| Background and Purpose: Depressive symptoms are the basis for the diagnosis of depression.Depressive symptoms mainly include emotional,cognitive and physical disorders,including significant and persistent low mood,loss of interest and lack of energy,fatigue,sleep disorders,loss of appetite,pain and other physical bodies.Discomfort,lack of concentration,slow thinking,memory loss and other cognitive dysfunction,severe cases have hallucinations,suicidal tendencies[1].The global incidence of depression was about 11 percent in recent years,the increasing speed of social development also led to increased pressure,so that the incidence of depression increased year by year,by 2020 depression is likely to become the second largest illness against humanity[2,3].A multi-center study conducted by WHO found that the proportion of patients with depression in outpatient clinics was 2.6% to 29.5%.Some scholars in China found that depression patients accounted for 10.5% of patients in the same period of neurology clinics[4].Most patients with depression choose non-psychiatric treatment for the first time[5],especially neurology[6].Depression patients in neurology clinics often have sleep disorders,dizziness,headache,memory loss and other physical symptoms as the first complaints,depressed mood,loss of interest and other emotional symptoms,particularly hallucinations,suicide and other serious emotional symptoms not obvious[7],mostly mild to moderate depression based [8],and more patients The diagnosis is depression.The patients with depression have only the characteristics of some patients with depression.Due to the mild condition,they are more consistent with the classification criteria of Chinese mental disorders and the diagnostic criteria for the diagnosis of mild depressive episodes.Because the physical symptoms of patients in neurology clinics are prominent,it is easy to cover up their emotional symptoms,making patients with depression easy to miss diagnosis and misdiagnosis,resulting in patients’ unhealed or aggravated condition,and also wasting medical resources.Therefore,it is important to clarify the pathogenesis of depression and improve the accuracy of clinical diagnosis of depression in neurology clinics.At present,the research on the pathogenesis of depression is still insufficient.In recent years,the rapid development of functional magnetic resonance imaging has brought new ideas to the diagnosis and research of depression.Resting-state functional magnetic resonance imaging(rs-f MRI)has high spatial and temporal resolution,can display functional activities of specific parts of the brain,and has unique advantages such as non-invasive and repetitive operation in neuroimaging.The field of study is widely used.It is an imaging technique based on the effect of blood oxygen level dependent(BOLD),which indirectly reflects the function of brain local and neural networks through signal changes,from the early 1990 s to neuroscience and psychology.The development of science and other fields has had an important impact.It has been widely used in the research of various neurological or psychiatric diseases,and has gradually become one of the important means to explore the pathological and physiological activities of brain function.In order to explore the characteristics of patients with depression in neurology clinics,rs-f MRI technique was used to determine the pathogenesis of patients.From the perspective of the local brain region’s own activity,the amplitude of low-frequency fluctuation(ALFF)and the ratio of low-frequency amplitude were used.(fractional amplitude of frequency fluctuation,f ALFF)method,to explore the characteristics of brain neuron activity in patients with neurological outpatient depression;from the perspective of local brain activity,using regional homogeneity(Re Ho)method to explore the neurological outpatient depression status Synchronization of local neuronal activity in patients;from the perspective of local brain functional area and global brain activity coordination,using functional connectivity(FC)analysis methods to explore medial prefrontal cortex(MPFC)and whole brain activity Synchronization.To explore the changes of brain function area in patients with depression in neurology clinics,to explore the role of these altered brain regions in the pathogenesis,and to provide imaging evidence for the diagnosis and pathogenesis of patients with depression.Material and Methods: Participants: Visiting the Bethune First Hospital of Jilin University,in line with the Chinese Diagnostic Classification and Diagnostic Criteria for the diagnosis of mild depressive episodes,and 24 Hamilton Depression Scale(HAMD)scores for patients with depression 24 patients were included as patient groups.Sixteen healthy volunteers similar in age,sex,and the like were selected as normal controls.Collection and clinical evaluation of general data: Collect general data of two groups of subjects,and inquire the patient’s medical history characteristics by professionally trained neurologists: course of disease,chief complaint,age of first onset,number of illnesses,diagnosis and treatment,and each episode Clinical manifestations,etc.Hamilton Anxiety Scale(HAMA),24 HAMD,Patient Health Questionnaire Depression Scale(PHQ-9),General Anxiety Scale(GAD-7),Simple Intelligence Status Checklist(MMSE)Questionnaire score.Data collection: A sagittal 3D anatomical image and a resting state functional magnetic resonance image were acquired using a PHILPS 3.0T whole body magnetic resonance scanner.rs-f MRI data preprocessing: Image preprocessing often uses DPARSFA(Data processing assistant for resting-state f MRI http://www.restfmri.net/forum)software based on Matlab(R2011a)platform.Statistical analysis: SPSS 24.0 software was used for statistical analysis of general data,and a two-sample T test was performed to compare the general data and clinical evaluation between the two groups.The difference between the two groups was considered statistically significant at P < 0.05.Using dpadi software based on Matlab(R2011a)platform(http://rfmri.org/dpabi)and SPM12 software(Statistical parametric mapping http://www.fil.ion.ucl.ac.uk/spm/),respectively The f ALFF data,Re Ho data,and FC data of the two groups were subjected to a one-sample T test.Then,a two-sample T test between groups was performed to calculate the f ALFF value,Re Ho value,and FC value of the two groups,and the age and sex of the two were used as covariates.The removal was performed using the method of displacement test,and P < 0.01 was considered to be statistically significant.The two groups were compared with the areas of f ALFF,Re Ho,and FC that were enhanced or weakened.Results: There was no significant difference in gender,age,occupation,education level and MMSE score between the patient group and the normal control group(P<0.05).More women than men in depression,female: male 1.7:1;mostly 35 to 50,young and middle-aged,accounting for 46% of the patient group;education level is mostly primary school and below,junior high school culture level;farmers account for 62.5%,unemployed Accounted for 12.5%.There were significant differences in HAMD score,HAMA score,PHQ-9 score and GAD-7 score between the two groups(P>0.05).According to the HAMD score,mild depression accounted for 79%,moderate depression accounted for 17%,and severe depression accounted for 4%.PHQ-9 scores showed mild depression accounted for 46%,moderate depression accounted for 29%,moderate to severe depression.25%,that is,mostly mild to moderate depression.According to the HAMA score,mild anxiety accounted for 4%,moderate anxiety accounted for 83%,moderate-to-severe anxiety accounted for 13%;GAD-7 score showed that no anxiety accounted for 13%,mild anxiety accounted for 58%,moderate Anxiety accounts for 29%,that is,patients with depression are often accompanied by mild to moderate anxiety.The patients with physical symptoms as the first complaint accounted for about 83%,and the emotional symptoms were the first complaints,accounting for 17%.Common physical symptoms were mainly caused by sleep disorders(insomnia,early awakening,difficulty falling asleep,difficulty in sleeping),dizziness,headache,memory loss,etc.The rs-f MRI images of the patient group and the normal control group: the left iliac crest of the left side of the patient group,the f ALFF value of the right cerebellum 6 area and the lingual gyrus were higher than the control group;the right side of the patient group was the posterior central gyrus,the upper occipital lobe,and the horn The Re Ho value of the return site was higher than that of the control group.Compared with the control group,the FC values of the right central posterior gyrus,the right temporal iliac crest,the left fusiform gyrus,the left inferior temporal gyrus,and the medial prefrontal cortex were increased.Conclusions: The number of women with depression in neurology clinics is more than that of males,mostly young and middle-aged.The education level is mostly primary school and below,junior high school education level,farmers and unemployed people,mainly mild to moderate depression,mostly with physical symptoms as the first complaint..Using resting brain functional magnetic resonance scanning technique,f ALFF,Re Ho,and FC as analytical methods to study the resting brain function changes in normal controls and patients with depression.The study found that there are multiple brain function in the brain of patients with depression.Anomalous activity.The f ALFF value of the left temporal iliac crest,the right cerebellum 6 area,and the right lingual gyrus of the patient group was higher than that of the control group,that is,the local neurons in the above area increased their activity.The Re Ho value of the right central posterior gyrus,the right occipital lobe,and the right anterior horn of the patient group was higher than that of the control group,that is,the synchronization of local neuronal activity in the above region was enhanced.Compared with the control group,the FC value of the right central posterior gyrus,the right medial temporal gyrus,the left fusiform gyrus,the left inferior temporal gyrus and the medial prefrontal cortex increased,that is,the functional connection between the upper region and the medial prefrontal lobe Enhanced.Changes in the function of these sites may play an important role in the pathogenesis of depression,and provide new evidence for the pathogenesis of depression. |
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