利培酮和氯氮平治疗慢性稳定期精神分裂症脑白质纤维改变的对比分析  

Comparative analysis of white matter fiber changes of chronic stable schizophrenia treated with risperidone and clozapine

作　　者：刘念[1,2] 吕粟[2] 肖媛[2] 唐碧秋[2] LIU Nian;LÜ Su;XIAO Yuan;TANG Biqiu(Department of Radiology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Huaxi MR Research Center(HMRRC),Department of Radiology,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]川北医学院附属医院放射科,南充637000 [2]四川大学华西医院放射科华西磁共振研究中心,成都610041

出　　处：《磁共振成像》2022年第10期79-85,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(编号:82071908、82202124);川北医学院博士科研启动基金项目(编号:CBY21-QD09)。

摘　　要：目的对比分析利培酮和氯氮平治疗的慢性精神分裂症患者的脑白质纤维改变的特征性差异。材料与方法前瞻性采集2010年1月至2018年8月四川大学华西医院确诊的27例病程超过5年未治疗、20例利培酮单药及17例氯氮平单药治疗超过5年的稳定期慢性精神分裂症患者和24例正常对照者的磁共振弥散张量成像数据,通过FSL软件提取4组被试的各向异性分数(fractional anisotropy,FA)和平均弥散系数(mean diffusivity,MD)值,对4组间的FA和MD值采用协方差分析,采用FDR进行多重比较校正。结果与正常对照组相比,未治疗组和氯氮平治疗组的FA值降低,MD值增加(P<0.05);利培酮治疗组除左钩状束、双弓状束之外(P>0.05),其余17条纤维束的FA值降低(P<0.05),而MD值差异无统计学意义(P>0.05)。与未治疗组相比,利培酮治疗组除右上纵束、左弓状束之外(P>0.05),其余18条纤维束的FA值升高,双皮质脊髓束、双扣带回-海马通路、双下额枕束、左丘脑前辐射、左扣带-扣带通路、左下纵束、左上纵束、右钩状束、胼胝体膝部的压部和膝部的MD值降低(P<0.05);氯氮平治疗组的FA和MD值差异均无统计学意义(P>0.05)。与氯氮平治疗组相比,利培酮治疗组双丘脑前辐射、双下额枕束、双下纵束、左皮质脊髓束、左钩状束、右弓状束、右扣带回-海马通路、胼胝体压部和膝部的FA值升高;双下额枕束、双钩状束、左下纵束、右扣带回-海马通路的MD值降低(P<0.05)。临床症状严重程度与FA值呈负相关,与MD值呈正相关(P<0.05)。结论长期氯氮平治疗比利培酮治疗的慢性精神分裂症患者显示出更严重、更广泛的白质微结构损伤,提示不同抗精神病药物治疗的脑白质特征存在差异。Objective:To compare the characteristic differences of white matter fiber between patients with chronic stable schizophrenia treated with risperidone and clozapine.Materials and Methods:Magnetic resonance diffusion tensor imaging(DTI)data were collected from 27 never-treated chronic schizophrenia patients with more than 5 years illness duration,20 patients with risperidone monotherapy,17 patients with clozapine monotherapy for more than 5 years,and 24 healthy controls in West China Hospital of Sichuan University from January 2010 to August 2018.FSL software was used to extract the anisotropy fraction(FA)and mean diffusivity(MD)values of the four groups.Covariance analysis was used for FA and MD values between the four groups.FDR was used for multiple comparison correction.FA and MD were correlated with clinical symptom scores,drug dose,and illness duration.Results:Compared with healthy control group,the never-treated group and clozapine-treated group showed decreased FA and increased MD value(P<0.05),the risperidone-treated group showed decreased FA values of 17 fiber tracts(P<0.05)except left uncinate tracts and double arcuate tracts(P>0.05),while MD values had no significant difference(P>0.05).Compared with the never-treated group,the risperidone-treated group showed significantly increased FA values of the other 18 fasciculus(P<0.05)except the left arcuate fasciculus and right superior longitudinal fasciculus(P>0.05),and decreased MD values involving bilateral corticospinal tract,bilateral cingulate cingulate pathway,bilateral inferior fronto-occipital tract,left anterior thalamic radiation,left cingulate cingulate pathway,left inferior longitudinal tract,left superior longitudinal tract,right uncinate tract,the splenium and the genu of the corpus callosum(P<0.05).There were no significant differences in FA and MD between the clozapine-treated group and never-treated group(P>0.05).Compared with the clozapine-treated group,the risperidone-treated group showed significantly increased FA values involving bilatera

关 键 词：精神分裂症 利培酮 氯氮平 弥散张量成像 各向异性分数 平均弥散系数 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]