首发精神分裂症脑白质微结构异常与临床症状、认知损害及早期转归的关系  

Associations of white matter microstructural abnormalities with clinical symptoms,cognitive impairment and clinical outcomes in the early course of first-episode schizophrenia

作　　者：翁深宏[1] 王高华[1] 徐顺生[1] 刘忠纯[1] 张钦然 邹秀芬[2] 何长春 段旭君[3] 胡茂林 宗小芬 Weng Shenhong;Wang Gaohua;Xu Shunsheng;Liu Zhongchun;Zhang Qinran;Zou Xiufen;He Changchun;Duan Xujun;Hu Maolin;Zong Xiaofen(Department of Psychiatry,Renmin Hospital of Wuhan University,Wuhan 430060,China;School of Mathematics and Statistics,Wuhan University,Wuhan 430072,China;School of Life Science and Technology,University of Electronic Science and Technology of China,Chengdu 611731,China)

机构地区：[1]武汉大学人民医院精神卫生中心,430060 [2]武汉大学数学与统计学院,430072 [3]电子科技大学生命技术学院,成都611731

出　　处：《中华行为医学与脑科学杂志》2021年第11期997-1004,共8页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金项目(81901357);国家重点研发计划(2018YFC1314600);湖北省自然科学基金项目(2019CFB481);武汉大学医学部创新种子基金项目(TFZZ2018019)。

摘　　要：目的使用磁共振弥散张量成像(diffusion tensor imaging,DTI)技术,从全脑水平探讨首发未服药精神分裂症患者脑白质纤维连接完整性,探索各向异性分数(fractional anisotropy,FA)改变与临床症状、认知功能的关系,及其在预测精神分裂症治疗后认知功能及临床症状变化中的作用。方法2019年11月至2020年12月,招募38例首发精神分裂症患者(患者组)及38例对照(对照组)。采用威斯康星卡片分类测试(Wisconsin card classification test,WCST)、数字广度测试(顺背/倒背)、言语流畅性测试、Stroop范式(A/B/C)、连线测试(trail making test,TMT-A和TMT-B)、阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评定患者8周单药利培酮治疗前后认知功能和临床症状变化。采集受试者磁共振T1、DTI数据,比较组间FA差异,通过支持向量机(support vector machine,SVM)分析来评估异常FA值在区分患者与健康对照中的准确性,采用多元逐步回归分析或广义线性模型探索白质完整性与临床症状、认知功能间的关联。结果治疗前,患者组右半球内侧颞叶、楔叶、前扣带回、顶下小叶FA值较正常组降低,双侧半球中扣带回FA值较正常组升高(P<0.01,GRF校正)。SVM分析显示有四种组合均能区分出患者与对照,准确率89.47%。基线期,患者右顶下小叶FA值与WCST-总耗时(β=0.489,P=0.003,FDR校正)、正确思考时间(β=0.450,P=0.008,FDR校正)及错误思考时间(β=0.435,P=0.008,FDR校正)正相关,与Stroop-C(β=0.345,P=0.035,FDR校正)、TMT-B(β=0.296,P=0.042,FDR校正)、PANSS-P(β=0.321,P=0.042,FDR校正)正相关;患者右内侧颞叶FA值与TMT-A(β=-0.425,P=0.009,FDR校正)、TMT-B(β=-0.325,P=0.026,FDR校正)负相关;患者右侧中扣带回FA值与WCST-总耗时(β=0.585,P=0.002,FDR校正)、正确思考时间(β=0.524,P=0.003,FDR校正)、错误思考时间(β=0.536,P=0.003,FDR校正)正相关,与数字广度顺背负相关(β=-0.319,P=0.042,FDR校正),与TMT-B正�Objective To investigate the associations of brain white matter integrity deficits,and to explore the association of fractional anisotropy(FA)abnormality with clinical symptoms and cognitive impairments,as well as the prediction effect of the FA alterations on symptoms and cognitive function outcomes in the acute stage of schizophrenia from the whole brain level based on magnetic resonance diffusion tensor imaging(DTI).Methods From November 2019 to December 2020,thirty-eight patients with first-episode schizophrenia and 38 healthy controls were recruited in this study.Wisconsin card classification test(WCST),digit span test(DST forward/backward),verbal fluency test,Stroop(A/B/C),trail making test(TMT-A/B),as well as positive and negative syndrome scale(PANSS)were utilized to evaluate patients'cognitive function and clinical symptoms both before and after 8 weeks of risperidone monotherapy.T1-weighted images and DTI data of all the subjects were collected.FSL and SPM8 were used to preprocess MRI data and compare the between-group differences of FA.Support vector machine(SVM)analysis was used to evaluate the accuracy of abnormal FA values in differentiating schizophrenic patients from healthy controls.Finally,stepwise multiple regression analysis or generalized linear models were used to explore the associations between white matter integrity and symptoms or cognition.Results Before treatment,patients'FA values of right medial temporal lobe(mTL),cuneus,anterior cingulate gyrus(ACG)and inferior parietal lobe(IPL)were significantly lower than those in healthy controls(P<0.01,GRF corrected),and patients'FA values of bilateral middle cingulate gyrus(mCG)were significantly higher than those in the control group(P<0.01,GRF corrected).SVM analysis showed that four combinations could distinguish the patients from the control with the most accurate rate of 89.47%.Patients'baseline decreased FA values in the right IPL were positively associated with their increased total response time in WCST(β=0.489,P=0.003,FDR corrected),

关 键 词：精神分裂症 弥散张量成像 各向异性分数 利培酮 认知功能 

分 类 号：R749.3[医药卫生—神经病学与精神病学]