伴有暴力倾向的精神分裂症患者低频振幅与分数低频振幅静息态功能影像学研究

目的探讨伴有暴力倾向的精神分裂症患者静息状态下脑自发神经活动特征以及其脑功能异常的神经病理生理机制。方法纳入符合ICD-10诊断标准的精神分裂症患者35例(男24例、女11例)。采用PANSS评分评估患者临床症状严重程度。利用修订版外显攻击行为量表(Modified Overt Aggression Scale,MOAS)评分将患者分为暴力组和无暴力组。应用静息态功能磁共振成像(resting state functional magnetic resonance imaging,rs-fMRI)技术,采集所有患者静息状态下脑fMRI数据,基于DPABI V2.3(Data Processing&Analysis of Brain Imaging,DPABI)软件,对数据进行预处理后得到低频振幅(amplitude of low-frequency fluctuation,ALFF)及分数低频振幅(fractional amplitude of low-frequency fluctuation,fALFF)图,采用双样本t检验比较2组图像差异。提取所有患者全脑区的ALFF、fALFF值与PANSS评分进行Pearson相关分析。结果暴力组(n=18)较无暴力组(n=17)右侧顶上回、右侧顶下缘角回ALFF值减低,而右侧小脑下部、左侧小脑下部和左侧丘脑的fALFF值增高(均经GRF校正,体素水平P<0.01,簇水平P<0.05)。Pearson相关分析显示,精神分裂症患者(n=35)右侧小脑下部、小脑蚓部、右侧颞中回ALFF值与PANSS阴性症状评分呈正相关(r=0.437、0.610、0.656);右侧角回fALFF值与PANSS阴性症状评分呈负相关(r=-0.723);左侧内侧额上回fALFF值与PANSS敌对性评分呈正相关(r=0.647,均经GRF校正,体素水平P<0.01,簇水平P<0.05)。结论相较于无暴力患者,伴有暴力倾向的精神分裂症患者多个脑区ALFF、fALFF值存在差异,提示伴有暴力行为的患者多个脑区自发神经活动异常。

Resting state functional magnetic resonance imaging study of amplitude of low-frequency fluctuation and fractional amplitude of low-frequency fluctuation in schizophrenia with violent behaviors

Objective To study the characteristics of spontaneous neural activity of schizophrenia patients under resting state,and to explore the neuropathological mechanism of brain dysfunction in schizophrenia with violent behaviors based on the methods of the amplitude of low frequency fluctuation(ALFF)and the fractional amplitude of low frequency fluctuation(fALFF),using resting state functional magnetic resonance imaging(rs-fMRI).Methods Thirty-five patients diagnosed with schizophrenia by ICD-10 were included in the study,and divided into the violent and non-violent group by the Modified Overt Aggression Scale(MOAS)score.The Positive and Negative Symptom Scale(PANSS)was used to assess the severity of clinical symptoms.The DPABI V2.3(Data Processing&Analysis of Brain Imaging,DPABI)software was run on MATLAB2017b platform,the MRI data were preprocessed and were analyzed by ALFF and fALFF.Two-sample t-test was compared by DPABI software to recognize the differences between the two groups.The Pearson correlation analysis of ALFF/fALFF and PANSS scores were carried out.Results Compared with non-violent group(n=17),the ALFF values decreased in the Parietal_Sup_R and Parietal_Inf_R(AAL),and the fALFF increased in the bilateral inferior cerebellum lobe and Thalamus_L(AAL)in violent group(n=18).All the results were corrected by GRF(voxel level P<0.01,cluster level P<0.05).Pearson correlation analysis shows that the ALFF values of all schizophrenia(n=35)were positively correlated with PANSS-NS in the right inferior cerebellum lobe,Vermis,and Temporal_Mid_R(AAL,r=0.437,0.610,0.656 respectively).And the fALFF values of all schizophrenia(n=35)were negatively correlated with PANSS-NS in the Angular_R(AAL,r=-0.723)and positively correlated with PANSS-P7 scores in the Frontal_Sup_Medial_L(AAL,r=0.647)respectively.All the results were corrected by GRF(voxel level P<0.01,cluster level P<0.05).Conclusions The ALFF/fALFF abnormalities of schizophrenia patients with violent behaviors are in multiple brain regions,suggesting that violent schizophrenia patients may have abnormal spontaneous neural activity in several brain regions.