青少年单心室心脏病患者认知、焦虑和抑郁调节区域的大脑异常。
Brain abnormalities in cognition, anxiety, and depression regulatory regions in adolescents with single ventricle heart disease.
机构信息
UCLA School of Nursing, University of California, Los Angeles, CA, 90095, USA.
Department of Anesthesiology, University of California, Los Angeles, CA, USA.
出版信息
J Neurosci Res. 2018 Jun;96(6):1104-1118. doi: 10.1002/jnr.24215. Epub 2018 Jan 6.
BACKGROUND
Single ventricle heart disease (SVHD) adolescents show cognitive impairments and anxiety and depressive symptoms, indicating the possibility of brain injury in regions that control these functions. However, brain tissue integrity in cognition, anxiety, and depression regulatory sites in SVHD remains unclear. We examined brain tissue changes in SVHD compared to controls using T2-relaxometry procedures, which measure free water content and show tissue injury.
METHODS
Proton-density and T2-weighted images, using a 3.0-Tesla MRI, as well as anxiety (Beck anxiety inventory [BAI]), depressive symptoms (patient health questionnaire-9 [PHQ-9]), and cognition (wide range assessment of memory and learning 2 [WRAML2] and Montreal cognitive assessment [MoCA]) data were collected from 20 SVHD (age: 15.8 ± 1.1 years, male/female: 11/9) and 36 controls (age: 16.0 ± 1.1 years, male/female: 19/17). Whole-brain T2-relaxation maps were calculated, normalized to a common space, smoothed, and compared between groups and sexes (analysis of covariance; covariates: age, sex; p < 0.001).
RESULTS
SVHD subjects showed significantly increased BAI and PHQ-9 and reduced MoCA and WRAML2 scores over controls. Several brain regions in SVHD showed increased T2-relaxation values (chronic injury), including the cingulate, and insula, hippocampus/para-hippocampal gyrus, thalamus, hypothalamus, amygdala, frontal white matter, corpus callosum, brainstem, and cerebellar areas. Decreased T2-relaxation values (acute injury) emerged in a few regions, including the prefrontal and cerebellar cortices in SVHD over controls. In addition, male SVHD showed more brain changes over female SVHD.
CONCLUSIONS
Adolescents with SVHD showed significant brain injury with variable male-female differences in areas that control cognition, anxiety, and depression, which may contribute to functional deficits found in the condition.
背景
单心室心脏病（SVHD）青少年表现出认知障碍以及焦虑和抑郁症状，这表明控制这些功能的区域可能存在脑损伤。然而，SVHD 患者认知、焦虑和抑郁调节部位的脑组织完整性仍不清楚。我们使用 T2 弛豫度测量程序（可测量自由水含量并显示组织损伤）检查了 SVHD 与对照组之间的脑组织变化，该程序使用 3.0T MRI 获得质子密度和 T2 加权图像，以及焦虑（贝克焦虑量表[BAI]）、抑郁症状（患者健康问卷-9 [PHQ-9]）和认知（广泛范围评估记忆和学习 2 [WRAML2]和蒙特利尔认知评估[MoCA]）数据。从 20 名 SVHD 患者（年龄：15.8±1.1 岁，男/女：11/9）和 36 名对照组（年龄：16.0±1.1 岁，男/女：19/17）中收集了这些数据。计算了全脑 T2 弛豫图，将其归一化为共同空间，进行平滑处理，并在组间和性别间进行比较（协方差分析；协变量：年龄、性别；p<0.001）。
结果
SVHD 患者的 BAI 和 PHQ-9 明显升高，MoCA 和 WRAML2 评分明显降低。SVHD 患者多个脑区 T2 弛豫值升高（慢性损伤），包括扣带回和脑岛、海马/海马旁回、丘脑、下丘脑、杏仁核、额叶白质、胼胝体、脑干和小脑区域。SVHD 患者的少数脑区 T2 弛豫值降低（急性损伤），包括 SVHD 患者的前额叶和小脑皮质。此外，男性 SVHD 患者的脑改变比女性 SVHD 患者更明显。
结论
SVHD 青少年表现出明显的脑损伤，且认知、焦虑和抑郁调节区域存在可变的性别差异，这可能导致该疾病中发现的功能缺陷。
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