早发型和晚发型强迫症患者静息态脑功能连接差异及其与认知灵活性的相关分析  

Differences of resting-state brain functional connectivity in patients with early-onset and late-onset obsessive compulsive disorder and their correlation with cognitive flexibility

作　　者：蒋金 刘月龄 陈璐[1] 汪永光[1] 万珂 朱春燕[1] Jiang Jin;Liu Yueling;Chen Lu;Wang Yongguang;Wan Ke;Zhu Chunyan(School of Mental Health and Psychological Sciences,Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学精神卫生与心理科学学院,合肥230032

出　　处：《中华行为医学与脑科学杂志》2023年第1期24-30,共7页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金(81771456);安徽省省属高校与人工智能研究院协同创新项目(GXXT-2021-003)。

摘　　要：目的探讨早发型强迫症和晚发型强迫症患者目标导向网络与习惯化网络静息态脑功能连接的差异以及差异脑区功能连接强度与认知灵活性的相关性。方法2019年10月至2021年4月纳入40例强迫症患者,其中早发型强迫症患者22例,晚发型强迫症患者18例。使用威斯康星卡片分类测试(Wisconsin card sorting test,WCST)、Stroop任务、连线测试(trail making test,TMT)任务评估所有被试的认知灵活性。分别选取目标导向网络相关脑区—尾状核、眶额叶皮质、腹内侧前额叶皮质、前扣带回,以及习惯化网络相关脑区—壳核、辅助运动区和脑岛作为功能连接的感兴趣区(region of interest,ROI),使用matlab2011a平台中的DPABI和SPM12插件进行全脑功能连接分析,比较早发型强迫症患者与晚发型强迫症患者在两网络上功能连接的差异。使用SPSS 25.0软件,采用χ2检验、独立样本t检验、Pearson相关分析对数据进行分析。结果与早发型强迫症患者相比,晚发型强迫症患者左侧辅助运动区与左侧壳核、左侧脑岛功能连接显著增强。晚发型强迫症在WCST中持续性错误总数大于早发型强迫症[(20.61±11.30)个,(14.95±8.94)个,P<0.05]。晚发型强迫症患者左侧壳核-左侧辅助运动区的功能连接与持续性反应总数(r=0.678,P=0.003)和错误反应总数(r=0.590,P=0.013)呈显著正相关;晚发型强迫症患者左侧辅助运动区-左侧脑岛的功能连接与完成第一个分类所需应答数(r=0.485,P=0.049)呈显著正相关。结论相比于早发型强迫症患者,晚发型强迫症患者习惯化网络功能连接更强,且这种功能连接的增强与患者认知灵活性表现相关,同时晚发型强迫症患者较早发型强迫症患者的认知灵活性受损更严重。Objective To explore the differences of the resting-state functional connectivity(FC)between goal-directed network and habituation networks in patients with early-and late-onset obsessive compulsive disorder(OCD)and the correlation between the strength of FC in the differential brain regions and cognitive flexibility.Methods From October 2019 to April 2021,40 patients with OCD were included in this study,including 22 patients with early-onset OCD and 18 patients with late-onset OCD.The cognitive flexibility of all subjects was assessed using the Wisconsin card sorting test(WCST),the Stroop task and the trail making test(TMT).The brain regions which were associated with goal-directed network(caudate,orbitofrontal cortex,ventromedial prefrontal cortex,and anterior cingulate cortex)and the brain regions which were associated with habituation network(putamen,supplementary motor area and insula)were selected as FC regions of interest(ROI).The DPABI and SPM12 plug-ins in the matlab2011a platform were used for whole brain FC analysis to compare the difference of FC between patients with early-onset OCD and patients with late-onset OCD on the two networks.The data were analyzed by SPSS 25.0 withχ2 test,independent samples t-test,and Pearson correlation analysis.Results Compared with patients with early-onset OCD,patients with late-onset OCD had significantly enhanced FC of the left supplementary motor area with the left putamen and left insula.The total number of persistent errors of WCST in patients with late-onset OCD was greater than that in patients with early-onset OCD((20.61±11.30),(14.95±8.94),P<0.05).The FC of the left putamen-left supplementary motor area was significantly and positively correlated with the total number of sustained responses(r=0.678,P=0.003)and the total number of incorrect responses(r=0.590,P=0.013)in patients with late-onset OCD.The FC of the left supplementary motor area-left insula was significantly positively correlated with the number of responses required to complete the first classif

关 键 词：早发型强迫症 晚发型强迫症 目标导向网络 习惯化网络 认知灵活性 

分 类 号：R749.7[医药卫生—神经病学与精神病学]