青少年精神病自杀未遂患者脑代谢物的磁共振波谱研究
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摘要
磁共振波谱（MRS）是一种独特的技术，可以直接评估在大脑中的各种生化代谢产物的浓度。它除了具有非侵入性，较高的空间分辨率，还不需要放射性示踪剂，也不会有电离辐射，故较其他成像有独特的优势。因此常常被用来在不同的神经精神障碍，如抑郁症、精神分裂症等分子病理生理学研究。目前MRS检查的脑代谢产物主要有：N-乙酰天门冬氨酸(NAA)、胆碱化合物（Cho）、肌酸(Cr)等。
研究方法采用横断面病例-对照研究设计。（1）第一部分研究，应用MRS成像系统检测15例青少年自杀未遂抑郁症患者和15名健康对照的双侧额叶白质、海马NAA、Cho、Cr代谢产物，分别计算额叶、海马双侧NAA／Cr、Cho／Cr比率，分析患者组和对照组之间代谢指标的组间差异。（2）第二部分研究，应用MRS成像系统检测13例青少年自杀未遂精神分裂症患者与14例青少年无自杀精神分裂症患者和15名健康对照的双侧额叶白质NAA、Cho、Cr代谢产物，分别计算双侧额叶白质NAA／Cr、Cho／Cr比率，分析患者组和对照组之间代谢指标的组间差异。
结果（1）第一部分，青少年自杀未遂抑郁症组左侧额叶白质NAA／Cr(1．66±0．53)明显低于对照组(2．07±0．50)（P<0.05）；左侧海马Cho／Cr(1．34±0．50)明显高于对照组(0．98±0．34)（P<0.05）。（2）第二部分，青少年自杀未遂精神分裂症患者双侧额叶白质NAA／Cr、Cho／Cr与无自杀精神分裂症患者和健康对照对照之间无差异。
结论（1）第一部分，青少年自杀未遂抑郁症患者存在左侧额叶神经元活力下降，左侧海马细胞膜代谢异常。（2）第二部分，青少年自杀未遂精神分裂症患者双侧额叶代谢功能无明显改变。
Magnetic Resonance Spectroscopy (MRS) is a unique technique that can directly assess the concentration of various biochemical metabolites in the brain. MRS in addition to being noninvasive has a high spatial resolution and requires neither radioactive tracers nor ionizing radiation—a distinct advantage over other imaging modalities. Thus, it is used in the study of molecular pathophysiology of different neuropsychiatric disorders, such as, the major depressive disorder schizophrenia.These metabolites include N-acetylaspartate (NAA), choline-containing compounds(Cho),creatine (Cr), et al.
Methods (1)The frist study objective to identify the possible alterations of brain functioning in prefrontal white matter and hippocampus in youths with suicide-attempted depression using MRS. MRS was performed on prefrontal white matter and hippocampus in15youths with suicide-attempted depression and15healthy controls. The NAA, Cho and Cr were measured and the ratios of NAA/Cr and Cho/Cr were determined.(2)The second study objective to identify the possible alterations of brain functioning in prefrontal white matter in youths with suicide-attempted schizophrenia using MRS. MRS was performed on prefrontal white matter in13youths with suicide-attempted schizophrenia,14youths with non-suicidal schizophrenia, and15healthy controls. The NAA, Cho and Cr were measured and the ratios of NAA/Cr and Cho/Cr were determined.
Results (1)The ratios of NAA/Cr in the left prefrontal white matter of the youths with suicide-attempted depression were significantly less than that of the healthy controls(P<0.05). The ratios of Cho/Cr in the left hippocampus of the youths with suicide-attempted depression were significantly higher than that of the healthy controls(P<0.05).(2) There were no significant differences in both the ratios of NAA/Cr and Cho/Cr in youths with schizophrenia and healthy controls.
Conclusion (1)There might exist reduced neuronal function in left prefrontal.and abnormal turnover of membrane in left hippocampus in youths with suicide-attempted depression.(2) The metabolites such as NAA, Cho in white matter of frontal lobes were not significantly altered in suicide-attempted schizophrenia.
研究方法采用横断面病例-对照研究设计。（1）第一部分研究，应用MRS成像系统检测15例青少年自杀未遂抑郁症患者和15名健康对照的双侧额叶白质、海马NAA、Cho、Cr代谢产物，分别计算额叶、海马双侧NAA／Cr、Cho／Cr比率，分析患者组和对照组之间代谢指标的组间差异。（2）第二部分研究，应用MRS成像系统检测13例青少年自杀未遂精神分裂症患者与14例青少年无自杀精神分裂症患者和15名健康对照的双侧额叶白质NAA、Cho、Cr代谢产物，分别计算双侧额叶白质NAA／Cr、Cho／Cr比率，分析患者组和对照组之间代谢指标的组间差异。
结果（1）第一部分，青少年自杀未遂抑郁症组左侧额叶白质NAA／Cr(1．66±0．53)明显低于对照组(2．07±0．50)（P<0.05）；左侧海马Cho／Cr(1．34±0．50)明显高于对照组(0．98±0．34)（P<0.05）。（2）第二部分，青少年自杀未遂精神分裂症患者双侧额叶白质NAA／Cr、Cho／Cr与无自杀精神分裂症患者和健康对照对照之间无差异。
结论（1）第一部分，青少年自杀未遂抑郁症患者存在左侧额叶神经元活力下降，左侧海马细胞膜代谢异常。（2）第二部分，青少年自杀未遂精神分裂症患者双侧额叶代谢功能无明显改变。
Magnetic Resonance Spectroscopy (MRS) is a unique technique that can directly assess the concentration of various biochemical metabolites in the brain. MRS in addition to being noninvasive has a high spatial resolution and requires neither radioactive tracers nor ionizing radiation—a distinct advantage over other imaging modalities. Thus, it is used in the study of molecular pathophysiology of different neuropsychiatric disorders, such as, the major depressive disorder schizophrenia.These metabolites include N-acetylaspartate (NAA), choline-containing compounds(Cho),creatine (Cr), et al.
Methods (1)The frist study objective to identify the possible alterations of brain functioning in prefrontal white matter and hippocampus in youths with suicide-attempted depression using MRS. MRS was performed on prefrontal white matter and hippocampus in15youths with suicide-attempted depression and15healthy controls. The NAA, Cho and Cr were measured and the ratios of NAA/Cr and Cho/Cr were determined.(2)The second study objective to identify the possible alterations of brain functioning in prefrontal white matter in youths with suicide-attempted schizophrenia using MRS. MRS was performed on prefrontal white matter in13youths with suicide-attempted schizophrenia,14youths with non-suicidal schizophrenia, and15healthy controls. The NAA, Cho and Cr were measured and the ratios of NAA/Cr and Cho/Cr were determined.
Results (1)The ratios of NAA/Cr in the left prefrontal white matter of the youths with suicide-attempted depression were significantly less than that of the healthy controls(P<0.05). The ratios of Cho/Cr in the left hippocampus of the youths with suicide-attempted depression were significantly higher than that of the healthy controls(P<0.05).(2) There were no significant differences in both the ratios of NAA/Cr and Cho/Cr in youths with schizophrenia and healthy controls.
Conclusion (1)There might exist reduced neuronal function in left prefrontal.and abnormal turnover of membrane in left hippocampus in youths with suicide-attempted depression.(2) The metabolites such as NAA, Cho in white matter of frontal lobes were not significantly altered in suicide-attempted schizophrenia.
引文
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2.殷大奎.齐心协力、脚踏实地、全面推进新世纪精神卫生工作--全国第三次精神卫生工作会议报告.中国心理卫生杂志.2002,16(1)：4—8.
3. Asberg M,Traskman L,Thoren P.5-HIAA in the cerebrospinal fluid:a biochemic suicide predictor. Arch Gen Psychiatry.1976,33(10):1193-1197.
4.于彩霞,冀德才,刘勇,等.抑郁症自杀未遂患者血清总胆固醇水平研究.临床精神医学杂志2008,18(5)：339-340.
5.洪武,方贻儒,王祖承.脑源性神经营养因子和抑郁症.中国神经精神疾病杂志.2007,33(11)：702-703.
6. Maria A, Oquendo J, John Mann. Neuroimaging findings in major depression, suicidal behavior and aggression. Clin Neurosc Res,2002,1:377.
7.杨正汉,冯逢,王霄英,等.磁共振成像技术指南(修订版).人民军医出版社.333-339.
8.李进,况伟宏,邹可,等.自杀未遂抑郁症患者海马代谢的磁共振质子波谱研究.四川大学学报(医学版).2009；40(1)：59-62.
9.沈渔邨,于欣,刘协和,等.精神病学(第五版)
10、高鸿云.青少年自杀.中国实用儿科杂志,2007,22(3)：169-172.
11、景璐石,黄颐,冯军.青少年自杀的流行病学研究进展.中国行为医学科学,2008,17(1)：92-93.
12、Konarski JZ, McIntyre RS, Kennedy SH,et al. Volumetric neuroimaging investigations in mood disorders: bipolar disorder versus major depressive disorder. Bipolar Disord.2008,10:1-37.
13、Fossuti P, Ergis AM, Allilaire JF.Escutive functioning in unipolar depresion:a review.Encephale,2002,28:97-107.
14、王雪琦,路长林,孙学军,等.侧脑室微量注射神经生长因子对实验性抑郁症大鼠抑郁行为和海马神经元损伤的影响.中国行为医学科学,2002,11(5)：481-484.
15、Tsai G, Coyle JT. N-acetylaspartate in neumpsychiatric disorders. Prog Neurobiol,1995,46:531-540.
16、Rao NP, Venkatasubramanian G, Gangadhar BN. Proton magnetic resonance spectroscopy in depression.Indian J Psychiatry.2011,53(4):307-311.
17、Wang Y, Jia Y, Xu G, et al.Frontal white matter biochemical abnormalities in first-episode, treatment-naive patients with major depressive disorder: A proton magnetic resonance spectroscopy study.J Affect Disord.2012Feb,136(3):620-6.
18、孙彦,高成阁,马现仓,等.重性抑郁症首次发病患者额叶、海马磁共振质子波谱分析及其与认知功能的相关性.中华精神科杂志,2007,40(2)：70-73.
19、Kate T, Inubushi T, Kato N. Magnetic resonance spectroscopy in affeetive disordem.J Neuropsyehiatry Clin Neurosei,1998,10:133-147.
20. Schennach—Wolff R,Jager M, Seemuller F,et al. Outcome of suicidal patients with schizophrenia:results from a naturalistic study. Acta Psychiatr Scand.2010,121(5):359-370.
21.高云翔,冯文魁.精神疾病患者自杀行为特征分析.包头医学院学报.2009,25(6)：27-28.
22. Wright IC, Rabe-Hesketh S, Woodruff PW, et al.Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiatry.2000,157:16-25.
23. Steen RG, Hamer RM, Lieberman JA.Measurement of brain metabolites by1H magnetic resonance spectroscopy in patients with schizophrenia:a systematic review and meta-analysis. Neuropsychopharmacology.2005,30:1949-1962.
24. Stecn RG, Hamer RM, Lieberman JA. Measurement of brain metabolites by1H magnetic resonance spectroscopy in patients with schizophrenia:a systematic review and meta-analysis. Neumpsychopharmacology.2005,30(11):1949.1962.
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