精神分裂症早发未用药患者脑质子磁共振波谱的异常特征

Hydrogen proton magnetic resonance spectroscopy study in first-episode drug-na（i）ve patients with early onset schizophrenia

目的 探讨早发未经药物治疗的精神分裂症男性、女性患者前额叶和丘脑的神经生化代谢物质特点及差异.方法 纳入符合DSM-Ⅳ中精神分裂症诊断标准的早发患者44例（患者组）,其中男25例（男性患者组）、女19例（女性患者组）,以及健康对照者50名（对照组）,其中男30名（男性对照组）、女20名（女性对照组）.采用多体素质子磁共振波谱（hydrogen proton magnetic resonance spectroscopy,^1H-MRS）在患者入院24 h内抗精神病药治疗之前及健康对照入组时检测所有受试者前额叶和丘脑N-乙酰基天冬氨酸（N-acetylaspartate,NAA）、胆碱复合物（choline-congtaining compounds,Cho）与肌酸复合物（creatine compounds,Cr）.采用PANSS评估患者临床症状.结果 男性与女性患者组之间PANSS总分及各因子分、病程的比较,差异均无统计学意义.男性患者组和女性患者组的NAA/Cr值：左侧前额叶（1.44±0.27和1.41 ±0.24）、右侧前额叶（1.41 ±0.28和1.39 ±0.26）及左侧丘脑（1.47±0.28和1.49±0.29）均分别低于同性别对照组（1.62±0.33和1.60±0.34、1.65±0.32和1.59 ±0.30、1.62 ±0.36和1.71±0.36）,差异均有统计学意义（t值分别为2.18、2.06、2.23、2.28、2.20、2.09,均P＜0.05）.男性与女性患者组之间1H-MRS各代谢指标比较,差异均无统计学意义,且2组前额叶、丘脑的NAA/Cr值、Cho/Cr值与PANSS总分及各因子分、病程间均无相关性（r=-0.37 ～0.27,P＞0.05）.结论 早发未经药物治疗的精神分裂症患者可能存在双侧前额叶和左侧丘脑的神经元损害,这种损害与临床症状和病程均无直接关系,未发现存在性别差异.

Objective To investigate the neurochemical metabolite levels and the potential effects of gender on prefrontal lobe and thalamus in first-episode drug-na^ve patients with early-onset schizophrenia using hydrogen proton magnetic resonance spectroscopy （^1H-MRS）.Methods Forty-four early-onset schizophrenia patients,including 25 males and 19 females,who met with the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition （DSM-Ⅳ）,and 50 healthy volunteers including 30 males and 20 females were recruited.The patients with hospitalization of less than 24 h and without any antipsychotic medicine,and healthy volunteers were examined by using muhi-voxel ^1H-MRS.The N-acetylaspartate （NAA）,Choline-congtaining compounds （Cho）,and creatine compounds （Cr） in he prefrontal lobe and thalamus were measured.The patients were evaluated with the Positive and Negative Syndrome Scale （PANSS） as well.Results There were no significant differences on the total score,sub-score of PANSS and duration of illness between male and female patients.The NAA/Cr ratios in the left prefrontal lobe,right prefrontal lobe and left thalamus were lower in both male and female patients than those in the same gender normal controls respectively （1.44 ± 0.27 vs.1.62 ± 0.33,t =2.18 ; 1.41 ± 0.24 vs.1.60 ± 0.34,t =2.06; 1.41 ±0.28 vs.1.65 ±0.32,t =2.23; 1.39 ±0.26 vs.1.59 ±0.30,t =2.28; 1.47 ±0.28vs.1.62±0.36,t =2.20; 1.49 ±0.29 vs.1.71 ±0.36,t =2.09; all P 〈0.05）.There were no significant differences in the ^1H-MRS metabolism indexes between male and female （P 〉0.05）.There were no correlation among the NAA/Cr and Cho/Cr in prefrontal lobe and thalamus,score of PANSS,duration of illness （r =-0.37-0.27,P 〉 0.05）.Conclusions Abnormalities of neuroal function in bilateral prefrontal lobe and left thalamus are present in first-episode drug-naive patients with early onset schizophrenia and there maybe no correlation with either clinical symptoms or duration of illness.