首发未经治疗的强迫症患者局部脑血流变化及其与执行功能缺陷的关系  

A study on the correlation between the regional cerebral blood flow and the executive function damage in first-episode untreated patients with obsessive-compulsive disorder

作　　者：岳计辉[1] 温盛霖[2] 程敏锋[2] 程木华[3] 

机构地区：[1]中山大学附属第五医院精神心理医学科,珠海519000 [2]中山大学附属第三医院精神心理科 [3]中山大学附属第三医院核医学科

出　　处：《中国神经精神疾病杂志》2012年第10期603-607,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：广东省科技计划基金(编号:2010B031600311)

摘　　要：目的检测强迫症患者大脑局部脑血流(Regional Cerebral Blood flow,rCBF),分析其与执行功能损害的关系。方法对26例强迫症患者及20例正常对照者,在静息和激活(即执行认知活动)状态下,应用SPECT进行脑rCBF显像。采用统计参数图(Statistical Parametric Mapping,SPM)分析强迫症患者大脑rCBF变化特点。应用威斯康星卡片分类测验改良版(Modified Wisconsin Card Sorting Test,M-WCST)评价其执行功能。结果与对照组相比,在激活状态下患者组的基底节和左枕叶rCBF增高(Z>3.29,P<0.001),静息状态下左顶下小叶及小脑蚓部rCBF降低(Z>3.29,P<0.001);患者组WCST的完成分类数(4.13±2.00)、正确应答数(67.13±10.43)、错误应答数(47.13±22.41)、持续错误数(18.10±11.33)等成绩均差于正常对照组[分别为(5.43±1.10)、(83.37±14.22)、(27.43±13.47)、(5.53±3.36)](P<0.05或P<0.01)。患者组WCST与左侧额叶直回、眶回CBF明显相关(Z>3.29,P<0.001)。结论强迫症患者存基底节、枕叶和小脑rCBF灌注异常,执行功能损伤与眶额叶功能有关;强迫症病理机制包括眶额叶-基底节循环,及枕叶和小脑功能紊乱。Objective To analyze the correlation of the regional cerebral blood flow （rCBF） with the damage on executive function in first-episode untreated patients with obsessive-compulsive disorder （OCD）. Methods The rCBF imaging was conducted on 26 OCD and 20 normal controls by using the single photon emission computed to- mography （SPECT） under the resting condition and active condition （active executive function）. Statistical Parametric Mapping （SPM） was used to analyze rCBF data. Modified Wisconsin Card Sorting Test （M-WCST） was used to evalu- ate the executive function. Results In the patients group, the rCBF in the basal ganglia and left inferior parietal lobule was higher （Z 〉 3.29 ,P 〈 0.001 ）under active condition while the rCBF in the left inferior parietal lobule and vermis cerebelli was lower （Z 〉 3.29,P 〈 0.001 ）under resting condition. The performance on the M-WCST items was significantly poorer in patient group than in control group （P 〈 0.05 or P 〈 0.01 ）. These M-WCST items included the finished classified items [ （4.13 ± 2.00） vs. （5.43 ± 1.10）], the correct answer items [（67.13 ± 10.43） vs. （83.37 ± 14.22）], the wrong answer items [（47.13 ± 24.41） vs. （27.43 ± 13.47）] and the lasting wrong answer items [（18.10 ± 11.33） vs. （5.53 ± 3.36）]. There was no significant correlation between the WCST and rCBF in the gyrus rectus and gyri orbitales in the left frontal lobe. Conclusions Patients with OCD have abnormalities on the rCBF per- fusion in the basal ganglia, lobus occipitalis and cerebellum. The damage on executive function in OCD is related to the function of the orbital frontal lobe. Thus, obsessive-compulsive disorder may involve the dysfunction in the orbital frontal-basal ganglia loop, lobus occipitalis and cerebellum.

关 键 词：强迫症 局部脑血流 SPM执行功能 

分 类 号：R749.7[医药卫生—神经病学与精神病学]