首发精神病患者与健康对照组额叶腹内侧Y-氨基丁酸浓度的比较（英文）  

Comparison of the density of gamma-aminobutyric acid in the ventromedial prefrontal cortex of patients with first-episode psychosis and healthy controls

作　　者：杨志磊 朱雅靖 宋振华 梅力 张建业 陈天意 王颖婵 徐一峰 江开达 李瑶 刘登堂 

机构地区：[1]First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine [2]Shanghai Jiading District Mental Health Center [3]School of Biomedical Engineering, Shanghai Jiao Tong University [4]Shanghai Hongkou District Mental Health Center

出　　处：《上海精神医学》2015年第6期341-347,共7页Shanghai Archives of Psychiatry

基　　金：supported by the Shanghai Municipal Severe Mental Illness Key Laboratory Programme(14-K03);the Shanghai Municipal Health System Important Disease Cooperative Research Programme(2014ZYJB0002);the Shanghai Municipal Commission of Health and Family Planning Key Programme(20134006);the Shanghai Municipal Hospital Appropriate Technology Programme(SHDC12014214);the Programme of the National Natural Science Foundation of China(81371479);a research grant from the Shanghai Mental Health Center(2012-YJ-06);a grant from the Shanghai Municipal Mental Illness Clinical Medicine Center(2014)

摘　　要：背景：大脑中γ-氨基丁酸（γ-aminobutyric acid,GABA）的浓度和功能异常不仅是精神分裂症的一个重要病因学假说,而且也可能与认知功能下降和精神分裂症阴性症状相关。运用高场强磁共振波谱分析（magnetic resonance spectroscopy,MRS）的研究发现慢性精神分裂症患者额叶腹内侧（ventromedial prefrontal cortex,vmP FC）的GABA异常浓度,但患者既往使用抗精神病药物可能会对这些结果产生混杂。目标：比较首发精神病患者和健康对照组vmP FC中的GABA浓度,并评估vmP FC中GABA浓度与精神病性症状严重程度之间的关系。方法：共纳入22例首发精神病患者（10例精神分裂症患者和12例精神分裂样障碍患者）和23名健康对照者,应用单体素^1H-MRS来检测vmP FC中的GABA和其它代谢产物的浓度。22例患者中13例患者没有用过药物,9例患者使用抗精神病药物少于3天。采用阳性和阴性症状量表（the Positive and Negative Syndrome Scale,PANSS）评估患者组的精神病症状严重程度。结果：患者组vmP FC的GABA浓度的均值（SD）显著高于对照组（2.28[0.54]v.1.93[0.32]mM,t=2.62,p=0.012）。其它代谢产物的浓度——包括N-乙酰天冬氨酸（N-acetylaspartic acid,NAA）、谷氨酸（glutamic acid,GLU）和谷氨酰胺（glutamine,GLN）,在患者组和对照组之间没有显著差异。患者vmP FC中的GABA浓度与PANSS总分或三个PANSS分量表（阳性症状、阴性症状、一般精神病理）中的任何一个评分之间没有显著相关性。GABA浓度与病程之间无相关性,但与患者年龄显著相关（r=0.47,p=0.026）。结论：首发精神病患者vmP FC中的GABA浓度升高证实了该异常情况与药物使用是相互独立的。我们需要更大规模的研究来证实vmP FC中的GABA浓度与精神病症状严重程度之间不存在相关性,但这也提示脑部病理变化与临床症状之间存在若干个中间环节。Background： Abnormality in the concentration and functioning of gamma-aminobutyric acid（γ-aminobutyric acid, GABA） in the brain is not only an important hypothetical link to the cause of schizophrenia but it may also be correlated with the cognitive decline and negative symptoms of schizophrenia. Studies utilizing high field magnetic resonance spectroscopy（MRS） report abnormal density of GABA in the ventromedial prefrontal cortex（vmP FC） of patients with chronic schizophrenia, but these results may be confounded by study participants＇ prior use of antipsychotic medications.Aim： Compare the density of GABA in the vmP FC of patients with first-episode psychosis to that in healthy controls and assess the relationship of GABA density in the vmP FC to the severity of psychotic symptoms.Methods： Single-voxel ~1H-MRS was used to assess the concentration of GABA and other metabolites in the vm PFC of 22 patients with first-episode psychosis（10 with schizophrenia and 12 with schizophreniform disorder） and 23 healthy controls. Thirteen of the 22 patients were drug-na？ve and 9 had used antipsychotic medication for less than 3 days. The Positive and Negative Syndrome Scale（PANSS） was used to evaluate the severity of psychotic symptoms in the patient group. Results： The mean（sd） GABA density in the vmP FC was significantly higher in patients than in controls（2.28 [0.54] v. 1.93 [0.32] mM, t=2.62, p=0.012）. The densities of other metabolites – including N-acetylaspartic acid（NAA）, glutamic acid（GLU）, and glutamine（GLN） – were not significantly different between patients and controls. Among the patients, GABA density in the vmP FC was not significantly correlated with PANSS total score or with any of the three PANSS subscale scores for positive symptoms, negative symptoms, and general psychopathology. GABA concentration was not associated with the duration of illness, but it was significantly correlated with patient age（r=0.47, p=0.026）.Conclusions： Elevation of GAB

关 键 词：首发精神病 首发精神分裂症 未经药物治疗 磁共振波谱 Y-氨基丁酸 额叶腹内侧 中国 

分 类 号：R749.3[医药卫生—神经病学与精神病学]