未经治疗的强迫障碍患者大脑灰质体积改变：基于MRI体素的形态学分析研究  

Alterations of brain gray matter volume in untreated patients with obsessive-compulsive disorders： a high resolution MRI and voxel-based morphometry study

作　　者：马丽沙[1] 徐曙[1] 黄茹燕[1] 肖朝勇[2] 李宗鸿[2] 胡君[2] 李成林[2] 刘文[2] 

机构地区：[1]南京医科大学附属脑科医院医学心理科,南京210029 [2]南京医科大学附属脑科医院影像科,南京210029

出　　处：《中华神经医学杂志》2014年第12期1198-1202,共5页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金面上项目（81171277）

摘　　要：目的应用磁共振成像（MRI）基于体素的形态学分析法（VBM）探讨未经治疗的强迫障碍（OCD）患者大脑灰质体积改变及其与临床症状之间的相关性。方法选择自2012年1月至2013年12月于南京脑科医院失眠、神经症门诊就诊的46例OCD患者和31例健康对照者，对其行磁共振扫描；使用SPM8、VBM8、REST等软件对影像学数据进行处理分析；采用耶鲁-布朗强迫量表（Y-BOCS）、17项汉密尔顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA）等评估患者临床症状。在控制受试性别、年龄、受教育年等因素前提下，分析强迫障碍患者平均大脑灰质体积改变与临床症状严重程度之间的关系。结果和对照组相比，OCD组的大脑左侧距状裂周围皮层（BA18：MNI坐标：x=-17，y=-77，z=-5；相连体素：673；t=-4．426；P〈0．01未校正）、左侧前楔叶（BA7；MNI坐标：：x=-2，y=-51，z=-44；相连体素：1420；t=-4．222；P〈0．01未校正）及右侧扣带中回（BA32；MNI坐标：x=12，y=20，z=-44；相连体素：618；t=-4．716；P〈0．01未校正）等部位的灰质体积显著降低，差异均有统计学意义；且左侧距状裂周围皮层灰质体积的降低和YBOCs总分呈显著正相关（r=0．380，P=0．009）。结论左侧距状裂周围皮质、右侧扣带回、左侧楔前叶的灰质体积改变构成OCD的病理生理学基础。左侧距状裂周围皮质的灰质体积改变能客观地反映OCD的严重程度。Objective To investigate the correlations between the gray matter （GM） volume changes and the clinical characteristics manifestations in untreated obsessive-compulsive disorder （OCD） patients using high resolution MR/and voxel-based morphometry （VBM） method. Methods Forty-six untreated patients with OCD, admitted to our hospital from January 2012 to December 2013 and fulfilled our inclusion criteria, and 31 age-, gender-, and education-matched healthy controls were chosen in our study; they were scanned with magnetic resonance imaging （MRI） for VBM by using SPM8, VBM8 and REST software tools. The Yale-Brown Obsessive Compulsive Scale （Y-BOCS）, Hamilton Rating Scale for Depression 17-Item （HAMD-17） and Hamilton Anxiety Rating Scale （HAMA） were used to assess the clinical symptoms. The relationship between the average gray matter volume and the severity of clinical symptoms in patients with OCD was analyzed while such elements as gender, age, and the years of education were controlled. Results As compared with the controls, the studied patients with OCD showed significantly reduced gray matter volume in the left calcarine （BA18; MNI coordinate： x=-17, y=-77, z=-5; connected voxels： 673; t=-4.426; P〈0.01 uncorrected）, left precuneus （BA7; MNI coordinate： x=-2, y=-51, z=-44; counectedvoxels：1420; t=-4.222; P〈0.01uncorrected） andrightcingnlate gyrus（BA32; MNI coordinate： x=12, y=20, z=44; connected voxels： 618; t=-4.716; P〈0.01 uncorrected）. Significant positive correlation was observed between the decreased volume in left calcarine and total YBOCS scores （r=0.380, P=-0.009）. Conclusion The gray matter volume changes of left calcarine, left precuneus and fight cingnlate gyrus underlie the pathophysiology of OCD; the gray matter volume change of left calcarine can objectively reflect the severity of OCD.

关 键 词：强迫障碍 基于体素的形态学分析法 磁共振 扣带回 楔前叶 枕叶 

分 类 号：R749.7[医药卫生—神经病学与精神病学]