血流重建术对成人烟雾病患者抑郁焦虑状态的影响

目的 探讨血流重建术对成人烟雾病患者抑郁、焦虑状态和脑灌注的影响,并分析抑郁、焦虑状态改变与脑灌注变化的相关性.方法 连续纳入2015年1月至2016年6月我院收治的成人烟雾病患者64例,其中手术治疗42例(联合血流重建组16例、间接血流重建组26例),保守治疗22例(保守治疗组).在入院时、治疗6个月(±1个月)和治疗12个月(±1个月)时,分别采用患者健康问卷抑郁自评量表(PHQ-9)和广泛性焦虑障碍量表(GAD-7)评估抑郁、焦虑状态,入院和6个月(±1个月)时采用头颅计算机断层扫描灌注成像(CTP)评估脑灌注.采用方差分析和最小显著差异法比较各组患者焦虑、抑郁症状改善情况和脑灌注变化,采用Pearson相关性分析探究情绪改善程度和脑灌注变化改善程度的相关性.结果 3组患者性别、年龄、受教育年限、入院时美国国立卫生研究院中风量表(NIHSS)评分、脑白质病变Fazekas评分和卒中史差异均无统计学意义(P均>0.05).联合血流重建组和间接血流重建组术后6个月PHQ-9评分和GAD-7评分均较入院时降低(P均<0.05),术后12个月PHQ-9和GAD-7评分较术后6个月相比差异均无统计学意义(P均>0.05).联合血流重建组和间接血流重建组术后6个月时PHQ-9和GAD-7评分的改善程度差异均无统计学意义(P>0.05).保守治疗组患者术后6、12个月PHQ-9和GAD-7评分与入院时相比差异均无统计学意义(P均>0.05).术后6个月联合血流重建组和间接血流重建组脑灌注达峰时间(TTP)均较入院时下降(P=0.04、0.04),脑血流量(CBF)均较入院时提高(P=0.02、0.04).术后6个月时手术治疗患者PHQ-9评分的改善程度与TTP的改善程度呈正相关(r=0.62,P<0.01).结论 血流重建术可改善成人烟雾病患者的抑郁、焦虑情绪,且间接血流重建术和联合血流重建术效果相当.手术可能通过改善烟雾病患者的脑灌注来改善患者的抑郁、焦虑状态.

Effect of revascularization on depression and anxiety of adult patients with moyamoya disease

Objective To investigate the effect of revascularization on depression, anxiety and cerebral perfusion in adult patients with moyamoya disease, and analyze the correlation between depression, anxiety and cerebral perfusion. Methods Sixty-four consecutive adult patients with moyamoya disease admitted to our hospital from Jan. 2015 to Jun. 2016 were enrolled, including 42 cases receiving surgical treatment (16 cases in combined revascularization group and 26 cases in indirect revascularization group) and 22 cases receiving conservative treatment (conservation treatment group). Depression and anxiety were assessed by patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7-item (GAD-7) at admission, 6 months (±1 month) and 12 months (±1 month) after treatment. Cerebral perfusion was assessed by head computed tomography perfusion (CTP) at admission and 6 months (±1 month) after treatment. Analysis of variance and the least significant difference method were used to analyze the improvement of depression and anxiety and the changes of cerebral perfusion in each group. Pearson correlation analysis was used to analyze the correlation between the improvement of emotion and cerebral perfusion. Results There were no significant differences in gender, age, years of education, National Institutes of Health stroke scale (NIHSS) score, Fazekas score or stroke history at admission among the 3 groups (all P>0.05). Six months after surgery, the PHQ-9 and GAD-7 scores were decreased compared with those at admission in both combined and indirect revascularization groups (all P<0.05), while there were no significant differences in PHQ-9 or GAD-7 score between 12 months and 6 months after surgery in both groups (P>0.05). There was no significant difference in the improvement degrees of PHQ-9 and GAD-7 scores between the combined and indirect revascularization groups 6 months after surgery (P>0.05). The PHQ-9 and GAD-7 scores 6 and 12 months after surgery were similar with those at admission in the conservation treatment group (all P>0.05). Six months after surgery, the time to peak (TTP) was significantly decreased compared with those at admission in the combined and indirect revascularization groups (P=0.04 and 0.04), while the cerebral blood flow (CBF) was significantly increased (P=0.02 and 0.04). The improvement of PHQ-9 score was positively correlated with the improvement of TTP 6 months after surgery (r=0.62, P<0.01). Conclusion Revascularization can improve the depression and anxiety of adult patients with moyamoya disease. The effect of indirect revascularization and combined revascularization is similar. The surgery may improve the depression and anxiety by improving cerebral perfusion.