男性精神分裂症患者前额叶质子波谱特点及其与执行功能的关系

A ~1H-MRS study of the prefrontal lobe in male schizophrenics

目的探讨男性精神分裂症患者前额叶氢质子磁共振波谱(proton magnetic resonance spectrosco-py,1H-MRS)的特点及与执行功能的关系。方法纳入26例7d内未使用抗精神病药物及影响脑内乙酰胆碱神经递质药物的男性精神分裂症患者及28名男性正常对照。两组在入组24h内采用多体素1H-MRS检测前额叶生化代谢物N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr),完成NAA/Cr值、Cho/Cr值和NAA/(Cho+Cr)值的计算,同时进行威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)评定受试者的执行功能。结果患者组左侧前额叶NAA/Cr值(1.40±0.34)低于对照组(1.69±0.31),差异有统计学意义(t=2.93,P<0.01)。患者组WCST的错误应答数、持续应答数、持续错误数均明显高于对照组(t分别为2.32、2.25、2.40,P均小于0.05),分类数和概念化水平应答数均明显低于对照组(t=2.91,P<0.01;t=2.46,P<0.05)。患者组左侧前额叶NAA/Cr值与错误应答数、持续错误数呈正相关(r=0.45,P<0.05;r=0.47,P<0.05),与分类数、概念化水平应答数呈负相关(r=-0.54,P<0.01;r=-0.56,P<0.01)。结论男性精神分裂症患者左侧前额叶可能存在神经元功能和(或)结构异常,这可能是引起额叶执行功能障碍的原因。

Objective To identify the metabolic alterations in the prefrontal lobe in male patients with schizophrenia by proton magnetic resonance spectroscopy（1H-MRS）,and to study the relationship between metabolic alterations and executive function.Methods The study was conducted in 26 male schizophrenics with medicine-free for at least 7 days and 28 normal controls.A multi-voxel 1H-MRS on the prefrontal lobe was performed in all the subjects within 24 hours of admission.Wisconsin Card Sorting Test（WCST）was used to evaluate executive function.The NAA,Cho and Cr were measured and the ratios of NAA/Cr,Cho/Cr and NAA/（Cho＋Cr）were calculated.Results Compared with normal controls,the patients demonstrated significantly lower NAA/Cr ratio（t=2.93,P0.01）in the left prefrontal lobe and poorer performance in WCST（P0.05）.The NAA/Cr ratio in the left prefrontal lobe was positively associated with the responses errors and the perseverative errors of WCST（r=0.45,P0.05;r=0.47,P0.05）and negatively associated with the categories completed and conceptual level responses（r=-0.54,P0.01;r=-0.56,P0.01）.Conclusions Abnormalities in neuronal function and/or integrity are present in the left prefrontal lobe of male schizophrenics.The neuron damage in the left prefrontal lobe of male schizophrenic may be the primary cause of cognition dysfunction.