精神分裂症患者基于事件前瞻记忆缺陷的功能磁共振成像特点  

A fMRI study of event-based prospective memory in patients with schizophrenia

作　　者：朱殿明 张建业 宋振华 龙彬 刘登堂[1] Zhu Dianming;Zhang Jianye;Song Zhenhua;Long Bin;Liu Dengtang(Department of Psychiatry,Shanghai Mental Health Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属精神卫生中心,200030

出　　处：《神经疾病与精神卫生》2020年第2期82-88,F0003,共8页Journal of Neuroscience and Mental Health

基　　金：国家自然科学基金项目(81371479);上海市精神卫生中心科研基金项目(2018-YJ-20)。

摘　　要：目的应用功能磁共振成像(fMRI)技术探讨精神分裂症基于事件前瞻记忆缺陷的生物学基础及神经机制。方法采取横断面病例对照研究方法,共招募20名健康志愿者(对照组)和20例精神分裂症患者(观察组)入组,以双重任务前瞻记忆实验范式作为刺激任务,同时应用阳性与阴性症状量表和阴性症状评定量表评定精神症状严重程度,采用锥体外系不良反应量表评定锥体外系不良反应严重程度。应用Matlab2011b,SPM8软件对影像学数据进行预处理及统计分析。采用独立样本t检验分析比较两组的脑区激活情况,设定激活差异显著水平为P<0.005(未校正)。选取前瞻记忆主要激活脑区,应用REST1.8软件提取激活脑区的血氧水平依赖性信号强度,采用Pearson相关分析探究脑区激活强度的相关因素。结果预处理中发现,观察组2例被试者有明显的头部运动(移动>2.5 mm,转动>2.5°),剔除图像分析,最后观察组18例,对照组20例被试者的图像数据进入统计分析。相对于健康志愿者,精神分裂症患者在执行前瞻记忆任务时的正确率较低且反应时更长[(83.40±15.33)%比(94.30±10.94)%,(870.54±156.70)ms比(757.33±187.44)ms;均P<0.05]。进行中任务的反应时与阴性症状量表评分呈正相关(r=0.494,P=0.037),前瞻记忆任务的正确率与智商呈正相关(r=0.558,P=0.016),前瞻记忆任务的反应时与氯丙嗪等效剂量呈正相关(r=0.492,P=0.038)。fMRI扫描显示精神分裂症患者右额中回、双侧顶下小叶(角回、缘上回)、右前扣带回以及右楔前叶脑区激活明显低于健康志愿者(均P<0.005)。右缘上回(r=-0.589,P=0.010)、左角回(r=-0.593,P=0.010)、右楔前叶(r=-0.590,P=0.010)的激活程度与氯丙嗪等效剂量呈负相关。右前扣带回(r=-0.537,P=0.021)、右额中回(r=-0.501,P=0.034)的激活程度与进行中任务的反应时呈负相关。结论前瞻记忆需要消耗认知资源。精神分裂症患者存在显著�Objective To investigate the neural mechanism of event-based prospective memory(PM)deficits in schizophrenia patients utilizing functional magnetic resonance imaging(fMRI).Methods A total of 20 healthy volunteers and 20 patients with schizophrenia were enrolled in this cross-sectional case-control study.The event-based PM tasks(double-task paradigm,including the ongoing task and PM task)was performed as the stimulus tasks.In addition,Positive and Negative Symptom Scale and Scale for the Assessment of Negative Symptoms(SANS)were used to assess the severity of mental symptoms,and Rating Scale for Extrapyramidal Side Effects was used to assess the severity of extrapyramidal side effects.Matlab 2011b and SPM8 software were used to preprocess and analyze the imaging data.Independent sample t-test was used to analyze and compare the activation of brain area between the two groups.The significant difference between the two groups was set as P<0.005(uncorrected).In this study,REST 1.8 software was used to extract the signal intensity of blood oxygen level dependence in the brain area activated by prospective memory.Pearson correlation analysis was used to explore the related factors of activation intensity in the brain area.Results In the pretreatment,two subjects in the observation group had obvious head movement(movement>2.5 mm,rotation>2.5°).Excluding image analysis,18 subjects in the observation group and 20 subjects in the control group entered the statistical analysis.Patients with schizophrenia has lower accuracy and a longer reaction time(RT)of the PM tasks compared to healthy volunteers[(83.40±15.33)%vs(94.30±10.94)%,(870.54±156.70)ms vs(757.33±187.44)ms;P<0.05].In addition,the RT of ongoing task was positively correlated with the SANS scores(r=0.494,P=0.037),and the accuracy of PM task was positively associated with IQ(r=0.558,P=0.016).Moreover,we found a negative relationship between the RT of PM task and chlorpromazine equivalents(r=0.492,P=0.038).Patients showed lower activations in right middle frontal

关 键 词：精神分裂症 认知功能缺陷 前瞻记忆 功能磁共振成像 

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]