| Objective: Cerebrovascular disease is one of the most devastating diseases to human beings and the leading cause of death and disability for adults in China.Cerebrovascular diseases often cause psychiatric complications like anxiety/depression,which seriously impair patients’ cognitive function,daily living abilities and social function,and increase the risk of death.Ischemic cerebrovascular disease(ICVD)is the most common type of cerebrovascular disease.It has a high incidence,accounting for about 80% of all cerebrovascular diseases.At present,the diagnosis of ICVD patients comorbid with depression/anxiety is mainly based on clinical manifestations and psychiatric scale scores.There is still a lack of objective diagnostic indicators.It has been suggested that abnormal echogenicity of brainstem raphe(BR)detected by transcranial sonography(TCS)is associated with depressive symptoms in psychiatric disorders and certain diseases,such as Parkinson’s disease,epilepsy,and migraine.Abnormalities in BR echogenicity have been proposed as a biomarker of Parkinson’s disease comorbid with depression.However,it is not known whether abnormal BR echogenicity is also associated with depression/anxiety symptoms in ICVD patients.In this study,BR echogenicity and the depression/anxiety scale scores of ICVD patients were evaluated to study the relationship between abnormal BR echogenicity and depression/anxiety symptoms in ICVD patients.Plasma concentrations of monoamine neurotransmitters were measured in ICVD patients with anxiety/depression.The aim of this study was to explore the pathophysiology and provide objective diagnostic basis for ICVD patients with depression/anxiety,which is conducive to accurate diagnosis,early intervention,effective treatment,thus improving the quality of life and survival of these patients.Methods: 1.Consecutive ICVD patients were recruited with written informed consents from the Department of Neurology in our hospital from October to December in 2019.The Hamilton Depression Rating Scale(HAMD),Hamilton Anxiety Scale(HAMA)score assessments and TCS examinations were performed.Venous blood was collected.Demographic and clinical information for all subjects were collected including: gender,age,previous stroke history,hypertension,diabetes,coronary heart disease,education,Mini-mental State Examination Scale(MMSE)score,Montreal Cognitive Assessment Scale(MOCA)score.Blood test results were recorded: fasting plasma glucose,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,triglyceride,homocysteine,blood urea nitrogen,creatinine,uric acid,cystatin C,activated partial thromboplastin time,fibrinogen,thrombin time,prothrombin time,D-dimer,and so on.2.According to HAMD scale scores,the ICVD patients were divided into a depressed group(≥ 7 points)and a non-depressed group(<7 points).The differences in general clinical data and BR echogenicity between these two groups were analyzed.According to HAMA scale scores,the ICVD patients were divided into an anxiety group(≥ 7 points)and a non-anxiety group(< 7 points),and the differences in general clinical data and BR echogenicity between these two groups were analyzed.3.According to the results of BR echogenicity examination,the ICVD patients were divided into an abnormal BR echogenicity group(including BR echogenicity reduction,interruption,and disappearance)and a normal BR echogenicity group to study the relationship between BR echogenicity and depressive/anxiety symptoms.4.Plasma of ICVD patients with HAMD and HAMA scores above the diagnostic thresholds for moderate depression and confirmed anxiety(HAMD>17 and HAMA>14)were examined with high performance liquid chromatography(HPLC)for neurotransmitters 5-hydroxytryptamine,dopamine,and noradrenaline.Results: 1.A total of 176 ICVD patients were enrolled in this study.There were130 ICVD patients comorbid with both anxiety and depression,including 47 males and83 females.There were 38 ICVD patients having neither anxiety nor depression,including 21 males and 17 females.There were 130 ICVD patients comorbid with depression,including 47 males(36.15%)and 83 females(63.85%).There were 46 ICVD patients without depression,including 25 males(54.35%)and 21 females(46.67%).All ICVD patients comorbid with depression were accompanied with anxiety.There were 138 ICVD patients comorbid with anxiety,including 51 males(36.96%)and 87 females(63.04%).There were 38 ICVD patients without anxiety,including 21males(55.26%)and 17 females(44.74%).There were significantly more females(r=4.653,p=0.031),higher HAMA scores(r=3.027,p=0.000),and more BR echogenicity abnormalities(r=8.995,p=0.003)in the depressed ICVD patients compared to the non-depressed patients.There were no significant inter-group differences in age,previous history of stroke,hypertension,diabetes mellitus,coronary heart disease,education,MMSE score,MOCA score,fasting plasma glucose,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,triglyceride,homocysteine,blood urea nitrogen,creatinine,uric acid,cystatin C,activated partial thromboplastin time,fibrinogen,thrombin time,prothrombin time,and D-dimer.2.Among ICVD patients,there were significantly more females(r=4.131,p=0.042),higher HAMD scores(r=3.027,p=0.000),and more BR echogenicity abnormalities(r=12.940,p=0.000)in the anxiety group compared to the non-anxiety group.There were no significant inter-group differences in age,previous history of stroke,hypertension,diabetes mellitus,coronary heart disease,MMSE score,MOCA score,fasting plasma glucose,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,triglyceride,homocysteine,blood urea nitrogen,creatinine,uric acid,cystatin C,activated partial thromboplastin time,fibrinogen,thrombin time,prothrombin time,and D-dimer.3.Among ICVD patients,there were statistically significant more females(r=5.745,p=0.017),higher HAMD(r=3.027,p=0.002)and HAMA scores(r=3.027,p=0.009)in the abnormal BR echogenicity group than in the normal BR echogenicity group.There were no statistical differences in age,previous history of stroke,hypertension,diabetes mellitus,coronary heart disease,MMSE score,MOCA score,fasting plasma glucose,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,triglyceride,homocysteine,blood urea nitrogen,creatinine,uric acid,cystatin C,activated partial thromboplastin time,fibrinogen,thrombin time,prothrombin time,and D-dimer.The correlation analysis for ICVD with depression/anxiety and changes in BR echogenicity showed that depression severity(r=0.231,P=0.002)and anxiety severity(r=0.197,P=0.009)were positively correlated with BR echogenicity detected using TCS.The difference was statistically significant(P<0.05).4.There was no significant difference in monoamine neurotransmitter concentrations between the abnormal BR echogenicity group and the normal BR echogenicity group in ICVD patients with depression/anxiety(P>0.05).Conclusion: 1.Compared to ICVD patients without depression,ICVD patients comorbid with depression were more female,having higher HAMA scores,and more abnormal BR echogenicity.2.Compared to ICVD patients without anxiety,ICVD patients comorbid with anxiety were more female,having higher HAMD scores,and more abnormal BR echogenicity.3.Compared to ICVD patients with normal BR echogenicity,ICVD patients with abnormal BR echogenicity were more female,and had higher HAMA/HAMD scores.Abnormal BR echogenicity was positively correlated with the severity of anxiety/depression.4.Plasma concentrations of monoamine neurotransmitters 5-hydroxytryptamine,dopamine,and noradrenaline in ICVD patients comorbid with depression/anxiety were not different between the group with abnormal BR echogenicity and the group with normal BR echogenicity. |
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