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

Abstract

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

CLC Number:

R743.3

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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References 38

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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	FMA
项目	r值	P值
SDNN	0.905	< 0.001
RMSSD	0.957	< 0.001
PNN50	0.982	< 0.001
TP	0.940	< 0.001
VLF	0.870	< 0.001
LF	0.394	0.034
HF	0.223	0.246
LF/HF	0.248	0.195
HAMD	-0.952	< 0.001

项目	MBI
项目	r值	P值
SDNN	0.934	< 0.001
RMSSD	0.954	< 0.001
PNN50	0.952	< 0.001
TP	0.961	< 0.001
VLF	0.919	< 0.001
LF	0.409	0.027
HF	0.350	0.063
LF/HF	0.179	0.352
HAMD	-0.919	< 0.001

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