首发儿童精神分裂症患者病前社会能力与颅脑结构的关系

Relationship between premorbid social competence and brain structure in child with first-episode schizophrenia

目的 探讨首发儿童精神分裂症患者病前社会能力与颅脑结构之间的关系.方法 将144例首发儿童精神分裂症患儿设为研究组,140名健康儿童设为对照组,采用Achenbach儿童行为量表的第二部分（社会能力）评估6岁-11岁时的社会能力;以评分结果中位数将研究组分高分组（评分≥中位数）及低分组（评分〈中位数）各72例,并采用磁共振成像技术测量患儿的颅脑结构,并进行相关分析.结果 研究组Achenbach儿童行为量表社会能力总分及社交能力、学校情况因子分均显著低于对照组,差异均有统计学意义（P〈0.05或0.01）.研究组社会能力高分组与低分组的颅脑结构测量值比较经t检验及协方差分析显示：总分在第三脑室横径、第三脑室侧壁至左脑岛面距、右颞角宽度、顶叶脑沟宽及胼胝体厚,活动能力因子分在第三脑室横径、右颞角宽度及胼胝体厚,社交能力因子分在侧脑室体最大距、右颞角宽度、顶叶脑沟宽度,学校情况因子分在第三脑室侧壁至左右脑岛面距、顶叶脑沟宽度及左尾状核头宽度的高分组与低分组颅脑结构测量值比较差异均有统计学意义（P〈0.05或0.01）.研究组社会能力总分及活动能力、社交能力、学校情况因子分与顶叶脑沟宽度呈负相关（r=-0.367、-0.230、-0.332、-0.259）,与右颞角宽度呈正相关（r=0.389,0.326,0.280,0.236）,社会能力总分及学校情况因子分与第三脑室侧壁至左脑岛面距呈负相关（r=-0.208、-0.190）,活动能力及社交能力因子分与额叶脑沟宽度呈负相关（r=-0.18、-0.172）.结论 首发儿童精神分裂症患者存在病前社会能力降低,病前社会能力与颅脑结构存在相关关系,社会能力越低,脑室扩大和脑结构异常越明显.

Objective To explore the relationship between premorbid social competence and brain strut ture in child with first-episode schizophrenia. Methods 144 children with first episode sehizophrenia were selected as study group, and 140 health children were selected as control group. With Achenbach＇s Child Behavior Check list （CBCL）, the social competence of children at the age of 6y to 11y were assessed; the patients were divided into high-score group （social competence score ≥ median ） and low-score group （so cial competence score 〈 median） （72 cases in each group）. The patients＇ brain structures were measured MRI. Results The total CBCL score, social competence score and school factor in study group were low er than those in control group, and the differences were statistically significant （P〈0.05 or 0.01）; In study group, brain structure measurement in high score group and low-score group were compared with t test and covariance analysis： total score lies in the third ventricle transverse diameter, third ventricle side wall to the left insula distance, right temporal width, parietal sulcus width and corpus callosum thickness;social competence score lies in the third ventricle transverse diameter, right temporal width and cor- pus callosum thickness; social factor lies in lateral ventricle maximum distance, right temporal width, parietal suleus width; school factor lies in third ventricle side wall to left-right insula distance, parietal sulcus width and left head of caudate nucleus. The brain structure measurement in high-score and low-score were significantly different （P〈0.05 or 0.01）. For study group, the total social competence score, activity, social skill and school factor were negatively correlated to parietal sulcus width （r = 0. 367, -0. 230, -0. 332, -0. 259）, positively correlated to right temporal width （r=0. 389, 0. 326, 0. 280, 0. 236）; the total social competence score and school factor were negatively correlated to third ventricle side wall-left insula distance （r=-0. 208, -0. 190）; activity, social skill were negatively correlated to parietal sulcus width （r=-0.18, -0. 172）. Conclusion There is a decrease in social competence in child with first-episode schizophrenia. The premorbid social competence is significantly correlated with the brain structure. The lower social competence is, the more obvious enlarged ventricle and brain structure abnormalities are.