创伤后应激障碍的记忆损害与脑结构磁共振研究

Study on memory function impairment and structural MRI in posttraumatic stress disorder.

目的探讨创伤后应激障碍(post-traumatic stress disorder,PTSD)患者的记忆功能损害以及结构性核磁共振的变化。方法收集符合美国精神障碍诊断与统计手册第四版诊断标准的16例PTSD患者、17例首发抑郁症患者和28名正常对照。采用临床应用的PTSD诊断量表(Clinician Administered PTSD Scale,CAPS)、汉密尔顿焦虑量表、汉密尔顿抑郁量表评定临床症状;韦氏记忆量表评定记忆功能;以磁共振静态三维结构进行影像学检查。结果 PTSD组理解记忆、延迟理解记忆、视觉再生、延迟视觉再生得分均明显低于对照组和抑郁症组(P均小于0.05)。PTSD组视觉再生、延迟视觉再生记忆成绩与CAPS得分呈负相关(r=-0.66,P<0.05;r=-0.53,P均小于0.05),但与情绪症状评分均无相关性(P均大于0.05)。PTSD组和抑郁症组的额叶、颞叶灰质体积均明显小于对照组(未校正的P<0.001);而PTSD组颞叶灰质体积小于抑郁症组(未校正的P<0.001)。结论 PTSD的记忆损害与创伤症状而非抑郁症状明显相关,而其脑结构损害也与抑郁症有所不同,提示PTSD的记忆损害可能独立于抑郁症状之外。

Objective To investigeate the memory impairments and characterize MRI changes in Posttraumatic stress disorder（PTSD）.Methods Sixteen PTSD patients and 17 depressive patients who met with diagnostic and statistical manual of mental disorders-fourth edition（DSM-IV） diagnosis and 28 healthy volunteers were recruited in the study.clinical assessment,including DSM-IV PTSD Scale（CAPS）,Hamilton Anxiety Scale,Hamilton Depression Scale,Wechsler Memory Scale for memory function and MRI static 3D structures were used to evaluate the patients.Results The comprehension,delayed comprehension,regeneration and delayed regeneration scores were lower in PTSD than in depression and normal control groups（P0.05）.The visual regeneration and delayed visual regeneration scores were negatively correlated with CAPS scores,but not with HAMA nor with HAMD in PTSD（P0.01,P0.05,P0.05）.The gray matter volume of some brain areas including the frontal and temporal lobes were lower in PTSD and depression than in the normal control groups [P0.001（uncorrected）].The gray matter volume of the temporal lobe was lower in PTSD than in depression groups [P0.001（uncorrected）].Conclusions The memory function impairments of PTSD patients are negatively correlated with the symptom severity of PTSD and the structural lesions are different between PTSD and depression patients,suggesting the memory impairments may not be associated with depression.