近红外光谱脑功能成像辅助诊断强迫症的临床价值  

Clinical value of functional near-infrared spectroscopy to aid in the diagnosis of obsessive-compulsive disorder

作　　者：乔勇军 宋小慧[1] 谢青[1] 崔立军[1] 何美朵[2] 金海燕[2] Qiao Yongjun;Song Xiaohui;Xie Qing;CuiLijun;He Meiduo;Jin Haiyan(Department of Rehabilitation Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Clinical Psychology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院康复医学科,上海200025 [2]上海交通大学医学院附属瑞金医院临床心理科,上海200025

出　　处：《中华精神科杂志》2024年第3期147-154,共8页Chinese Journal of Psychiatry

基　　金：国家重点研发计划(2022YFC3601703);上海市卫健委面上项目(202040465)。

摘　　要：目的探讨近红外光谱脑功能成像(functional near-infrared spectroscopy,fNIRS)技术检测强迫症患者执行言语流畅性任务时额叶和双侧颞叶脑激活特征及其在强迫症辅助诊断中的价值。方法前瞻性收集2022年6月至2023年6月在上海交通大学医学院附属瑞金医院心理科就诊的30例强迫症患者(强迫症组)的临床资料,其中男17例,女13例,年龄16~41岁,受教育9~19年。同期招募年龄、受教育程度相匹配的自愿参与研究的30名健康对照者(健康对照组),其中男12名,女18名,年龄19~54岁,受教育9~19年。使用fNIRS检测受试者执行言语流畅性任务期间前额叶和双侧颞叶的血流动力学变化,并输出特定指标:额叶和双侧颞叶积分值、重心值及斜率。采用双样本独立t检验和非参数Mann-Whitney U检验分析强迫症患者与健康对照者之间的指标差异,采用二元logistic回归模型分析强迫症的影响指标,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析fNIRS指标对强迫症患者和健康对照者分类诊断的效果,并同时计算指标的最佳截断值。结果执行言语流畅性任务时,强迫症组的组词数显著低于健康对照组[M(Q1,Q3)][9.0(7.0,12.0)个比12.0(10.0,16.3)个,Z=2.80,P=0.005];额叶积分值、斜率和双侧颞叶积分值显著低于健康对照组[32.3(-7.8,62.2)比123.7(96.2,181.3),Z=5.76;0.0005±0.0012比0.0015±0.0016,t=-2.54;87.0±71.4比186.1±90.3,t=-4.71],额叶和双侧颞叶重心值显著高于健康对照组[(60.4±13.8)s比(54.4±7.8)s,t=2.80;60.3(55.5,65.0)s比56.2(52.7,59.2)s,Z=-2.42],差异均具有统计学意义(均P<0.05);两组双侧颞叶斜率差异无统计学意义(t=-1.60,P=0.116)。将存在统计学差异的指标纳入二元logistic回归模型后结果显示额叶积分值显著影响强迫症是否患病(OR=0.958,95%CI:0.932~0.985,P=0.003),并且ROC曲线显示额叶积分值对强迫症是否患病的分类较好,最佳截断值为68.2,灵敏度为0.900,特�Objective To investigate the hemodynamic characteristics of frontal cortex and bilateral temporal lobes in patients with obsessive-compulsive disorder(OCD)during verbal fluency tasks using functional near-infrared spectroscopy(fNIRS),and assess the value of fNIRS in aiding OCD diagnosis.Methods Clinical data of 30 OCD patients who visited the Psychology Department at Ruijin Hospital,affiliated with the Shanghai Jiaotong University School of Medicine between June 2022 and June 2023 were prospectively collected.There were 17 males and 13 females aged 16-41 years,and the education level was 9-19 years.Another 30 healthy control participants voluntarily participated in the study,including 12 males and 18 females aged 19-54 years with 9-19 years of education.Cerebral hemodynamic changes in the prefrontal and bilateral temporal lobes were detected using fNIRS during verbal fluency tasks.Specific parameters including integral values,centroid values,and slopes for both the prefrontal and bilateral temporal lobes were analyzed using independent two-sample t-tests and non-parametric Mann-Whitney U tests.Influencing indicators for OCD were analyzed using a binary logistic regression model.Receiver Operating Characteristic(ROC)curve analysis was plotted to evaluate the diagnostic performance of fNIRS indicators in distinguishing OCD patients from healthy controls,and the optimal cutoff value were calculated.Results OCD patients generated significantly less words during the verbal fluency task compared to healthy controls(M(Q1,Q3))(Number of 9.0(7.0,12.0)vs 12.0(10.0,16.3),Z=2.80,P=0.005).The integral values and slopes of the frontal lobe,and the integral values of the bilateral temporal lobes,were significantly lower in OCD patient group(32.3(-7.8,62.2)vs 123.7(96.2,181.3),Z=5.76;0.0005±0.0012 vs 0.0015±0.0016,t=-2.54;87.0±71.4 vs 186.1±90.3,t=-4.71),while centroid values of both the frontal and bilateral temporal lobes were higher((60.4±13.8)seconds vs(54.4±7.8)seconds,t=2.80;60.3(55.5,65.0)seconds vs 56.2(52.7,59.2)s

关 键 词：强迫性障碍 近红外光谱脑功能成像 言语流畅性任务 脑激活 辅助诊断 最佳截断值 积分值 

分 类 号：R749.7[医药卫生—神经病学与精神病学]