无抽搐电休克治疗对精神分裂症患者脑质子波谱的影响  

Proton magnetic resonance spectroscopy study of prefrontal lobe and thalamus in schizophrenics on modified electroconvulsive therapy

作　　者：甘景梨 李晓琼 段惠峰 杨家明 王长虹[3] 杨秀双 高存友 蒋战魁 

机构地区：[1]解放军第九十一中心医院全军精神疾病防治研究所,河南焦作454003 [2]解放军第九十一中心医院医学影像中心,河南焦作454003 [3]新乡医学院第二附属医院 [4]焦作市精神病院

出　　处：《中华医学杂志》2012年第29期2063-2065,共3页National Medical Journal of China

摘　　要：目的探讨无抽搐电休克治疗（MECT）对精神分裂症患者前额叶和丘脑神经生化代谢物质的影响。方法2010年11月至2011年6月期间在解放军第九十一中心医院全军精神疾病防治研究所住院的31例精神分裂症患者，给予8次MECT。治疗前和治疗后采用多体素磁共振质子波谱（。H-MRS）分析指标为N-乙酰基天冬氨酸／肌酸复合物（NAA／Cr）、胆碱复合物／肌酸复合物（Cho／Cr），同时进行阳性与阴性症状量表（PANSS）评定。结果（1）治疗后左侧前额叶、左侧和右侧丘脑NAA／Cr值，均显著高于治疗前（1．50±0．31比1．35±0．30，t=2．07，P〈0．05；1．53±0．31比1．38±0．27，t=2．03，P〈0．05；1．51±0．29比1．36±0．26，t=2．14，P〈0．05）。（2）影响左侧前额叶NAA／Cr变化值的主要因素是发病年龄、PANSS减分率、治疗前PANSS总分和病程；影响左侧丘脑NAA／Cr变化值的主要因素是发病年龄、病程；影响右侧丘脑NAA／Cr变化值的主要因素是治疗前PANSS总分。结论无抽搐电休克治疗对精神分裂症患者前额叶和丘脑可能具有增加NAA相对浓度、修复神经元功能等作用，而这些作用可能主要与患者的发病年龄大小、病程长短和病情严重程度等有关。Objective To explore the potential effects of modified electroconvulsive therapy （MECT） in prefrontal lobe and thalamus in patients with schizophrenia by proton magnetic resonance spectroscopy （III-MRS）. Methods From November 2010 to June 2011, a total of 31 schizophrenics fulfilling the third edition of the Chinese Classification of Mental Disorders （CCMD-III） were recruited. And prefrontal lobe and thalamus were evaluated by multi-voxel 1 H-MRS before and after 8 sessions of MECT. The subjects were evaluated by the positive and negative syndrome scale （PANSS）. And the N- aeetylaspartate （NAA）, choline-containing compounds （Cho） and creatine compounds （Cr） were measured and the ratios of NAA/Cr and Cho/Cr determined. Results （ 1 ） In left prefrontal lobe and bilateral thalamus, the NAA/Cr ratio at post-treatment demonstrated higher than that at pre-treatment （ 1.50 ± 0.31 vsl.35±0.30, t=2.07, P〈0.05; 1.53 ±0.31 vs 1.38 ±0.27, t=2.03, P〈0.05; 1.51 ±0.29 vs 1.36 ± 0.26, t = 2.14, P 〈 0. 05 ）. （ 2 ） The major influencing factors of the changes of NAA/Cr in left prefrontal lobe were age of onset, decrease rate of PANSS, baseline PANSS total score and duration of illness. And the major influencing factors for left thalamus were age of onset and duration of illness while a major influencing factor for right thalamus was baseline PANSS total score. Conclusion MECT may modify brain metabolism as measured by 1H-MRS. The pattern of changes suggests possible neuroprotective effects in schizophrenics. And these effects are correlated with age of onset, duration and severity of illness.

关 键 词：精神分裂症 电休克治疗 磁共振波谱学 

分 类 号：R749.3[医药卫生—神经病学与精神病学]