偏执型精神分裂症和双相Ⅰ型躁狂发作患者额叶氢质子波谱比较研究

Comparative study of proton magnetic resonance spectroscopy on frontal lobe between patients with paranoid schizophrenia and patients with bipolar mania

目的比较偏执型精神分裂症和双相障碍Ⅰ型躁狂发作患者额叶氢质子波谱代谢物的异同。方法对符合美国精神障碍诊断统计手册第4版（DSM-Ⅳ）诊断标准的25例精神分裂症偏执型患者、20例双相Ⅰ型躁狂发作患者和32名正常对照进行氢质子波谱扫描，检测双侧额叶白质的N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌醇（mI）及肌酸（Cr）4种代谢产物，以Cr为参照物，分别计算双侧NAA／Cr、Cho／Cr及mI／Cr。统计方法采用多组间单因素方差分析、偏相关分析及额叶代谢物的左右对称性分析。结果偏执型精神分裂症组左侧额叶Cho／Cr比双相Ⅰ型躁狂组、正常对照组都升高[分别为（1．14±0．14）、（1．06±0．08）、（1．04±0．14）]，差异有显著性（P=0．03，P=0．01）；双相Ⅰ型躁狂组与正常对照组相比差异无显著性（P〉0．05）。3组之间左侧额叶NAA／Cr、mI／Cr；右侧额叶NAA／Cr、Cho／Cr、mI／Cr；左右额叶代谢物的单侧化指数与1．0相比差异均无显著性（P均〉0．05）。未发现两患者组额叶代谢物与症状量表分、病程相关。结论偏执型精神分裂症患者可能存在左侧额叶Cho／Cr的特异性升高。

Objective To compare biochemical characteristics of the frontal lobe tissue between patients with paranoid schizophrenia and patients with bipolar mania by using proton magnetic resonance spectroscopy （ ^1 H MRS）. Methods The ratios of N-Acetylaspartate （NAA） , choline（CHo） and myoinositol（mI） to creatine （Cr） were measured using a 3.0 T GE Signa EXCITE MR system in 25 patients with paranoid schizophrenia, 20 patients with bipolar mania and 32 healthy subjects matched for age, gender, and years of education. ANOVA and partial correlation analysis were used for statistic process. Cerebral asymmetry of frontal lobe metabolism were also analyzed. Results Patients with paranoid schizophrenia presented markedly elevated Cho/Cr in left frontal lobe regions when compared to patients with bipolar mania and normal controls （ 1.14 ± 0. 14,1.06 ± 0.08,1.04 ± 0.14, respectively, P = 0.03, P = 0.01 ） , but patients with bipolar mania showed no significant difference with normal controls （ P 〉 0.05 ）. There were no significant difference in NAA/Cr , mI/Cr for left frontal lobe regions , and NAA/Cr, Cho/Cr, mI/Cr for right frontal lobe among the groups （ all P 〉 0.05 ）. The lateralization index of NAA/ Cr, Cho/Cr in frontal lobe region in three groups had no significant difference compared with 1.0 （ all P 〉 0.05 ）. No correlation were found between metabolite and symptoms scale scores, disease course. Conclusion Elevation of Cho/Cr in left frontal lobe regions may be special to patients with paranoid schizophrenia.