首发儿童少年精神分裂症患者脑白质体积与认知功能的关系研究

The correlation between the volume of brain white matter and cognitive function in childhood and adolescence-onset schizophrenia

目的探讨儿童少年精神分裂症患者脑白质体积与认知功能的关系。方法选取40例首发儿童少年精神分裂症患者(病例组)和用39名儿童少年健康志愿者(对照组),用三维梯度回波成像序列进行影像数据的磁共振图像采集。使用中文版精神分裂症认知功能成套测验(Chinese version of MATRICS consensus cognitive battery,MCCB)评估认知功能,用阳性与阴性症状量表(PANSS)评估精神分裂症患者的精神症状。用t检验比较两组间脑白质体积及认知功能的差异,用Pearson相关分析分析差异性脑白质体积与认知功能及精神症状的关系。结果病例组较对照组脑白质体积减小的脑区为左额叶(MNI:x=-27,y=12,z=21)、右边缘叶(MNI:x=18,y=-9,z=39)、左扣带回(MNI:x=-21,y=-18,z=45)(P<0.05)。左侧额叶与PANSS量表总分呈负相关(r=-0.344,P<0.05),左侧扣带回与阳性症状分及总分呈负相关(r=-0.326,-0.348),均差异有统计学意义(P<0.05)。与对照组比较,病例组连线测验评分显著增高(t=3.56,P<0.01),霍普金斯词汇学习及简易视觉空间记忆评分(t=-5.67,-8.66)显著降低,差异有统计学意义(P<0.05)。病例组右边缘叶体积与词语流畅分呈正相关(r=0.40,P<0.05)。结论首发儿童青少年精神分裂症患者存在多个脑白质区体积下降及认知功能缺损,认知功能缺损的病理生理机制可能与大脑白质体积异常有关。

Objective To investigate the relationship between brain white matter volume (WMV) and cognitive function(CF) in childhood and adolescence-onset schizophrenia(CAOS). Methods Forty childhood and adolescence-onset first-episode schizophrenia patients (case group) and thirty-nine healthy volunteers (control group) were selected.All subjects underwent a 3.0 T magnetic resonance imaging(MRI) scans for data acquisition.The Chinese version of MATRICS consensus cognitive battery(MCCB) was used to assess the cognitive function.The psychiatric symptoms of schizophrenia were assessed with the positive and negative syndrome scale (PANSS). And t test was applied to compare whether there were differences in WMV, CF between the two groups.Pearson correlation analysis was used to analyze whether the differences were related with cognitive function and mental symptoms. Results Compared with healthy controls, the case group exhibited WMV deficits in the region of left frontal lobe (LFL)(MNI: x=-27, y=12, z=21), right side limbic lobe(RSLL)(MNI: x=18, y=-9, z=39) and left cingulate gyrus (LCG)(MNI: x=-21, y=-18, z=45)(P<0.05). The WMV of LFL was negatively related with the total score (r=-0.344, P<0.05) and the WMV of LCG was negatively related with the positive symptoms score (r=-0.326, P<0.05) and total score (r=-0.348, P<0.05) of the PANSS.Besides, compared with the controls, the patients showed significant increase in the scores of Trail Making Test(t=3.56, P<0.01), while significant decrease in the scores of the HVLT-R and BVMT-R(t=-5.67, -8.66, P<0.05). The WMV of RSLL was positively correlated with verbal fluency test in the case group(r=0.40, P<0.05). Conclusion CAOS patients exist multiple reduced WMV and cognitive impairment, suggesting the importance of the WMV abnormalities in the pathophysiological mechanism of cognitive impairment.