广泛性焦虑症首次发病患者治疗前后前额叶皮质及海马神经生化物质的变化  

Changes of neuro-biochemical in bilateral frontal lobe and hippocampus in first episode patients with generalized anxiety disorder before and after treatment

作　　者：童梓顺[1] 肖攀攀[1] 刘赟[1] 

机构地区：[1]广州市脑科医院(广州市惠爱医院,广州医科大学附属脑科医院),510370

出　　处：《临床精神医学杂志》2015年第1期23-26,共4页Journal of Clinical Psychiatry

摘　　要：目的:观察广泛性焦虑症(GAD)首次发病患者坦度螺酮治疗前后双侧前额叶皮质及海马神经生化物质的变化。方法:对39例首发的GAD患者(GAD组)给予坦度螺酮治疗8周;分别于治疗前后进行汉密尔顿焦虑量表(HAMA)评分及磁共振质子波谱分析(1H-MRS)检测双侧前额叶及海马N-乙酰天门冬氨酸(NAA)、谷氨酸复合物(Glx)、胆碱复合物(Cho)、肌酸(Cr)水平;并与30名正常对照者(正常对照组)比较。结果:治疗前GAD组右侧额叶NAA/Cr、Cho/Cr值显著低于正常对照组(P<0.05或P<0.01),Glx/Cr值明显高于正常对照组(P<0.01);治疗后右侧额叶NAA/Cr、Cho/Cr值显著高于正常对照组(P<0.05或P<0.01);治疗前后左侧额叶及双侧海马各代谢指标相对浓度与正常对照组差异无统计学意义。相关分析显示,GAD组HAMA总分与右侧额叶NAA/Cr呈负相关(r=-0.732),与Glx/Cr呈正相关(r=0.569)(P均<0.01)。结论:GAD患者发病初期即存在右侧前额叶神经元代谢异常;坦度螺酮抗焦虑疗效可能与其调整脑组织代谢有关。Objective： To investigate the changes of neuro-biochemical in bilateral frontal lobe and hippocampus in first episode patients with generalized anxiety disorder（ GAD） before and after tandospirone treatment. Method： Thrity-nine first episode GAD patients（ GAD group） were treated by tandospirone for 8weeks. Before and after treatment,they were assessed by Hamilton anxiety scale（ HAMA）,and were examined by magnetic resonance proton spectrum analysis（^1H-MRS） to detecte the levels of n-acetylaspartate（ NAA）,choline-congtaining compounds（ Cho）,glutamic acid compounds（ Glx） and creatine compounds（ Cr） in bilateral prefrontal lobe and hippocampus. The resules of1H-MRS were compared with 30 normoal congtrols（ control group）. Results： Compared to the control group,the ratios of NAA / Cr and Cho / Cr in right frontal lobe in the GAD group before treatment were remarkablely lower（ P〈0. 05 or P〈0. 01）,the Glx / Cr was remarkablely higher（ P〈0. 01）; and after treatment,the ratios of NAA / Cr and Cho / Cr in right frontal lobe were remarkablely higher（ P〈0. 05 or P〈0. 01）. But the ratios of NAA / Cr,Glx / Cr,Cho / Cr in left frontal lobe and bilateral hippocampal before and after treatment were not significantly different from those in control group. The scroe of HAMA was negatively correlated with the ratios of NAA / Cr and Cho / Cr（ r =- 0. 732）,positively correlated with the ratio of Glx / Cr（ r = 0. 569） in the right frontal lobe in the GAD group（ all P〈0. 01）. Conclusion：The neurons metabolic abnormalities in right frontal lobe exist in early onset of GAD patients. The anti-anxiety effect of tandospirone is probably correlated with the regulation of abnormal metabolism of brain tissue.

关 键 词：广泛性焦虑症 坦度螺酮 氢质子磁共振成像波谱 神经生化物质 

分 类 号：R749.4[医药卫生—神经病学与精神病学]