强迫症的局部脑血流动态显像研究

目的　探讨强迫症患者各脑叶的代谢状态及脑功能异常与其发病的关系。　　方法　采用单光子发射计算机扫描 (SPECT)技术 ,对未服药的 2 2例强迫症患者于静息及症状诱发状态下行局部脑血流 (rCBF)动态显像研究。　　结果　 1 8例有rCBF异常 ,表现为皮层内局限性放射性分布稀疏、缺损区 ,异常脑叶主要为顶叶、额叶、颞叶 ,并发现脑功能异常与强迫症状的严重程度及药物治疗反应有关。　　结论　大脑顶叶、额叶等脑叶的功能异常是部分强迫症发病的神经病理学基础     

强迫症与抑郁症的脑单光子发射计算机断层扫描对照研究

目的探讨强迫症、抑郁症局部脑血流量(rCBF)特点。方法应用单光子发射计算机断层扫描(SPECT)技术,对首发且未经治疗的39例强迫症患者、36例抑郁症患者和39名正常人于静息状态下行脑血流显像。以小脑皮质的放射性计数值为参考,对局部脑血流进行半定量分析。结果强迫症组两侧前额叶、前颞叶rCBF高于正常组(P<0.01);抑郁症组两侧前额叶、枕叶、扣带回及右前颞叶、右顶叶rCBF低于正常组(P<0.05);在两侧前额叶、前颞叶、顶叶、枕叶及右后额叶、扣带回,强迫症组rCBF高于抑郁症组(P<0.05)。结论强迫症组的前额叶及前颞叶呈高灌注改变,抑郁症组脑血流普遍低灌注,SPECT技术可望作为二者鉴别诊断的客观依据之一。     

探讨SPECT/CT显像对偏头痛临床治疗疗效预测

目的 检测偏头痛大脑结构及局部脑血流(regional cerebral blood flow,rCBF),分析其与治疗疗效关系.方法 对34例临床诊断为偏头痛患者及11名正常对照者,应用SPECT/CT进行脑rCBF显像和CT显像.统计参数图(statistical parametric mapping,SPM)分析偏头痛患者大脑rCBF变化特点.并在西比灵、丙戊酸钠及黛力新治疗前及治疗后3个月,分别应用头痛程度量表评价头痛程度变化.结果 34例中CT均未发现大脑结构异常,但32例(94.1%)患者存在rCBF降低.与正常对比的SPM分析显示偏头痛患者的额叶、颞叶rCBF降低(t=6.48,P＜0.001).29例患者经过治疗后头痛程度量化得分明显降低(P＜0.001),但存在额叶rCBF降低患者,治疗后头痛程度量化分显著高于颞叶rCBF降低者(P＜0.01).结论 偏头痛患者一般大脑无器质性病变,但大多有额叶及颢叶rCBF降低,额叶rCBF受损者的治疗疗效较差.     

精神分裂症患者自我面孔识别能力及其与失言识别和执行功能的相关性研究

目的 探讨精神分裂症患者自我面孔识别能力及其与失言识别能力和执行功能的关系.方法 采用自我面孔识别任务(SFRT)、失言识别测试(FPT)和威斯康星卡片分类测验(WCST)对年龄、性别、文化程度相匹配57例门诊和住院精神分裂症患者(患者组)及50名健康对照者(对照组)的自我面孔识别能力、失言识别能力和执行功能进行测试;采用Spearman相关分析比较自我面孔识别能力与失言识别能力和执行功能的相关性.结果 (1)SFRT:患者组平均反应时[(2122±1124) ms]长于对照组[(1180±322) ms,P＜0.01],正确率[(80±16)％]低于对照组[(88±6)％,P＜0.01].(2) FPT:患者组总分[(42.20±14.52)分]、失言故事分[(29.98±15.64)分]和控制故事分[(12.22±5.62)分]均低于对照组[分别为(67.58±8.12)、(52.16±7.14)、(15.36±4.12)分,P＜0.05或P＜0.01].(3) WCST:除完成分类数和非持续性正确数外,患者组与对照组间其他各项WCST指标差异均具有统计学意义(P＜0.05或P＜0.01).(4)相关分析显示,患者组SFRT正确率与FPT失言故事分间呈正相关(r=0.328,P＜0.05),与WCST总应答数(r=-0.282,P ＜0.05)、错误应答数(r=-0.278,P＜0.05)、持续应答数(r=-0.397,P＜0.01)和非持续性错误数(r=-0.395,P＜0.01)呈负相关.结论 精神分裂症患者存在自我面孔识别能力、失言识别能力和执行功能的损害,患者自我面孔识别缺陷与心理理论和执行功能障碍可能具有某种共同的病理生理基础.     

首发未用药青少年抑郁障碍患者静息态脑功能磁共振研究

目的探讨首次发病未用药青少年抑郁障碍患者静息态脑功能的异常变化。方法应用静息态功能磁共振局部一致性方法,对19例首发未用药青少年抑郁障碍患者和24名健康对照的静息态脑功能磁共振图像进行比较。结果青少年抑郁障碍患者在双侧眶额叶(t=-4.379,P0.001)、双侧内侧前额叶(t=-4.379,P0.001)、右侧额下回(t=-6.057,P0.001)的局部一致性值高于对照组,差异有统计学意义。结论首发未用药的青少年抑郁障碍患者在双侧眶额叶、双侧内侧前额叶、右侧额下回静息态脑功能存在异常,这些脑区的功能异常可能与青少年抑郁障碍的病理生理机制有关。     

外伤性颅骨缺损修复前后灌注CT评价脑血流变化的研究

目的 探讨颅骨修复术对外伤性颅骨缺损患者脑血流动力学和神经症状的影响.方法 对14例外伤性颅骨缺损患者颅骨修复前后行脑灌注CT检查,比较修补侧基底节层面与侧脑室体部层面的底节区和颞叶皮层区4组感兴趣区,自身对照比较其rCBF均值差别,分别比较术前与术后7d,术前与术后6个月均值,并且对其神经症状变化情况进行随访.结果 (1)基底节层面底节区:术后7 d rCBF较术前有改善,P=0.044＜0.05;6个月随访rCBF较术前有改善,P=0.033＜0.05.(2)基底节层面颞叶皮层:术后7 d rCBF较术前有改善,P=0.001 ＜0.01;6个月随访rCBF较术前有改善,P=0.000 ＜0.01.(3)侧脑室体部层面底节区:术后7 d rCBF较术前无明显改善,P=0.275＞0.05;6个月随访rCBF较术前有明显改善,P=0.001 ＜0.05.(4)侧脑室体部层面颞叶皮层:术后7 d rCBF较术前无明显改善,P=0.064 ＞0.05;6个月随访rCBF较术前无明显改善,P=0.174＞0.05.其中发现靠近侧裂大血管处基底节水平层面脑组织血流因颅骨修复得以改善的程度更加明显.患者修复术后神经症状得到改善.结论 本研究应用灌注CT数据说明脑血管分布越密集,脑血流量恢复越明显,进一步充实完善了颅骨修复后脑血管储备功能改善的理论假说.     

男性酒精依赖患者的威斯康星卡片分类测验及脑质子波谱动态研究

目的 通过磁共振质子波谱(1H-MRS)检测酒精依赖患者额叶代谢物质的变化,探讨酒精依赖所致认知障碍的神经生物学基础.方法 分别于戒酒前和戒酒1个月时应用1H-MRS技术,检测10例男性酒精依赖患者(患者组)的额叶氮-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸(Cr)变化,并与10名正常对照者(对照组)进行比较;同时用威斯康星卡片分类测试(WCST)评定受试者的认知功能.结果 (1)戒酒前,患者组双侧前额叶灰质和白质NAA/Cr比值均低于对照组(P＜0.05),戒酒1个月时较戒酒前有好转(P=0.00),但仍低于对照组(P＜0.05);而Cho/Cr戒酒前后的差异元统计学意义(P＞0.05).(2)患者组戒酒前WCST中的完成分类数[(0.70±1.06)个]和概念化水平[(16.29±10.27)%]低于戒酒1个月时[分别为(3.80±2.15)个,(52.32±20.81)%],而错误应答数[(83.60±10.80)个]和持续性错误[(34.80±16.94)个]高于戒酒1个月时[分别为(42.80±21.06)个,(21.70±11.39)个;P＜0.05].(3)患者组戒酒前后右侧灰质NAA/Cr变化与WCST完成分类数的变化相关(r=0.7002,P＜0.05).结论 长期饮酒可导致酒精依赖患者前额叶代谢物浓度改变;其认知功能的损害,可能与酒精对前额叶代谢物浓度的影响有关.     

fMRI联合WCST对颅脑爆震伤额叶执行功能的评估

目的利用静息态功能磁共振成像(f MRI)和威斯康辛卡片分类测试(WCST)评估颅脑爆震伤恢复期的额叶执行功能。方法以同一次军事训练中受伤4例成年男性颅脑爆震伤为观察组,以6例健康男性成年人为对照;采集f MRI数据构建脑网络并计算其平均额叶度;同时进行WCST测试。结果受试者头动分析发现,平移不超过2 mm,角度不超过2°,无受试者因头动被剔除。观察组额叶度(4.750±0.646)显著低于对照组(5.550±0.409;P0.05);两组WCST测试结果均在正常范围内,但观察组WCST值(4.500±0.577)明显低于对照组(6.167±0.753;P0.05)。观察组额叶平均度和WCST测试得分具有显著相关性(r=0.821,P0.05),对照组额叶平均度和WCST测试得分也具有显著相关性(r=0.813,P0.05)。结论颅脑爆震伤恢复期额叶网络可能存在潜在的问题,会引起执行力测试在正常范围内的下降。     

分裂型人格特征大学生的执行功能评定

目的 探讨分裂型人格特征和抑郁情绪对大学生执行功能的影响. 方法 应用分裂型人格问卷(schizotypal personality questionnaire,SPQ)对某大学2007年4 461名新生进行普查,SPQ总分高于前10%分位(38分)的学生被认为有较明显的分裂型人格特征,为研究组.SPQ总分低于38分的学生,作为研究对照组.Wisconsin卡片分类测验(WCST) 评定执行功能.90项症状清单(SCL-90)用来评定抑郁情绪. 结果 研究组,WCST测验中的完成分类数(Z=2.916;P=0.004)、正确应答数(Z=2.98; P=0.003)、概念化水平百分数(Z=2.310; P=0.021)高于对照组,而错误应答数(Z=3.06; P=0.002)、选择错误率(Z=3.050; P=0.002)、持续错误数(Z=3.180; P=0.001)和持续错误率(Z=2.950; P=0.003)均低于对照组,显示相对较高的执行功能水平.根据SCL-90抑郁因子得分中位数分布,分别将2组再分为抑郁情绪高分组和抑郁情绪低分组.对于研究组,抑郁情绪高分组,在错误应答数(Z=1.965; P=0.049)和选择错误率(Z=1.963; P=0.050)方面优于抑郁情绪低分亚组.结论 具有分裂型人格特征大学生的执行功能水平高于其他学生,其中的原因部分与是否伴有明显抑郁情绪有关.     

精神分裂症患者面部表情认知与执行功能的相关性研究

目的:探讨精神分裂症患者面部表情认知功能和执行功能障碍的关系.方法:采用中国人面部情绪测验(CFET)和威斯康星卡片分类测验(WCST)对56例未用药精神分裂症患者进行评估,与49名正常健康者进行比较.结果:患者组CFET的总分及6种基本情绪认知评分均显著低于对照组(P＜0.01).患者组WCST显著较对照组为差.控制阳性症状量表(SAPS)和阴性症状量表(SANS)总分的偏相关分析显示.患者组CFET的惊正确分与WCST的总应答数呈正相关(r=-0.31,P＜0.05),悲正确分与CFET的错误应答数(r=-0.37,P＜0.01)、选择错误率(r=-0.38,P＜0.01)、持续性应答数(r=-0.34,P＜0.05)、持续性错误数(r=-0.48,P＜0.01)和持续性错误率(r=-0.40,P＜0.01)呈负相关,而与完成分类数(r=0.25,P＜0.05)呈正相关.结论:精神分裂症患者存在广泛的面部表情认知缺陷和执行功能障碍,患者面部表情认知功能与执行功能有相关性.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

The organization of the connections between the cortex and the claustrum in the monkey

The distribution of labelled cells and of extracellular granules in the claustrum has been studied after injections of horseradish peroxidase in several areas of the neocortex. The frontal and parietal lobes are related to the anterior and posterior halves respectively of the claustrum, and the occipital and temporal cortex to the posterior and inferior margins. Parts of the claustrum related to areas of the cortex in the frontal lobe overlap considerably in the antero-posterior dimension with parts related to widely separated but interconnected areas of the parieto-temporal cortex. Areas of cortex within one lobe which are interconnected are related to parts of the claustrum which overlap in the dorsoventral dimension.     

Experimental study of the projections of the nucleus of the tractus solitarius and the area postrema in the cat

Projections from the area postrema and adjacent parts of the medial solitary nucleus are demonstrated with the Nauta method following lesions limited exclusively to these structures. Experiments are controlled with lesions involving adjacent bulbar regions, cerebellum, and spinal cord. Ascending pathways in the dorsal and lateral columns of the spinal cord project ipsilaterally to the area postrema and bilaterally to a para-alar nucleus in the ventral periphery of the nucleus gracilis. Neurons in the area postrema project mainly inspilaterally to the dorsal and medial regions of the medial solitary nucleus. Neurons in the posterior half of the medical solitary nucleus project ipsilaterally to the lateral solitary nucleus, dorsal vagal nucleus, ambigus, retrofacial nucleus, and dorsal and lateral bulbar reticular formation. Projections to nuclei intercalatus and prepositus hypoglossi, bilaterally, and to the ipsilateral dorsal tegmental nucleus by way of the dorsal longitudinal fasciculus are also shown. No direct projections to the diencephalon are demonstrated. Control lesions in the dorsal column nuclei reveal projections to the contralateral inferior olive and thalamic reticular and ventrobasal nuclei, but not to the projection sites of the solitary nucleus. Evidence is given to support the hypothesis that ascening visceral pathways are interruped in the bulbar reticular formation and dorsal tegmental nucleus before reaching the diencephalon. Correlations are suggested with functional aspects of the central autonomic and reticular activating systems.