短程抗精神病药治疗对首次发病未服药精神分裂症患者丘脑-皮质环路的影响  

The effect of short-term antipsychotic treatment on disrupted thalamocortical functional connectivity in drug-naïve patients with first-episode schizophrenia

作　　者：吴国伟[1] 沈妍昱 张雯[1] 刘哲宁[1] 陈友凯 吕海龙 龙易成 邓梦婕 蒲唯丹[5] Wu Guowei;Shen Yanyu;Zhang Wen;Liu Zhening;Chen Eric;Lyu Hailong;Long Yicheng;Deng Mengjie;Pu Weidan(Department of Psyhiatry,the Second Xiangya Hospital,Central South University,Changsha 410011,China;First Clinical Medical College,Lanzhou University,Lanzhou 730000,China;Queen Mary Hospital,the University of Hong Kong,Hong Kong 999077,China;Department of Psychiatry,First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Medical Psychological Center,the Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院精神卫生研究所,长沙410011 [2]兰州大学第一临床医学院,兰州730000 [3]香港大学玛丽医院,中国香港999077 [4]浙江大学医学院附属第一医院精神卫生科,杭州310003 [5]中南大学湘雅二医院医学心理中心,长沙410011

出　　处：《中华精神科杂志》2022年第4期245-253,共9页Chinese Journal of Psychiatry

基　　金：国家自然科学基金(81701325, 82171510);大学生创新创业训练计划项目(S2021105330772, S2021105330303)。

摘　　要：目的探讨短程抗精神病药治疗对首次发病未服药精神分裂症患者丘脑-皮质环路的影响。方法在短程抗精神病药治疗前后, 采集83例首次发病未服药精神分裂症患者的静息态功能磁共振成像数据, 同时招募匹配的117名健康对照, 评估药物治疗前后的丘脑-皮质环路与临床症状的变化。采用左右两侧半球丘脑为种子点, 与全脑体素行功能连接分析。使用Spearman相关分析探索丘脑-皮质环路功能连接变化与临床症状变化之间的关系。结果 (1)基线期, 与健康对照相比, 精神分裂症患者丘脑-前额叶环路(包括额中回/下回、扣带中回/后回、顶下小叶等)的功能连接显著降低, 同时丘脑-感觉运动区环路(包括中央前回、颞上回/中回/下回、海马旁回、枕中回等)的功能连接显著增强(均P<0.05, FDR校正)。(2)短程抗精神病药治疗后, 精神分裂症患者基线期异常降低的丘脑-前额叶连接显著增强, 而基线期异常增强的丘脑-感觉运动区连接显著降低(均P<0.05, FDR校正)。(3)进一步相关分析显示, 治疗后丘脑-前额叶环路的连接增强及丘脑-感觉运动区环路的连接降低均与阳性与阴性症状量表总分的降低显著相关(r=0.435, P=0.014;r=0.394, P=0.028, 未校正)。结论首次发病未服药精神分裂症患者丘脑-皮质环路异常以丘脑-前额叶环路连接降低和丘脑-感觉运动区环路连接增强为特征;短程抗精神病药治疗能部分改善丘脑-皮质环路的功能异常, 且与临床症状的缓解相关。Objective This study aimed to investigate the effect of short-term antipsychotic medication treatment of patients with schizophrenia on the effect of the thalamocortical resting-state functional connectivity.Methods 83 first-episode drug-naïve schizophrenia patients and 117 matched healthy controls participated in the present study.The study collected resting-state fMRI data before and after the patients received short-term antipsychotics to assess the changes in the thalamocortical circuits and clinical symptoms.The directional interactions between the thalamus and other brain regions were investigated using a standard seed-based whole-brain correlation by choosing the bilateral thalamus as the seeds.Spearman′s correlation analysis was carried out between the change of abnormal functional connectivity and improved clinical symptoms in patients.Results Compared with the healthy controls,schizophrenia patients showed decreased thalamic-prefrontal functional connectivity(including the middle frontal cortex,inferior frontal cortex,middle cingulate cortex,posterior cingulate cortex,and inferior parietal lobe,all P<0.05,FDR corrected)and increased thalamic-sensorimotor functional connectivity(including the precentral gyrus,superior temporal cortex,middle temporal cortex,inferior temporal cortex,parahippocampus,and middle occipital cortex,all P<0.05,FDR corrected)at baseline.After short-term antipsychotic treatment,the thalamic-prefrontal hypo-connectivity was significantly enhanced,and the thalamic-sensorimotor hyper-connectivity was significantly decreased.Furthermore,the changes of abnormal functional connectivity were correlated significantly with the PANSS total score changes improvement(r=0.435,P=0.014;r=0.394,P=0.028,uncorrected).Conclusions The present study replicates previous findings that the abnormalities of thalamocortical circuits in schizophrenia are characterized by thalamic-prefrontal hypoconnectivity and thalamic-sensorimotor hyperconnectivity.Moreover,short-term antipsychotic treatment partly impr

关 键 词：精神分裂症 药物治疗 神经环路 

分 类 号：R749.3[医药卫生—神经病学与精神病学]