自主神经功能对卒中后抑郁患者运动功能的影响

doi:10.3969/j.issn.1006-9771.2024.02.013

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (2): 223-231.doi: 10.3969/j.issn.1006-9771.2024.02.013

自主神经功能对卒中后抑郁患者运动功能的影响

张明兰^1a, 张玲玲^1b, 王丽莎^1a, 刘莉^1b, 高润^1b, 饶江^1b, 刘婉^1b, 夏子安^1b, 张传文^1b, 程欣欣^1b()

1.南京医科大学附属脑科医院，a. 物理诊断科心电图室；b. 康复医学科，江苏南京市 210029

收稿日期:2023-04-17 修回日期:2023-12-12 出版日期:2024-02-25 发布日期:2024-03-01
通讯作者: 程欣欣 E-mail:417735101@qq.com
作者简介:张明兰(1985-)，女，汉族，江苏南京市人，硕士，主管技师，主要研究方向：心脏电生理。
基金资助:
1.江苏省卫健委重点项目(ZD2022030);2.江苏省哲学社会科学项目(21TYB013);3.南京市医学科技发展重点项目(ZKX17029);4.南京市卫生科技发展重点项目(ZKX22042);5.南京医科大学校基金项目(NMUB20210232)

Impact of autonomic nerve function on motor function in patients with post-stroke depression

ZHANG Minglan^1a, ZHANG Lingling^1b, WANG Lisha^1a, LIU Li^1b, GAO Run^1b, RAO Jiang^1b, LIU Wan^1b, XIA Zi'an^1b, ZHANG Chuanwen^1b, CHENG Xinxin^1b()

1a. Department of Electrocardiogram Room; b. Department of Rehabilitation Medicine, the Affiliated Brain Hospital of Nanjing Medical University, NanJing, Jiangsu 210029, China

Received:2023-04-17 Revised:2023-12-12 Published:2024-02-25 Online:2024-03-01
Contact: CHENG Xinxin E-mail:417735101@qq.com
Supported by:
Jiangsu Health Commission Key Project(ZD2022030);Jiangsu Philosophy and Social Science Project(21TYB013);Nanjing Medical Science and Technology Development Key Project(ZKX17029);Nanjing Health Science and Technology Development Key Project(ZKX22042);Nanjing Medical University Science and Technology Development Fund(NMUB20210232)

摘要/Abstract

摘要：

目的从脑局部一致性(ReHo)的角度探讨自主神经功能对卒中后抑郁(PSD)患者运动功能的影响。
方法 2020年1月至12月，选取南京医科大学附属脑科医院住院和门诊脑梗死患者60例，分为对照组(n = 30)和PSD组(n = 30)，采用Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)和汉密尔顿抑郁量表(HAMD)进行评定，并观测心率变异性(HRV)。两组各随机选取10例行静息态磁共振(rs-fMRI)扫描，计算ReHo。
结果 PSD组HRV各指标均低于对照组(|t| > 2.092, P < 0.05)。PSD组FMA和MBI评分与24 h正常R-R间期标准差(SDNN)、24 h相邻R-R间期差值的均方根值(RMSSD)、24 h相邻正常R-R间期差值> 50 ms的心搏数占心搏数的百分比(PNN50)、总功率(TP)、极低频功率(VLF)、低频功率(LF)呈正相关(r > 0.394, P < 0.05)，与HAMD呈负相关(|r| > 0.919, P < 0.001)。PSD组HAMD与SDNN、RMSSD、PNN50、TP、VLF呈负相关(|r| > 0.769, P < 0.001)。与对照组相比，PSD组的右侧直回(142体素，t = 6.575)、左侧内侧和旁扣带脑回(204体素，t = 4.925)的ReHo增加(GRF校正，P_-Voxel < 0.005，P_-Cluster < 0.05);右侧小脑(191体素, t = -6.487)、左侧颞中回(140体素，t = -5.516)以及左侧中央前回(119体素，t = -4.764) ReHo降低(GRF 校正，P_-Voxel < 0.005，P_-Cluster < 0.05)。
结论 PSD患者自主神经功能与运动功能障碍相关，自主神经对情绪、认知和运动脑区的调节可能是影响PSD患者运动功能的机制。

关键词: 卒中后抑郁, 心率变异性, 自主神经, 功能磁共振, 局部一致性

Abstract:

Objective To explore the impact of autonomic nerve function on motor function in patients with post-stroke depression (PSD) from the perspective of regional homogeneity (ReHo).
Methods From January to December, 2020, a total of 60 inpatients and outpatients with cerebral infarction in the Affiliated Brain Hospital of Nanjing Medical University were divided into control group (n = 30) and PSD group (n = 30). Two groups were assessed using Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI) and Hamilton Depression Scale (HAMD). Heart rate variability (HRV) was measured. Ten patients in each group were selected randomly to undergo resting state functional magnetic resonance imaging (rs-fMRI) to calculate ReHo.
Results All HRV indices were lower in PSD group than in the control group (|t| > 2.092, P < 0.05). In PSD group, FMA and MBI scores showed positive correlations with 24-hour standard deviation of normal-to-normal R-R intervals (SDNN), the root mean square of successive differences between normal heartbeats over 24 hours (RMSSD), the percentage of differences between adjacent normal R-R intervals over 24 hours that were greater than 50 ms (PNN50), total power (TP), very low frequency power (VLF) and low frequency power (LF) (r > 0.394, P < 0.05), and showed negative correlations with HAMD scores (|r| > 0.919, P < 0.001). HAMD scores in PSD group were negatively correlated with SDNN, RMSSD, PNN50, TP and VLF (|r| > 0.769, P < 0.001). Compared with the control group, the ReHo increased in PSD group in the right rectus gyrus (142 voxels, t = 6.575), the left medial and paracingulate gyri (204 voxels, t = 4.925) (GRF correction, P_-Voxel < 0.005，P_-Cluster < 0.05); and reduced in the right cerebellum (191 voxels, t = -6.487), the left middle temporal gyrus (140 voxels, t = -5.516), and the left precentral gyrus (119 voxels, t = -4.764) (GRF correction, P_-Voxel < 0.005，P_-Cluster < 0.05) in PSD group.
Conclusion Autonomic nerve function is related to motor dysfunction in patients with PSD. The modulation of emotional, cognitive and motor brain regions by the autonomic nervous system may play a role in influencing the motor function in patients with PSD.

Key words: post-stroke depression, heart rate variability, autonomic nerve, functional magnetic resonance imaging, regional homogeneity

中图分类号:

R743.3

张明兰, 张玲玲, 王丽莎, 刘莉, 高润, 饶江, 刘婉, 夏子安, 张传文, 程欣欣. 自主神经功能对卒中后抑郁患者运动功能的影响[J]. 《中国康复理论与实践》, 2024, 30(2): 223-231.

ZHANG Minglan, ZHANG Lingling, WANG Lisha, LIU Li, GAO Run, RAO Jiang, LIU Wan, XIA Zi'an, ZHANG Chuanwen, CHENG Xinxin. Impact of autonomic nerve function on motor function in patients with post-stroke depression[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 223-231.

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组别	n	性别/n		年龄/岁	病程/周	受损半球/n
组别	n	男	女	年龄/岁	病程/周	左侧	右侧
对照组	30	16	14	61.72±14.36	14.46±3.11	15	15
PSD组	30	17	13	63.80±11.90	15.23±4.38	14	16
χ²/t值		0.211		0.289	-0.376	0.443
P值		0.786		0.598	0.710	0.561

指标	对照组(n = 30)	PSD组(n = 30)	t值	P值
SDNN/ms	30.43±11.97	20.73±12.12	-3.065	0.003
RMSSD/ms	16.50±4.87	15.47±2.92	-2.224	0.030
PNN50/%	15.03±4.18	14.37±2.59	-2.121	0.039
TP/(ms²·Hz^-1)	1047.67±516.58	513.47±89.56	-5.487	< 0.001
VLF/(ms²·Hz^-1)	517.43±90.76	256.21±78.06	-11.751	< 0.001
LF/(ms²·Hz^-1)	215.41±84.72	176.93±51.34	-2.092	0.041
HF/(ms²·Hz^-1)	163.75±62.10	130.82±25.93	-2.635	0.011
LF/HF	1.44±0.80	1.39±0.42	-2.240	0.031

组别	n	HAMD	FMA	MBI
对照组	30	4.60±1.81	70.17±12.84	67.57±9.06
PSD组	30	16.47±5.39	21.96±9.91	30.19±9.95
t值		11.524	-16.276	-14.797
P值		< 0.001	< 0.001	< 0.001

项目	HAMD
项目	r值	P值
SDNN	-0.810	< 0.001
RMSSD	-0.966	< 0.001
PNN50	-0.954	< 0.001
TP	-0.883	< 0.001
VLF	-0.769	< 0.001
LF	-0.355	0.054
HF	-0.247	0.188
LF/HF	-0.211	0.263

自主神经功能对卒中后抑郁患者运动功能的影响

Impact of autonomic nerve function on motor function in patients with post-stroke depression

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脑区	MNI坐标			体素	t值
脑区	X	Y	Z	体素	t值
右侧直回	9	57	-18	142	6.575
左侧内侧和旁扣带脑回	-9	-42	33	204	4.925

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脑区	MNI坐标			体素	t值
脑区	X	Y	Z	体素	t值
右侧小脑	27	-51	-24	191	-6.487
左侧颞中回	-51	-72	18	140	-5.516
左侧中央前回	-36	-12	51	119	-4.764