青少年首发精神分裂症患者脑结构异常及其相关因素研究

Structural brain abnormalities and clinical features in childhood-onset schizophrenia

目的探讨青少年首发精神分裂症患者的脑结构异常及其相关因素。方法应用回顾性统计方法分析2013年1月至2016年4月新入院379例青少年精神分裂症患者临床资料及头部CT资料,分为头部CT正常组(340例)与头部CT异常组(39例)。观察青少年首发精神分裂症患者头部CT异常的发生率和脑结构异常类型,分析青少年首发精神分裂症患者脑结构异常的相关因素。结果青少年首发精神分裂症脑结构异常者39例,头部CT异常率为10.3%,其中脑室扩大17例(43.6%),脑沟增宽11例(28.2%),大枕大池7例(17.9%),蛛网膜囊肿4例(10.3%)。与头部CT正常者相比,青少年首发精神分裂症患者头部CT异常者年龄更小,母孕期异常(早产、剖宫产者)更多,差异有统计学意义(P<0.01)。应用Pearson相关分析,青少年首发精神分裂症患者头部CT异常者,脑结构异常的发生与年龄负相关(r=-0.31,P<0.01),与母孕期异常正相关(r=0.19,P<0.01);脑结构异常类型与性别、家族史、临床表现等无相关性(P>0.05)。结论青少年首发精神分裂症脑结构异常检出率较高,并且脑结构异常者起病年龄更小、母孕期异常更多,青少年精神分裂症脑结构异常可能为其神经生物学基础。

Objective To investigate the clinical features and structural brain abnormalities in childhood-onset schizophrenia.Methods Retrospective analysis clinical features and brain CT images of 379 patients diagnosed with schizophrenia from January 2013 to April 2016.The patients were divided into 2 groups;with（n = 39） and without（n = 340） structural brain abnormalities.Socio-demographic and clinical data were compared between two groups.To observe the abnormality rate of structure CT and the types of structural brain abnormalities and analyze the clinical features in childhood-onset schizophrenia.Results The abnormality rate of structure CT scan was 10.3%.There were 17 cases with ventricular dilatation,11 cases with broadening of cerebral sulci,7 cases with enlarged cisterna magna,4 cases with arachnoid cyst.Compared to without structural brain abnormalities,childhood-onset schizophrenia with structural brain abnormalities significantly had younger age,more frequent abnormal maternal pregnancy（P〈0.01）.The pearson correlation analysis showed that childhood-onset schizophrenia with structural brain abnormalities were positively correlated with abnormal maternal pregnancy（r = 0.19,P〈0.01） and negatively correlated with age（r =-0.31,P〈0.05）.Conclusion The abnormality rate of structure CT scan in childhood-onset schizophrenia is high.The childhood-onset schizophrenia with structural brain abnormalities exhibit younger age,more frequent abnormal maternal pregnancy.The structural brain abnormalities may play a big role in the neurobiology in childhood-onset schizophrenia.