首发精神分裂症阳性型患者脑功能MRI研究
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摘要
研究目的：利用DTI和MRS研究未经药物治疗的首发精神分裂症阳性型患者脑功能，探讨其病因学机制。
材料和方法：对26例患者和20例正常人行脑部常规MRI和DTI检查，两组均为右利手。选取胼胝体膝部、压部，双侧额叶白质，扣带束前部，海马头为ROI区测量FA值。其中12例患者行双侧额叶和海马2D~1H-MRS检查。对数据进行统计分析。
结果：
1．患者组、对照组常规MRI检查无阳性发现。
2．对照组左侧扣带束FA值大于右侧；患者组测量部位左右两侧相应ROI区FA值无差异。
3．患者组胼胝体压部、左右扣带束前部FA值低于对照组。
4．DTT纤维跟踪示：患者组胼胝体、扣带束纤维走行正常，在纤维跟踪图上不能比较其与对照组差异。
5．患者组左侧额叶白质Cho／Cr小于右侧；双侧额叶灰质各代谢物比值无差异；额叶白、灰质间各代谢物比值无差异。海马头NAA／Cr和Cho／Cr左侧小于右侧。
结论：
1．患者扣带束左大于右扩散异性偏侧化缺失、胼胝体压部白质纤维束受损。
2．患者额叶仅存在白质膜代谢异常而无神经元功能损害和白质纤维束完整性和方向性丧失，这可能为阳性型的特征表现。
3．患者可能在脑发育阶段已存在脑内连接异常，和左侧大脑半球，尤其是左侧边缘系统功能障碍，支持神经发育假说观点。
4．DTI和MRS可显示脑功能改变，联合运用在精神分裂症病因学研究中具有实用价值。
Objective: To perform the MRI, diffusion tensor imaging and proton MR spectroscopic imaging in first-episode and neuroleptic-naive patients with positive symptoms of schizophrenia and to have a better understanding of advanced MR technology in schizophrenia.
Methods: DTI was performed on 26 patients with positive symptoms of schizophrenia and 20 normal comparison subjects, and their fractional anisotropy values were subsequently measured in multiple brain regions. To measure FA values in genu and splenium of corpus callosum, frontal white matter, anterior cingulum, hippocampus respectively. And 12 patients were selected to perform MRS examination. Statistical analysis was performed.
Results: 1. The statistical results showed a remarkable left-greater-than-right asymmetry anisotropy in the anterior cingulum bundles in normal peoples. 2. Reduced FA was seen for splenium of corpus callosum in the schizophrenia patients than was seen in the comparison subjects. 3. Reduced FA was seen for both sides of the anterior cingulum in the schizophrenia patients, who showed a lack of normal left-greater-than-right asymmetry in the anterior cingulum than was seen in the comparison subjects. 4. The Cho/Cr in left frontal white matter was lower than that in fight of schizophrenic patients. 5. Brain metabolite levels did not differ between left anterior cingulate gray matter and right. 6. Brain metabolite levels did not differ between frontal white matter and gray matter. 7. The NAA/Cr, Cho/Cr in left hippocampus was lower than that in right of patients.
Conclusion: 1. The patients with positive symptoms of schizophrenia showed a lack of normal left-greater-than-right asymmetry seen in the comparison subjects.2. There date, while preliminary, suggest that impaired left cerebral hemisphere may be associated with positive symptoms of schizophrenia, which supports the brain dysfunction in schizophrenia. 3. Abnormalities in throughput of phospholipid membrane in frontal white matter maybe peculiarity of positive symptoms of schizophrenia. 4. The advanced MR technology was very useful in schizophrenia.
材料和方法：对26例患者和20例正常人行脑部常规MRI和DTI检查，两组均为右利手。选取胼胝体膝部、压部，双侧额叶白质，扣带束前部，海马头为ROI区测量FA值。其中12例患者行双侧额叶和海马2D~1H-MRS检查。对数据进行统计分析。
结果：
1．患者组、对照组常规MRI检查无阳性发现。
2．对照组左侧扣带束FA值大于右侧；患者组测量部位左右两侧相应ROI区FA值无差异。
3．患者组胼胝体压部、左右扣带束前部FA值低于对照组。
4．DTT纤维跟踪示：患者组胼胝体、扣带束纤维走行正常，在纤维跟踪图上不能比较其与对照组差异。
5．患者组左侧额叶白质Cho／Cr小于右侧；双侧额叶灰质各代谢物比值无差异；额叶白、灰质间各代谢物比值无差异。海马头NAA／Cr和Cho／Cr左侧小于右侧。
结论：
1．患者扣带束左大于右扩散异性偏侧化缺失、胼胝体压部白质纤维束受损。
2．患者额叶仅存在白质膜代谢异常而无神经元功能损害和白质纤维束完整性和方向性丧失，这可能为阳性型的特征表现。
3．患者可能在脑发育阶段已存在脑内连接异常，和左侧大脑半球，尤其是左侧边缘系统功能障碍，支持神经发育假说观点。
4．DTI和MRS可显示脑功能改变，联合运用在精神分裂症病因学研究中具有实用价值。
Objective: To perform the MRI, diffusion tensor imaging and proton MR spectroscopic imaging in first-episode and neuroleptic-naive patients with positive symptoms of schizophrenia and to have a better understanding of advanced MR technology in schizophrenia.
Methods: DTI was performed on 26 patients with positive symptoms of schizophrenia and 20 normal comparison subjects, and their fractional anisotropy values were subsequently measured in multiple brain regions. To measure FA values in genu and splenium of corpus callosum, frontal white matter, anterior cingulum, hippocampus respectively. And 12 patients were selected to perform MRS examination. Statistical analysis was performed.
Results: 1. The statistical results showed a remarkable left-greater-than-right asymmetry anisotropy in the anterior cingulum bundles in normal peoples. 2. Reduced FA was seen for splenium of corpus callosum in the schizophrenia patients than was seen in the comparison subjects. 3. Reduced FA was seen for both sides of the anterior cingulum in the schizophrenia patients, who showed a lack of normal left-greater-than-right asymmetry in the anterior cingulum than was seen in the comparison subjects. 4. The Cho/Cr in left frontal white matter was lower than that in fight of schizophrenic patients. 5. Brain metabolite levels did not differ between left anterior cingulate gray matter and right. 6. Brain metabolite levels did not differ between frontal white matter and gray matter. 7. The NAA/Cr, Cho/Cr in left hippocampus was lower than that in right of patients.
Conclusion: 1. The patients with positive symptoms of schizophrenia showed a lack of normal left-greater-than-right asymmetry seen in the comparison subjects.2. There date, while preliminary, suggest that impaired left cerebral hemisphere may be associated with positive symptoms of schizophrenia, which supports the brain dysfunction in schizophrenia. 3. Abnormalities in throughput of phospholipid membrane in frontal white matter maybe peculiarity of positive symptoms of schizophrenia. 4. The advanced MR technology was very useful in schizophrenia.
引文
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7、Miyamoto S, LaMantia AS, Duncan GE, et al. Recent advances in the neurobiology of schizophrenia. Mol lnterv, 2003, 3(1): 27-39.
8、Schwarzkopf SB, Lamberti JS, Jiminez M, et al. Visual evoked potential correlates of positive/negative symptoms in schizophrenia. Biol Psychiatry. 1990; 27(4): 400.
9、郝贵峰，张志珺，侯钢。首发精神分裂症结构磁共振研究进展。国外医学精神病学分册，2005，32(2)：125-128．
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2、王建平，梁耀坚，汤宜朗编著。变态心理学，北京：高等教育出版社，2005，190—205。
3、赵喜平．磁共振成像系统的原理及其应用[M]．北京：科学出版社，2000．12．
4、Prayer D, Prayer L. Diffusion-weighted magnetic resonance imaging of cerebral white matter development [J]. European Journal Radiology, 2003, 45(3):235-243.
5、Stevens JR. Anatomy of schizophrenia revisited. Schizophr Bull, 1997, 23: 373—383.
6、Maynard TM, Sikich L, Lieberman JA, et al. Neural development, cell-cell signaling, and the "two-hit"hypothesis of schizophrenia. Sehizophr Bull,2001, 27(3): 457-476.
7、Miyamoto S, LaMantia AS, Duncan GE, et al. Recent advances in the neurobiology of schizophrenia. Mol lnterv, 2003, 3(1): 27-39.
8、Schwarzkopf SB, Lamberti JS, Jiminez M, et al. Visual evoked potential correlates of positive/negative symptoms in schizophrenia. Biol Psychiatry. 1990; 27(4): 400.
9、郝贵峰，张志珺，侯钢。首发精神分裂症结构磁共振研究进展。国外医学精神病学分册，2005，32(2)：125-128．
10、王克威，谢世平，康冰，等。精神分裂症不同症状的MRI对照研究[J]。临床精神医学杂志，1998，8(2)：5-7．
11、Johnstone MS, Humphreys FH, Lang EC, et al. Schizophrenia:Concepts and clinical management.Cambridge University Press, 1999.74～100.
12、Buchsbaum MS, Tang CY, Peled S, et al. MRI white matter diffusion anisotropy and PET metabolic rate in schizophrenia [J]. Neuroreport, 1998, 9(3): 425-430.
13、Sun Z, Wang F, Cui L, et al. Abnormal anterior cingulum in patients with schizophrenia: a diffusion tensor imaging study [J]. Neuroreport, 2003, 14(14): 1833-1836.
14、Foong J, Maier M, Clark CA, et al. Neuropathological abnormalities of the corpus callosum in schizophrenia: a diffusion tensor imaging study [J]. J Neurol Neurosurg Psychiat, 2000, 68(2):242—244.
15、Deicken RF, Zhou L, SchuffN, et al. Proton magnetic resonance spectroscopy of the anterior cingulated region in schizophrenia. Schizophr Res, 1997; 27: 65-71.
16、Steel RM, Bastin ME, McConnell S, et al. Diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (~1H MRS) in Schizophrenic subjects and normal controls. Psychiatry Res, 2001; 106:161-170.
17、Brom ES, Woolston J, Frol A, et al. Hippocampal volume, spectroscopy, cognition, and mood in patients receiving corticosteroid therapy. Biol Psychiatry, 2004; 55: 538-545.
18、Babb SM, Ke Y, Lange N, et al. Oral choline increases choline metabolites in human brain, Psychiatry Res. 2004; 130: 1-9.
19、张芬茹，高成阁，邓惠兴，等。精神分裂症SPECT脑显像的影像特征及其应用价值。中国医学影像学杂志，2006；14(2)：149-150．
20、G Chouinard, L Annable, A Ross-Chouinard。Factors related to tardive dyskinesia. Am J Psychiatry 1979; 136:79-82.
21、Jellison BJ, Field AS, Msdow J, et al. Diffusion tensor imaging of cerebral white matter: apictorial review of physics, fiber tract anatomy, and tumor imaging patterns. Am J Neuroradiol, 2004,25(3): 356.
22、Melhem ER, Mori S, Mukundan G, et al. Diffusion tensor MR imaging of the brain and white matter tractography. AJR, 2002, 178: 3.
23、Lazar M, Weinstein DM, Tsuruda JS, et al. White matter tractography using diffusion tensor deflection. Hum Brain Mapp. 2003, 18: 306.
24、Ciccarelli O', Toosy AT, Parker GJ, et al. Diffusion tractography based group mapping of major white-matter pathways in the human brain. Neu-roimage. 2003, 19: 1545.
25、吴光耀，孙骏谟，田志雄，等．活体质子磁共振波谱技术分析[J]．国外医学临床放射学分册，2001，24(6)：347-350．
26、Nelson SJ. Multivoxel Magnetic Resonance Spectroscopy of Brain Tumors. Molecular Cancer Therapeutics, 2003, 2(5): 497
27、隋教秀，刘文，李永平，等。精神分裂症脑结构的核磁共振研究[J]．J Clin Psychol Med，2001，11(3)：134-136．
28、Dubb A, Gur R, Avants B, et al. Characterization of sexual dimorphism in the human corpus callosum[J]. Neuroimage, 2003, 20(1): 512-519.
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