广泛性焦虑障碍和强迫障碍的基于体素的大脑灰质体积研究  

Different traits of gray matter volume in general anxiety disorder and obsessive compulsive disorder: A voxel-based morphometric study

作　　者：阎浩[1] 黄悦勤[1] 刘肇瑞[1] 韩鸿宾[2] 张岱[1] 

机构地区：[1]北京大学第六医院,北京大学精神卫生研究所,卫生部精神卫生学重点实验室(北京大学),北京100191 [2]北京大学第三医院放射科,北京100191

出　　处：《中国心理卫生杂志》2015年第3期217-225,共9页Chinese Mental Health Journal

基　　金：“十一五”科技支撑计划“神经症早期识别与治疗方案优化研究”(2007BAI17B01)

摘　　要：目的:应用磁共振成像(MRI)技术探讨广泛性焦虑障碍(GAD)和强迫障碍(OCD)患者大脑灰质体积的特征性表现。方法:选取符合精神障碍诊断与统计手册第四修订版(DSM-IV-TR)或疾病和有关健康问题的国际统计分类第十次修订本(ICD-10)诊断标准的28例GAD、25例OCD及39例健康对照。全部研究对象完成高分辨率结构磁共振成像扫描,使用汉密顿焦虑量表(HAMA)和耶鲁布朗强迫量表(Y-BOCS)评估患者的焦虑或强迫症状严重程度。在全脑范围内采用基于体素的形态学分析方法,分别比较各组研究对象之间灰质体积的差异,并探讨GAD和OCD患者全脑灰质体积与HAMA和Y-BOCS总分的相关性。结果:与健康对照相比,GAD左侧前扣带回脑区灰质体积增加(P=0.016,小体积校正),OCD患者双侧眶额皮层等脑区灰质体积下降(P<0.001,未校正);GAD患者较OCD患者在双侧眶额皮层等多个脑区灰质体积增加(P<0.001,未校正)。GAD患者的HAMA总分与右侧颞叶的灰质体积增加相关,而OCD患者的HAMA总分则与眶额皮层等脑区的灰质体积变化相关(P<0.001,未校正)。讨论:GAD和OCD患者并未共享相同的灰质体积异常脑区,两种疾病可能具有完全不同的大脑结构特征,并且其焦虑症状具有不同的神经机制。Objective：To explore the traits of gray matter volume in general anxiety disorder （GAD）and ob-sessive compulsive disorder （OCD）by using magnetic resonance imaging （MRI）technique.Methods：Twenty-eight GAD,25 OCD and 39 normal controls were recruited.All patients were met the Diagnostic and Statistical Mannal of Mental Disorders,Fourth Edition,Text Revision （DSM-IV-TR）or the International Statistical Classifica-tion of Disease and Related Health Problems Tenth Revision （ICD-10）diagnostic criteria for GAD or OCD.All subjects underwent structural MRI scan.The severity of anxiety and OCD symptoms were rated in all patients with the Hamilton Anxiety Rating Scale （HAMA）and the Yale-Brown Obsessive Compulsive Scale （Y-BOCS）.The gray matter volume （GMV）was compared between all groups by using the voxel-based morphometry （VBM）a- nalysis.The correlation analysis between GMV and total scores of HAMA and Y-BOCS was performed in GAD and OCD.Results：The GMV was increased in regions including left anterior cingulate cortex in GAD （P =0.016,small volume correction）,while only decreased GMV was observed in OCD in bilateral orbitofrontal cortex （OFC）（P 〈0.001,uncorrected）.GAD had larger GMV than OCD in several regions including bilateral OFC （P 〈0.001,un-corrected）.The higher total score of HAMA was associated with increased GMV of right temporal cortex in GAD, and with the GMV of OFC in OCD （P 〈0.001,uncorrected）.Conclusion：No sharing of GMV abnormalities in GAD and OCD was observed in the current study.The traits of brain structure and the potential neural substrate of anxiety symptom in GAD and OCD may be significantly different.

关 键 词：广泛性焦虑障碍 强迫障碍 基于体素的形态学分析 灰质体积 

分 类 号：R749.72[医药卫生—神经病学与精神病学]