不同家族史情况的精神分裂症患者脑质子磁共振波谱特点的比较

目的 比较不同精神障碍家族史的精神分裂症患者前额叶和丘脑质子磁共振波谱特点的差异及其与临床症状、执行功能的关系.方法 对31例有精神分裂症家族史的精神分裂症患者(精神分裂症家族史组)、21例有其他精神障碍家族史的精神分裂症患者(其他精神障碍家族史组)和78例无精神障碍家族史的精神分裂症患者(家族史阴性组),采用多体素磁共振质子波谱技术检测前额叶和丘脑N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr)进行检测,计算NAA/Cr值、Cho/Cr值；采用阳性和阴性症状量表(PANSS)和威斯康星卡片分类测验(WCST)评定临床症状和执行功能,进行比较与相关分析.结果 精神分裂症家族史组和其他精神障碍家族史组左侧前额叶NAA/Cr值[分别为(1.32±0.27)、(1.33±0.24)]、右侧丘脑NAA/Cr值[分别为(1.33±0.28)、(1.34±0.27)]均低于家族史阴性组(1.48±0.32)、(1.50±0.34),差异有显著性(t值分别为2.48,2.00,2.47,2.01,P＜0.05).精神分裂症家族史组和其他精神障碍家族史组阴性症状分[分别为(20.7±6.42)分、(20.9±5.22)分]、持续错误数[分别为(37.3±11.5)分、(36.2±9.25)分]均高于家族史阴性组[(18.1±4.36)分、(31.6±9.33)分],差异有显著性(t值分别为2.43,2.50,2.59,2.00,P＜0.05)；分类数[分别为(1.81±0.53)分、(1.88±0.49)分]均低于家族史阴性组[(2.13±0.61)分],差异有显著性(t值分别为2.56,2.01,P＜0.05).3组左侧前额叶NAA/Cr值与PANSS总分、错误应答数均呈显著负相关(P＜0.05或0.01),与分类数、概念化水平呈正相关(P＜0.05或0.01)；精神分裂症家族史组、其他精神障碍家族史组左侧前额叶NAA/Cr值与阴性症状分(r值分别为-0.39,-0.43,P＜0.05)、持续错误数(r值分别为-0.50,-0.48,P＜0.01或0.05)呈负相关.结论 具有精神障碍家族史的精神分裂症患者的前额叶、丘脑神经元损害程度大于无家族史的患者,前额叶神经元损害程度与阴性症状严重程度和执行功能损害程度相关.

Proton magnetic resonance spectroscopy study on prefrontal lobe and thalamus in schizophrenia with or without mental disorder family history

Objective To compare the metabolic measures on prefrontal lobe and thalamus among schizophrenics with or without mental disorder family history by proton magnetic resonance spectroscopy (1 H-MRS),and to explore the relationship among metabolic measures,clinical symptom,and executive functioning.Methods Thirty-one schizophrenics with schizophrenia family history,21 schizophrenics with the other mental disorder family history,and 78 schizophrenics without mental disorder family history were examined at prefrontal lobe and thalamus by multi-voxel 1H-MRS.The N-acetylaspartate (NAA),Choline-congtaining compounds (Cho),and Creatine compounds (Cr) were measured and the ratios of NAA/Cr and Cho/Cr were determined.Meanwhile,Positive and Negative Syndrome Scale (PANSS) and Wisconsin Card Sorting Test (WCST) were also assessed in all schizophrenics.Results Both in schizophrenics with schizophrenia family history and with the other mental disorder family history,the NAA/Cr ratios showed lower than those in schizophrenics without mental disorder family history both on left prefrontal lobe and on fight thalamus ( P ＜ 0.05 ).Compared with schizophrenics without mental disorder family history,the score of negative symptoms and the perseverative errors demonstrated higher ( P＜ 0.05 or 0.01 ),the categories completed showed lower both in schizophrenics with schizophrenia family history and with the other mental disorder family history ( P＜0.05 ).The NAA/Cr ratios on left prefrontal lobe in all schizophrenics were significantly negatively related with the total score of PANSS and the responses errors (P ＜ 0.05 or P＜ 0.01 ),and positively related with the categories completed and the conceptual level responses ( P＜ 0.05 or P＜ 0.01 ).On left prefrontal lobe both in schizophrenics with schizophrenia family history and with the other mental disorder family history,the ratios of NAA/Cr were negatively related with the score of negative symptoms and the perseverative errors ( P ＜ 0.05 or 0.01 ).Conclusion The damages of neurons on prefrontal lobe and thalamus in schizophrenics with mental disorder family history may be more severe than those in schizophrenics without family history,and the damages on prefrontal lobe are related with negative symptoms and executive functioning.