精神分裂症临床特征与前额叶、丘脑氢质子磁共振波谱的相关性

目的 探讨不同临床特征的精神分裂症患者前额叶、丘脑氢质子磁共振波谱(1H-MRS)特点及其相关性.方法 将2007年8月至2010年4月期间在解放军第九十一中心医院全军精神疾病防治中心住院,符合中国精神障碍分类与诊断标准第3版的159例精神分裂症患者(患者组),分为男性(88例)与女性(71例)、首发(54例)与非首发(105例)、阴性(125例)与阳性(34例)、服药(96例)与未服药(63例)等不同亚组,在入组时采用多体素1H-MRS检测双侧前额叶和丘脑N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr),完成NAA/Cr值、Cho/Cr值的计算,并与健康对照组(45名)进行比较;患者组入组时同时进行阳性和阴性症状量表(PANSS)和威斯康星卡片分类测验(WCST)评定.结果 不同亚组患者的左侧前额叶、左侧丘脑NAA/Cr值均低于对照组(均P＜0.05),非首发、阴性、服药患者的右侧丘脑NAA/Cr值(分别为1.48 ±0.34,1.40±0.35,1.47 ±0.36)也均低于对照组(1.62±0.37),差异有统计学意义(t值分别为2.25、3.56、2.28,均P＜0.05或0.01);阴性患者的右侧丘脑NAA/Cr值低于阳性患者(1.60±0.37),差异有统计学意义(t =2.92,P＜0.01).未服药患者的右侧丘脑NAA/Cr值与病程显著负相关(r=-0.38,P＜0.05),Cho/Cr值与病程显著正相关(r=0.43,P＜0.01);阴性患者的右侧丘脑NAA/Cr值与PANSS总分和阴性症状分均负相关(r值分别为-0.36、-0.40,P＜0.05);不同亚组患者的左侧前额叶NAA/Cr值与PANSS总分、阴性症状分、WCST的错误应答数、持续错误数均负相关,与分类数、概念化水平均正相关(P＜0.05或0.01).结论 精神分裂症患者左侧前额叶和左侧丘脑可能均存在神经元功能和(或)结构的损害,非首发、阴性症状为主、既往服药等临床特征的患者可能还存在右侧丘脑异常,病程、临床症状等因素对质子波谱特点的影响不完全相同,应区别对待.

Proton magnetic resonance spectroscopy of prefrontal lobe and thalamus in schizophrenics: correlation with clinical characteristics

Objective To explore the characteristics of different subtypes of schizophrenics on prefrontal lobe and thalamus by proton magnetic resonance spectroscopy (1H-MRS) and its relationship.Methods From August 2007 to April 2010 at our center,a total of 159 schizophrenics fulfilling the third edition criteria of Chinese Classification of Mental Disorders (CCMD-Ⅲ) were recruited.And prefrontal lobe and thalamus were evaluated by muhi-voxel 1H-MRS.There were 88 males and 71 females.There were first-episode (n =54) and not-first-episode (n =105 ),negative subtype ( n =125 )and positive subtype ( n =34 ),medicated ( n =96) and non-medicated ( n =63 ) by different criteria.The levels of N-acetylaspartate ( NAA),choline-containing compounds (Cho) and creatine compounds (Cr) were measured and the ratios of NAA/Cr and Cho/Cr determined.Positive and negative syndrome soale (PANSS) and Wisconsin card sorting test (WCST) were also assessed.Only 45 normal controls received 1H-MRS.Results On left prefrontal lobe and left thalamus,the NAA/Cr ratios in different subtypes of patients were lower than those in normal controls ( P ＜ 0.05 or 0.01 ).The NAA/Cr ratios in patients of non-first-episode ( 1.48 ± 0.34),negative subtype ( 1.40 ± 0.35 ) and medicated ( 1.47 ± 0.36 ) on right thalamus were also lower than those in normal controls ( 1.62 ± 0.37,t =2.25,3.56,2.28,P ＜ 0.05 or P ＜ 0.01 ).Compared with positive subtype schizophrenics,the NAA/Cr ratios in those of negative subtype on right thalamus were lower ( 1.40 ± 0.35 vs 1.60 ± 0.37,t =2.92,P ＜ 0.01 ).On right thalamus of nonmedicated schizophrenics,there was a negative correlation between the duration of illness and the ratio of NAA/Cr (r =- 0.38,P ＜ 0.05 ) and a positive correlation between the duration of illness and the ratio of Cho/Cr (r =0.43,P ＜0.01 ).On right thalamus of negative subtype schizophrenics,the ratios of NAA/Cr were negatively correlated with the total score of PANSS and the score of negative factor respectively ( r =-0.36,-0.40,P＜0.05).On left prefrontal lobe of different subtypes,the ratios of NAA/Cr were negatively correlated with the total score of PANSS,the score of negative factor,responses errors and persistent errors (P ＜ 0.01 ) and positively correlated with completed categories and conceptual level responses ( P ＜ 0.05 or P ＜ 0.01 ).Conclusion Abnormalities in neuronal function and/or integrity are present on left prefrontal lobe and left thalamus in schizophrenics.And right thalamus is probably involved in non-first-episode subtype,negative subtype and non-medicated subtype.Different subtypes of schizophrenics may have different characteristics of 1 H-MRS due to the duration of illness and their clinical symptoms.