重度OSAS患者双侧额叶1H-MRS改变与抑郁症之间的相关性研究

目的探讨重度阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者双侧额叶1H-MRS变化及其与抑郁症之间的相关性。方法采用~1H-MRS成像技术检测56例重度OSAS患者(重度OSAS组)与56名健康对照者(健康对照组)的双侧额叶白质、双侧额叶扣带回N-乙酰天门冬氨酸(N-acetylaspartate,NAA)、胆碱复合物(Choline,Cho)、肌醇(myo-Inositol,mI)和肌酸(Creatine,Cr)的绝对值,并计算NAA/Cr、NAA/Cho、Cho/Cr、m I/Cr的比值。采用汉密顿抑郁量表(Hamilton Depression Scale,HAMD)分别对两组研究对象进行抑郁评分。分析OSAS组中具有统计学意义的1H-MRS参数与HAMD评分之间的相关性。结果重度OSAS组左侧额叶白质NAA/Cho(1.202±0.301)、NAA/Cr(1.727±0.450)及右侧额叶白质NAA/Cho(1.106±0.198)、NAA/Cr(1.652±0.451)均低于健康对照组,差异具有统计学意义(P0.05);双侧扣带回NAA/Cho分别为(1.163±0.216)、(1.149±0.238)均低于健康对照组,差异具有统计学意义(P0.05);双侧扣带回Cho/Cr(1.647±0.712,1.646±0.302)、mI/Cr(0.407±0.139、0.472±0.187)均高于健康对照组,差异具有统计学意义(P0.05)。重度OSAS组HAMD评分为(14.554±9.751)分,明显高于健康对照组,差异有统计学意义(P0.05)。双侧额叶白质及右侧扣带回NAA/Cho与HAMD评分呈负相关;双侧扣带回Cho/Cr、左侧扣带回m I/Cr与HAMD评分均呈正相关(P0.01)。结论重度OSAS患者双侧额叶存在异常代谢变化,代谢异常可能是抑郁症发生的病理生理基础。

Study on the correlation between 1 H-MRS changes of bilateral frontal lobe and depression in patients with severe OSAS

Objective To investigate the changes of 1 H-MRS in frontal lobe and its correlation with depression in patients with severe obstructive sleep apnea syndrome(OSAS).Methods 1 H-MRS imaging technology was used to detect N-acetyl-aspartate(NAA), choline(Cho), myoinositol(mI) and creatine(Cr) in the white matter of bilaterial frontal lobes and cingulate gyrus of bilateral frontal lobes in 56 patients with severe OSAS(severe OSAS group) and 56 healthy controls(healthy control group). The ratios of NAA/Cr, NAA/Cho, Cho/Cr and mI/Cr were calculated. The depression scores of the two groups of subjects were respectively evaluated by Hamilton Depression Scale (HAMD). The correlation between the statistically significant 1 H-MRS parameters and the HAMD scores in the OSAS group was analyzed. Results NAA/Cho (1.202±0.301) and NAA/Cr (1.727±0.450) of the white matter in the left frontal lobe and NAA/Cho (1.106±0.198) and NAA/Cr(1.652±0.451) of the white matter in the right frontal lobe in the severe OSAS group were all lower than those in the healthy control group, and the differences were statistically significant(P<0.05); The NAA/Cho of bilateral cingulate gyrus was (1.163±0.216) and (1.149±0.238) respectively, which were lower than those in the healthy control group. The difference was statistically significant(P<0.05);the ratios of Cho/Cr(1.647±0.712, 1.646±0.302) and mI/Cr (0.407±0.139,0.472±0.187) in bilateral cingulate gyrus were significantly higher than those in the healthy control group,and the differences were statistically significant(P<0.05). The HAMD score in the severe OSAS group was (14.554±9.751), which was significantly higher than that in the healthy control group,and the difference was statistically significant(P<0.05).NAA/Cho and HAMD score in the white matter of bilateral frontal lobes and right cingulate gyrus were negatively corre lated; the ratio of Cho/Cr in bilateral cingulate gyrus, mI/Cr in the left cingulate gyrus and HAMD scores were positively correlated(P<0.01).Conclusion There are abnormal metabolic changes in bilateral frontal lobes in the patients with severe OSAS. Abnormal metabolism may be the pathophysiological basis of depression.