强迫症患者单光子发射计算机断层扫描的特征

Correlation analysis between brain perfusion imaging and symptoms in patients with obsessive-compulsive disorder

目的观察强迫症患者局部脑血流灌注的特点,探讨脑灌注与临床严重程度、强迫思维、强迫行为间的关系。方法应用单光子发射计算机断层扫描(single photon emission computed tomography,SPECT)技术,对首发且未经治疗的40例强迫症患者和40例正常人于静息状态下行脑血流显像。以小脑皮质的放射性计数值为参考,计算各脑区放射性计数比值(RAR)。采用耶鲁-布朗强迫量表对强迫症患者进行临床特点评定。结果强迫症组的双侧前额叶、前颞叶的RAR值分别为(94.4±6.4,99.8±6.6,91.6±6.1,92.6±6.6),高于正常对照组(88.1±7.3,86.9±8.9,84.0±7.2,83.4±7.2),差异有显著性(t=6.78,11.93,7.15,9.40;均P<0.05)。强迫总分平均为(29.32±8.75)分,强迫思维分平均为(21.28±4.90)分,强迫行为分平均为(8.03±5.34)分。双侧前额叶、右侧前颞叶的RAR与强迫思维成正相关(r=0.617,0.309,0.358;均P<0.05);未显示脑灌注与强迫行为相关。结论强迫症患者双侧前额叶、前颞叶脑血流灌注存在明显增高现象,且双侧前额叶、右侧前颞叶高灌注与强迫思维程度成正相关。

Objective To evaluate brain perfusion in patients with OCD and its correlation with the severity of disease,obsession and compulsion scales. Methods Forty unmedicated patients with obsessive - compulsive disorder diagnosed by International Classification of Disease - 10 （ ICD - 10）, Y - BOCS scores ≥ 16, and 40 normal controls were en- rolled in the study. All subjects received cerebral blood perfusion imaging and Yale - Brown Obsessive - Compulsive Scale. Results Compared to the normal controls, patients demonstrated significantly higher RAR in both the right and the left anterior frontal lobe and temporal cortex. Left prefrontal lobe RAR in patients and in normal controls was 94.4 ± 6. 4 and 88.1 ± 7. 3 （t = 6. 78, P = 0. 001 ） respectively; Right prefrontal lobe RAR in patients and in normal controls was 99. 8 ±6. 6 and 86. 9 ± 8.9 respectively （t = 11.93,P 〈0. 001 ）. Left anterior temporal RAR in patients and in normal controls was 91.6 ± 6. 1 and 84. 0 ± 7.2 （ t = 7. 15, P = 0. 002 ） respectively ; Right anterior temporal cortex RAR in patients and in normal controls was 92. 6 ± 6.6 and 83.4 ± 7. 2 （ t = 9.40, P 〈 0.001 ） respectively. The mean scores of Y - BOCS,obsessive scales and compulsive scales were 29. 32 ±8.75,21.28 ±4. 90 and 8.03 ± 5.34. The RAR in bilateral anterior frontal lobes and temporal cortex was positively correlated with the obsessions subscales （r = 0. 617,0. 309, 0. 358, all P 〈 0. 05 ）. Conclusion Patients with OCD showed higher cerebral blood perfusion, mainly in prefrontal lobe and temporal cortex, which may play important roles in the occurrence of OCD. The dysfunction of prefrontal lobe and right temporal cortex may be the cause of obsessions.