| Objective1.Quantitative magnetic susceptibility imaging（QSM）was used to investigate the relationships between iron deposition in putamen and thalamus and clinical characteristics in patients with depression.2.Quantitative magnetic susceptibility imaging（QSM）was used to investigate the iron deposition in cerebrospinal fluid（CSF）in patients with depression and its relationship with clinical morbidity and severity.Methods1.Forty-four hospitalized patients with depression（depression group）were prospectively collected,and 16 healthy volunteers（HC group）were recruited.Hamilton Depression Scale 17-item（HDRS17）was used for follow-up assessment at baseline and 6 weeks after standardized treatment,and the depression group was divided into remission and non-remission groups based on the assessment results.At the same time,the whole brain was collected by QSM,and QSM values of putamen and thalamus were extracted.The QSM values of putamen and thalamus in depression group and HC group were compared by independent sample t test.Pearson correlation analysis was used to explore the relationship between the value of QSM in putamen and thalamus and clinical characteristics.Logistic regression was used to evaluate the ability of baseline QSM value to predict post-treatment outcomes in the depressed group.2.Forty-seven hospitalized patients with depression（depression group）were prospectively collected,and 21 healthy controls（HC group）matched with age and sex of depression group were collected.Follow-up evaluations were performed at baseline and 6 weeks after standardized treatment using the Hamilton Depression Scale17-item（HDRS17）,and the depression group was divided into remission and non-remission groups based on the results.At the same time,the whole brain of the subjects was collected by QSM technique at baseline and follow-up,and the whole brain was standardized by MNI152 brain template and the CSF Mask was extracted to obtain the QSM value of CSF（CSFQSM value）.Independent sample t test was used to compare CSFQSM values between the depression group and the HC group.Pearson correlation analysis was used to explore the relationship between CSFQSM and depression severity.Logistic regression was used to evaluate the ability of baseline CSFQSM to predict post-treatment outcomes in the depressed group.Results1.Excluding 12 subjects who were lost to follow-up,44 patients with depression were eventually included in this study,and were divided into remission group（n=28）and non-remission group（n=16）according to HDRS score.Compared with HC group,there were no significant differences in age,sex,education level and BMI in the depression group.After 6 weeks of standardized treatment for depression,the non-remission group also had higher HDRS scores at baseline compared with the remission group.2.At baseline,the QSM values of putamen and thalamus in the depression group were significantly higher than those in the HC group,and the differences were statistically significant.In addition,the QSM values of putamen and thalamus in the depression group and their baseline HDRS scores were significantly positively correlated with the QSM values of putamen and thalamus by Pearson correlation analysis.3.After 6 weeks of standardized treatment,there were significant differences in QSM values in putamen and thalamus between the remission group and the non-remission group.The QSM values of putamen and thalamus in the remission group were not significantly different from those in the HC group.However,the QSM values of putamen and thalamus in the non-remission group were significantly different from those in the HC group.4.In order to verify whether QSM data can be used to quantify brain iron,linear regression was used to find that in this study,the QSM values of putamen and thalamus in HC group were significantly correlated with the iron distribution in postmortem samples as reported by Hallgren.（putamen: r=0.981,P<0.001;Thalamus:r=0.992,P<0.001）.5.The mean HDRS score of 47 depression patients enrolled in this study was22.8±8.2,the mean age of onset was 35.4±3.7 years old,the mean frequency of onset was 3.0±0.9,and the mean total course of disease was 19.1±3.6 weeks.Compared with HC group,there were no statistically significant differences in age,sex,education level,and body mass index（BMI）in the depression group.After 6 weeks of standardized treatment,the non-remission group showed higher HDRS scores at baseline,younger age of onset,more episodes,and a longer overall course of disease than the remission group.6.All 6 subjects who underwent CSF lumbar puncture were excluded from cerebral inflammation,and their ferritin levels in CSF ranged from 9.15 to 12.19mg/L,with an average of 10.50±1.06mg/L.The CSFQSM of 6 subjects ranged from 8.6 to 11.2 ppb,with an average of 9.7±1.1 ppb.The results of individual comparison and correlation analysis showed that although the QSM value measured by CSF was slightly lower than the measured CSF ferritin level（only the value was slightly smaller,and there was no statistical difference）,there was a significant high correlation between the two（r=0.904,P =0.013）,suggesting that CSFQSM value could effectively reflect the CSF ferritin level.7.At baseline,the CSFQSM value was significantly higher in the depressed group than in the HC group（P <0.001）.In addition,there was a significant correlation between CSFQSM value and HDRS score in the depressed group（r=0.644,P<0.001）.8.After 6 weeks of standardized treatment,the depression group was divided into remission group（n=33）and non-remission group（n=14）according to the treatment effect.There was no significant difference between the remission group and HC group（P >0.05）,while there was still significant difference between the non-remission group and HC group（P <0.001）.The CSFQSM value and HRDS score of the two groups of subjects still showed consistent changes,that is,the correlation analysis results showed that the CSFQSM value and HDRS score of the two groups of subjects were significantly positive correlation（remission group: r=0.382,P=0.028;Non-remission group: r=0.595,P =0.025）.9.Multivariate Logistic regression analysis was performed using the dependent variable Y,the CSFQSM value at baseline as the independent variable,and the difference between the remission group and the non-remission group as the covariate.The results showed that baseline CSFQSM value（OR=2.816,95%CI: 1.031-7.691,P=0.043）,age of onset（OR=0.751,95%CI: 0.514-0.994,P =0.046）and total course of disease（OR=2.284,95%CI: 1.077-5.180,P =0.048）were independent predictors of complete outcome of patients with depression after treatment（in which baseline CSFQSM value and total course of disease were risk factors and age of onset was protective factor）.ROC curve analysis showed that the combined model of age of onset,total course of disease and baseline CSFQSM value had the largest area under curve（AUC）,which was 0.971.The sensitivity and specificity were 100% and 90.9%,respectively,and the corresponding Youden index was 0.909.Conclusion1.Iron deposition in putamen and thalamus was positively associated with the severity of depression.QSM can quantitatively measure iron distribution in brain.2.Iron deposition in CSF is closely related to the severity and prognosis of depression,which may be a powerful entry point to explore the mechanism of depression. |
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