46±0.20 37.286 <0.001 aP<0.05 vs对照组；bP<0.05 vs非慢性应激组.
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表 3 慢性应激组与非慢性应激组患者预后比较
Table 3. Comparison of prognosis between chronic stress group and non-chronic stress group
预后指标 慢性应激组(n=78) 非慢性应激组(n=42) χ2/t P 6月临床治愈[n(%)] 38(48.72) 31(73.81) 7.033 0.008 抑郁发作时间（月, Mean±SD） 8.19±2.94 5.77±1.69 4.910 <0.001
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