摘要：

目的: 探讨帕金森病伴抑郁患者脑功能连接（FC）与丘脑底核脑深部电刺激术（STN-DBS）后抑郁改善率的相关性。方法: 纳入2019年9月至2020年4月在中国科学技术大学附属第一医院行STN-DBS的38例帕金森病患者（包括帕金森病伴抑郁25例和帕金森病不伴抑郁13例）以及性别、年龄相匹配的32例健康志愿者，均进行静息态fMRI检查，术前和术后2年采用汉密尔顿抑郁量表 17项（HAMD-17）评估抑郁程度，计算抑郁改善率。Spearman秩相关分析探讨帕金森病伴抑郁患者功能连接与抑郁改善率的相关性。结果: 帕金森病伴和不伴抑郁患者与正常对照者存在34个差异功能连接（均P=0.000）。帕金森病伴抑郁与不伴抑郁患者存在4个差异功能连接，分别为左侧枕下回-右侧辅助运动区（t=6.028，P=0.000）、右侧岛叶-右侧外眶回（t=5.525，P=0.000）、左侧旁中央小叶-左侧枕下回（t=5.545，P=0.000）、右侧旁中央小叶-左侧枕下回（t=5.578，P=0.000）。Spearman秩相关分析结果显示，帕金森病伴抑郁患者右侧枕上回-右侧岛叶zFC值（r_s=-0.544，P=0.009）和左侧颞下回-左侧岛叶zFC值（r_s=-0.765，P=0.010）与抑郁改善率呈负相关关系。结论: 帕金森病伴抑郁患者右侧枕上回-右侧岛叶和左侧颞下回-左侧岛叶的功能连接与抑郁改善率呈负相关关系。

关键词: 帕金森病, 深部脑刺激法, 丘脑底核, 抑郁, 磁共振成像

Abstract:

Objective: To explore the correlation between functional connectivity (FC) in the brains of Parkinson's disease (PD) patients with depression and the improvement rate of depression after subthalamic nucleus deep brain stimulation (STN-DBS). Methods: This study included 38 PD patients (25 with depression and 13 without depression) who underwent STN-DBS at The First Affiliated Hospital of University of Science and Technology of China from September 2019 to April 2020. All participants underwent resting-state fMRI. The severity of depression was assessed using Hamilton Depression Rating Scale-17 Items (HAMD-17) before and 2 years after the surgery, and the improvement rate of depression was calculated. Spearman rank correlation analysis was used to investigate the relationship between FC and the improvement rate of depression in PD patients with depression. Results: There were 34 different FC between PD patients with and without depression compared to control group (P = 0.000, for all). Among patients with PD, those with depression showed 4 distinct FC compared to those without depression, including left precuneus-right supplementary motor area (t = 6.028, P = 0.000), right insula-right lateral orbital gyrus (t = 5.525, P = 0.000), left paracentral lobule-left precuneus (t = 5.545, P = 0.000), and right paracentral lobule-left precuneus (t = 5.578, P = 0.000). Spearman rank correlation analysis revealed a negative correlation between the zFC values of right precuneus-right insula (r_s = -0.544, P = 0.009) and left temporal pole-left insula (r_s = -0.765, P = 0.010) and the improvement rate of depression in PD patients with depression. Conclusions: The FC of right precuneus-right insula and left temporal pole-left insula in PD patients with depression is negatively associated with the improvement rate of depression.

Key words: Parkinson disease, Deep brain stimulation, Subthalamic nucleus, Depression, Magnetic resonance imaging