男性首发精神分裂症患者利培酮治疗前后质子波谱比较研究

Effect of risperidone tablets on brain metabolite ratios in male first-episode schizophrenia： relationship with treatment response

目的探讨男性首发精神分裂症患者前额叶和丘脑神经生化代谢物质的特点以及利培酮治疗的影响。方法在22例男性首发精神分裂症患者治疗前和经8周利培酮治疗后，采用多体素磁共振质子波谱（1H—MRS）检测前额叶和丘脑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值的计算。对照组的30名正常男性进行相同指标的检测。患者组每次1H—MRS检测的同时进行阳性与阴性症状量表（PANSS）和威斯康星卡片分类测验（WCST）评估临床症扶和执行功能。结果患者组治疗前左侧前额叶、左侧丘脑的NAA／Cr值均低于对照组[（1．37±0．33），（1．61±0．38）；（1．46±0．35），（1．71±0．38）]，差异均有统计学意义（t=2．57，P〈0．05；t=2．36，P〈0．05）；患者组治疗前后各代谢指标的差异均无统计学意义（P〉0．05）。患者组治疗前后左侧前额叶NAA／Cr变化值与PANSS总分变化值、阴性症状分变化值、错误应答数变化值、持续错误数变化值呈负相关（r值分别为-0．46，-0．48，-0．42，-0．40，均P〈0．05），与分类数变化值、概念化水平变化值呈正相关（r值分别为0．44，0．42，均P〈0．05）。结论前额叶和丘脑的神经元损害可能在男性精神分裂症患者首次发病时便存在，利培酮短期内应用可能并不能对生化代谢物质产生明显影响。

Objective To identify the metabolite levels and to study the potential effects of risperidone tablets on prefrontal lobe and thalamus in male first-episode schizophrenia by proton magnetic resonance spectroscopy （1H-MRS）. Methods Twenty-two male first-episode schizophrenics were examined at prefrontal lobe and thalamus by muhi-voxel 1H-MRS before and after 8 weeks＇ risperidone tablets treatment, and 30 normal controls were assessed once. The patients were also received positive and negative syndrome scale（PANSS） and Wisconsin card sorting test （WCST） before and after treatment. The N-acetylaspartate （NAA） , Choline-congtaining compounds （Cho） , and Creatine compounds （Cr） were measured and the ratios of NAA/Cr,Cho/Cr were determined. Results On left prefrontal lobe and left thalamus, the NAA/Cr ratio in patients before treatment demonstrated lower than those in normal controls （ （ 1.37 ± 0.33 ） vs（ 1.61 ± 0.38 ）, t = 2.57, P 〈 0.05 ; （ 1.46 ± 0.35 ） vs （ 1.71 ± 0.38 ） , t = 2.36, P 〈 0.05 ）. There were no significant differences in both the ratios of NAA/Cr and Cho/ Cr between pre- and post-treatment （P〉 0.05）. The changes of NAA/Cr on left prefrontal lobe post-treatment were negatively related with the alterations of the total score of PANSS （ r = - 0.46, P 〈 0.05 ） , the score of negative symptoms （ r = - 0.48, P 〈 0.05） ,the responses errors （ r = - 0.42, P 〈 0.05 ） and the perseverative errors （ r = - 0.40, P 〈 0.05 ） , meanwhile, positively related with the alterations of the categories completed （ r = 0.44, P 〈 0.05 ） and the conceptual level responses （ r = 0.42, P 〈 0.05 ）. Conclusions Abnormalities in neuronal function and/or integrity presented on prefrontal lobe and thalamus maybe exist in male first-episode schizophrenics. Short-term antipsychotic treatment with risperidone tablets may have no effects on measures of prefrontal lobe and thalamus.