伴有执行功能障碍的精神分裂症患者汉字工作记忆前额叶激活模式  

The activation model of the prefrontal cortex in schizophrenia accompanied by dysexecutive syndromes during the Chinese words working memory tasks： an fMRI study

作　　者：吴大兴[1] 谭长连[2] 颜莉蓉[4] 胡德文[4] 胡治平[3] 姚树桥[1] 

机构地区：[1]中南大学湘雅二医院医学心理研究中心,长沙410011 [2]中南大学湘雅二医院放射科,长沙410011 [3]中南大学湘雅二医院神经内科,长沙410011 [4]国防科技大学机电工程与自动化学院

出　　处：《中国行为医学科学》2008年第2期134-137,共4页Chinese Journal of Behavioral Medical Science

基　　金：国家自然科学基金资助项目（30100054,30570609）;国家杰出青年科学基金资助项目（60225015）

摘　　要：目的探讨伴有执行功能障碍的精神分裂症患者与正常人在执行汉语数字工作记忆认知作业时大脑额叶皮层的激活特征及其异同。方法利用功能磁共振成像技术，观察9例精神分裂症患者和13名年龄、教育程度与患者组相匹配的正常人在进行汉语数字工作记忆认知作业时大脑激活区域的位置、范围和强度。采用威斯康星卡片分类测验（WCST）评估额叶执行功能。结果精神分裂症患者较正常人WCST成绩差、工作记忆作业时反应时延长[（1487±509）ms；（1073±255）ms，t=2．53，P〈0．05]，正确率低[（73．8±20．5）％；（91．2±14．6）％，t=2．34，P〈0．05]。正常组进行汉语言语工作记忆作业时左右额叶均有激活，且以右侧额叶为主。伴有执行功能障碍的精神分裂症组左右额叶无差异。正常组减精神分裂症组，有差异的激活区以左侧前额区（BA6／24／32／47）为主。精神分裂症组减正常组，差异以右侧前额区（BA9／44／45）为主。结论伴有执行功能障碍的精神分裂症患者执行汉语工作记忆时额叶皮层通路激活异常。Objective To investigate the different pattern of brain prefrontal cortex （PFC） activation in the Chinese Words item recognition working memory（WM） task between schizophrenia （Sch） patients accompanied by dysexecutive syndromes and normal healthy subjects（control）. Methods Functional magnetic resonance imaging （fMRI） was performed on 9 Sch and 13 normal groups. The subjects were asked to conduct the WM task visually presented on the screen. Function of PFC was assessed by Wisconsin Card Sorting Test （WCST）. Results The reaction time [ （ 1487 ± 509 ） ms vs （ 1073 ± 255 ） ms, t = 2.53, P 〈 0.05 ] had delayed and correct rate [（73.8 ±20.5）% vs （91.2 ±14.6）%, t=2.34, P〈0.05] had decreased and WCST result had lowed when patients were being taken the WM task, and results were significant difference worse than normal group. Brain activation in Chinese words item-recognition task involves in broadly left and right hemisphere cortex and the right prefrontal lobes is dominant in normal subjects, but no significant difference was found between patients＇ bilateral hemisphere. Both bilateral frontal lobe especially the right lobe were activated during Chinese Words WM task in control group, while on significant difference was found between left and right frontal lobe in Sch group. Activated areas with difference were mainly found in left prefrontal cortex （BA6/24/32/47） when control groups data sub- tract Sch groups （ control 〉 Sch）, while those mainly found in right prefrontal cortex （ BA9/44/45 ） when Sch groups data subtract control groups （ Sch 〉 control）. Conclusion These findings suggested that the prefrontal cortex of Sch patient accompanied by dysexecutive syndromes have some functional activation deficits when conducting the Chinese Words phonological working memory tasks.

关 键 词：精神分裂症 前额叶 执行功能障碍 汉字言语工作记忆 功能磁共振成像 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R749.94[医药卫生—临床医学]