伴发迟发性运动障碍精神分裂症患者大脑皮质形态学磁共振成像研究  

Brain cortex morphology abnormalities in schizophrenic patients with tardive dyskinesia:A magnetic resonance imaging study

作　　者：于婷[1] 范丰梅[1] 李艳丽[1] 杨贵刚[1] 谭淑平[1] 王志仁[1] 杨甫德[1] 周东丰[2] 谭云龙[1] 

机构地区：[1]北京回龙观医院北京大学回龙观临床医学院,北京100096 [2]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

出　　处：《中国心理卫生杂志》2017年第7期518-522,共5页Chinese Mental Health Journal

基　　金：北京市自然科学基金重点项目(7151005)

摘　　要：目的:分析伴发迟发性运动障碍(TD)精神分裂症患者大脑皮质形态学特征及其与异常不自主运动严重程度间的关联,探讨TD发生可能的病理机制。方法:研究纳入伴发TD精神分裂症患者(TD组)32例、不伴发TD精神分裂症患者(非TD组)31例及健康对照(对照组)21例,TD和非TD组合并为精神分裂症组。分别采用阳性和阴性症状量表(PANSS)、异常不自主运动量表(AIMS)评估患者的精神病理和异常不自主运动症状;用磁共振成像技术采集头颅磁共振成像数据,应用Freesurfer软件计算大脑皮质体积、厚度、表面积及皮质下结构体积,比较3组间皮质形态学差异。结果:精神分裂症组右伏隔核、双海马、左额上回、左中央前上沟皮质体积以及左中央前上沟表面积比对照组小;TD组较非TD组右伏隔核体积小,左中央前上沟皮质体积、表面积大(均P<0.05);以氯丙嗪当量和PANSS阴性症状分为协变量进行协方差分析,TD组左中央前上沟皮质体积、表面积仍较非TD组大[(2.03±0.07)×10~3mm^3 vs.(1.68±0.07)×10~3 mm^3,(1.01±0.03)×10~3 mm^2 vs.(0.84±0.03)×10~3 mm^2;均P<0.05]。相关分析结果显示,精神分裂症组右额下回皮质厚度与PANSS阳性症状分、一般病理分负相关,与PANSS总分正相关;左枕颞侧沟皮质体积与PANSS一般病理分、PANSS总分负相关;右额下回皮质体积与PANSS阳性症状分正相关;右顶内沟顶横沟皮质体积与PANSS阳性症状分正相关。TD组AIMS总分与左中央前上沟皮质体积正相关(r=0.46,P<0.01)。结论:TD患者左中央前上沟皮质体积、表面积增加,且与TD症状严重程度有关;左中央前上沟在TD的发病机制中可能起运动补偿作用。Objective： To investigate the possible pathological mechanisms of tardivc dyskinesia （TD） by an- alyzing brain cortex morphological changes and it＇s correlation to abnormal involuntary movement in schizophrenic patients with TD. Methods： Thirty-two schizophrenia patients with TD （TD group）, 31 schizophrenia patients with- out TD （ non-TD group） and 21 healthy volunteers （ control group） were recruited. Combined TD and non TD group into schizophrenia group. The psychopathological symptoms and abnormal involuntary movement were as- sessed with the Positive and Negative Syndrome Scale （PANSS） and Abnormal Involuntary Movement Scale（AIMS）. The brain magnetic resonance imaging （MRI） data and Freesurfer software were used to measure the gray matter volume, cortical thickness, cortical surface area and volume of sub-cortical regions among the three groups. Results： Schizophrenia group had significantly smaller gray matter volume in right nucleus accumbens, bilat- eral hippocarnpus, left superior frontal gyms, left precentral sulcus superior part, and cortical surface area in left pre- central sulcus superior part than the controls. The TD group had significantly smaller gray matter volume in right nucleus accumbens, larger gyms gray matter volume and cortical surface area in left precentral sulcus superior part than non-TD group （Ps 〈0. 05）. To test the difference between TD and non-TD group further, the chlorpromazine equivalent dose and PANSS negative scores was controlled, the TD group still had significantly larger gray matter volume and surface area in left precentral sulcus superior part than the non-TD group [ （2. 03 ± 0.07） × 10^3mm3 vs. （1.68 ±0.07） × 10^3mm3, （1.01 ±0. 03） × 10^3mm2 vs. （0. 84 ±0.03）×10^3mm2; Ps 〈0. 05]. Correlation analyses showed in schizophrenia group the cortical thickness in right inferior frontal gyms correlated negatively with PANSS positive and general scores, positively with total scores; cortical volume in left occip

关 键 词：运动障碍 药源性 磁共振成像 皮质形态 精神分裂症 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]