阴性症状为主的精神分裂症男性患者认知功能及灰质密度改变

Three Dimensional MRI of Male Schizophrenia Patients and the Relationship Between Their Symptoms and Brain Structure

目的:运用基于体素的脑形态测量学方法(VBM),探讨以阴性症状为主的精神分裂症男性患者大脑结构形态学的改变,及其与精神病理学症状的关系。方法:15例阴性症状为主的成年男性精神分裂症患者和15例正常对照参与实验,所有研究对象均接受威斯康星卡片分类测验(WCST)与磁共振检查,获取磁共振T1加权像和高分辨率3D图像后进行VBM分析,比较患者组和正常对照组局部脑区灰质密度的差异性。结果:在威斯康星测验中,阴性症状为主的精神分裂症患者完成测查的总应答数、错误应答数和持续性错误数显著高于正常对照组,正确应答数和完成分类数与正常对照组没有显著差异。VBM分析显示患者右侧额上回,左侧额中回,左额内侧回,右侧楔叶,左侧颞中回的灰质密度较正常对照组低,未发现患者组灰质密度有明显增高的脑区。结论:以阴性症状为主的精神分裂症患者存在显著的额叶执行功能低下;双侧额叶灰质密度的下降可能是其执行功能损害的病理生理基础。

Objective：To explore the pathological mechanism of brain structure in schizophrenia male patients with predominant negative symptoms by Voxel-based Morphometry（VBM） and Wiconsin Card Sorting test（WCST）.Methods：Schizophrenia patients were assessed by the Scale for Assessment of Positive Symptoms（SAPS）,the Scale for Assessment of Negative Symptoms（SANS）.Finally,fifteen male schizophrenia with predominant negative symptoms and fifteen matched healthy controls participated in the study and finished the Wisconsin Card Sorting Test（WCST） and 3D MRI scans.Results：The total trails,the number of response errors and perseverant response errors of WCST in the patient group were significantly higher than those in the control group（P〈0.05）.However,there were no significant differences in the number of correct responses and the number of categories between the two groups.In addition,schizophrenia patients showed significantly lower gray matter density than healthy controls in the right superior frontal gyrus,left middle frontal gyrus,left medial frontal gyrus,right cuneus,and left middle temporal gyrus.There was no area showing higher gray matter density in the patient group compared with the control group.Conclusion：Compared with the healthy controls,schizophrenic patients with predominant negative symptoms show significant frontal executive function impairments.The reduction of gray-matter-density in the bilateral frontal regions is probably the pathophysiological basis for the cognitive impairment in negative subtype schizophrenia patients.