精神分裂症首次发病患者面孔情绪认知与额叶白质纤维功能的相关性

Facial emotion cognition deficits and the damage of white matter fiber tracts in the frontal lobe by diffusion tensor imaging in patients with first-episode schizophrenia

目的 比较首次发病未用药精神分裂症患者和健康对照者对面孔情绪的识别差异及其与脑额叶白质纤维损伤之间的关系.方法 对56例首次发病未用药精神分裂症患者（患者组）和30名健康对照者（对照组）进行磁共振弥散张量成像（diffusion tensor imaging）扫描;采用FACT方法和面孔情绪认知测试对额叶进行确定性纤维追踪,计算受损的额叶白质纤维各向异性分数（fractional anisotropy,FA）、平均弥散率（mean diffusivity,MD）、径向扩散系数（radial diffusivity,RD）、轴向扩散系数（axial diffusivity,AD）等各项参数值;对面孔情绪的识别差异,分别与PANSS量表和受损白质纤维的各项参数进行Pearson线性相关分析.结果 （1）患者组对50％高兴和50％生气的情绪判别为高兴情绪个数与对照组比较差异无统计学意义;将100％高兴和0生气[（9.96±2.42）个]、75％高兴和25％生气情绪[（9.91±2.33）个]判断为高兴情绪的个数低于对照组[（11.40±1.48）、（11.30± 1.44）个;t=-3.332,-3.325;均P＜0.01].将25％高兴和75％生气情绪[（2.24±2.57）个]、0高兴和100％生气情绪[（1.78±2.66）个]判断为高兴情绪的个数高于对照组[（0.83±2.21）、（0.70±2.02）个;t=2.537、2.056;P＜0.05或P＜0.01];对所有出现在屏幕上的图片反应时间总和的均值高于对照组（t=6.441,P＜0.01）.（2）脑额叶损伤相对显著的5条白质纤维为右侧背外侧额上回、右侧岛盖部额下回、右侧内侧额上回、左侧中央前回、左侧嗅皮质,除患者组右侧岛盖部额下回白质纤维FA值和左侧中央前回白质纤维AD值高于对照组,其他有统计学意义的参数均值均低于对照组（t=-2.993 0～2.830 0,P＜0.01或P＜0.05）.（3）患者组对5种类型面孔情绪识别与PANSS量表各因子分的线性相关分析结果未显示差异有统计学意义.（4）患者组将25％高兴和75％生气判别为高兴情绪（r=0.362,P=0.007）、将0高兴和100％生气判别为高兴情绪（r=0.476,P=0.000）与左侧中央前回白质纤维FA值呈正相关.结论 首次发病未用药精神分裂症患者不能精确识别面孔情绪,额叶白质纤维存在损伤,且二者相关.

Objective To explore facial emotion cognition character and the correlation to frontal lobe white matter fiber tracts in first-episode of schizophrenia patients in comparison with healthy control.Method The diffusion tensor imaging data were obtained from 56 patients with untreated first-episode schizophrenia and 30 healthy controls subjects.Fiber tracking was performed in the whole cerebral cortex of brain.The parameter of impairment white matter fiber tracts were obtained,such as fractional anisotropy,mean diffusivity,radial diffusivity,axial diffusivity.Computer-based facial emotion cognition test was used to evaluate difference of facial emotion identification.The correlation between ability of identifying ambiguous emotion and the parameter of impairment white matter fiber tracts,and the correlation between ability of identifying ambiguous emotion and PANSS scale were explored by linear correlation analysis.Result （1） Between patients and healthy control,there was no significant difference in the proportion of recognition as happy emotion to mixture of 50% happy emotion plus 50% angry emotion.In patients group,the number of regarding 100% happy emotion plus 0 angry emotion （9.96±2.42） and regarding 75% happy emotion plus 25% angry emotion （9.91 ± 2.33） both as happy emotion were significantly lower than the healthy control （11.40 ± 1.48,11.30± 1.44;t=-3.332,-3.325;all P〈0.01）.The number of regarding 25% happy emotion and 75% angry emotion as happy emotion（2.24±2.57）,and the number of regarding 0 happy emotion and 100% angry emotion as happy emotion（1.78 ± 2.66） were higher than healthy control（0.83 ± 2.21,0.70±2.02;t=2.537,2.056;P〈0.05 or P〈0.01）.The total response time for all images on screen was significantly longer than healthy control（t=6.441,P〈0.01）.（2）There are five relative serious fiber tracts impaired.Patients with schizophrenia were demonstrated lower activation in right dorsolateral frontal gyru,right inferior frontal operculum,right medial frontal gyrus,left precentral gyrus,left olfactory cortex （t=-2.993 0-2.830 0,P〈0.01 or P〈0.05）,in comparison with healthy controls,except FA value of right inferior frontal operculum and AD value of left precentral gyrus were found higher in patients group.（3） There was no correlation between identifying facial emotion and PANSS.（4）The correlation between identifying ambiguous emotion and the parameter of impairment or white matter fiber tracts was explored by linear correlation analysis,which found FA value of left precentral gyrus positively correlated to the number of identifying happy emotion from 25% happy emotion plus 75% angry emotion （r=0.362,P=0.007）,and from 0 happy emotion plus 100% angry emotion （r=0.476,P=0.000）.Conclusion This study suggests that schizophrenia patients could not identify facial emotion accurately and their white matter fiber tracts in the frontal lobe are damaged significantly.The impairment of facial emotion recognition is correlated with the abnormality of white matter fiber tracts.