有和无家族史的青年双相情感障碍Ⅰ型患者脑灰质体积基于体素形态学对比研究

A Brain Gray Matter Voxel-Based Morphometry Contrastive Analysis in Young Bipolar Disorder-Ⅰ Patients with and Without Family History

目的对比有和无精神疾病家族史的双相情感障碍Ⅰ型(BD-Ⅰ)青年患者及正常对照者脑灰质体积差异,探讨BD-Ⅰ遗传相关的脑灰质结构改变。方法搜集BD-Ⅰ型青年患者有精神疾病家族史18例、无家族史39例及相匹配的正常对照者49名,运用基于体素形态学分析(VBM)方法分析组间全脑灰质体积差异,并进一步对患者脑灰质总体积及有异常改变脑区的体积值与一般临床资料、汉密尔顿抑郁量表(HAMD)、贝克躁狂量表(BRMS)及阳性和阴性症状量表(PANSS)评分进行Pearson相关分析。结果与正常组比较,有家族史组左侧颞上、下回,右侧颞上回,双侧梭状回及双侧前扣带回灰质体积明显减小,右侧额极-眶额回、右顶上小叶及小脑蚓部灰质体积增大;无家族史组双侧海马-海马旁回-杏仁体、双侧前扣带回灰质体积明显减小。BD患者组之间比较,有家族史组小脑蚓部灰质体积明显大于无家族史组。总体BD患者全脑灰质体积与病程呈负相关(r=-0.549,P=0.03),与PANSS阴性分呈正相关(r=0.479,P=0.01)。结论有和无家族史BD患者均存在脑灰质体积异常,前者异常脑区更广泛,小脑蚓部灰质体积增加更可能是与BD遗传相关的结构改变。

Objective To perform contrastive analysis of brain gray matter volume discrepancies among Bipolar Disorder type I（ BD-Ⅰ） young patients with and without family history of mental illness and normal controls,and explore brain gray matter structural abnormalities in BD patients relating to genetic factors. Methods Eighteen BD-Ⅰ young patients with family history of mental illness and 39 BD-Ⅰ young patients without family history of mental illness,as well as 49 matched normal controls were respectively recruited. Discrepancies of total brain gray matter volume among the 3 groups were analysed by using VBM. Pearson correlation analysis among gray matter volume values of total brain gray matter and abnormal brain area in patients with general clinical data,HAMDS,BRMS and PANSS scores was performed. Results Contrasted with normal controls,gray matter volume significantly decreases were found in left superior and interior temporal gyrus,right superior temporal gyrus,bilateral fusiform gyrus and bilateral anterior cingulate gyrus,increases in right frontal pole-orbital frontal cortex,right superior parietal lobe and cerebellar vermis in BD patients with family history. Significant decreases were found in the bilateral hippocampus-parahippocampus gyrus-amygdala areas and bilateral anterior cingulate gyrus in BD patients without family history. Contrasted between the two patient groups,gray matter volumes in cerebellar vermis in patients with family history were bigger than those without family history. The total gray matter volume values in all BD patients were negatively correlated with disease duration and positively correlated with PANSS negative scores.Conclusion Gray matter volume abnormalities existed both in BD patients with and without family history,with pattern of abnormalities which were not the same completely. The increase in volumes in the cerebellar vermis were probably structural changes related to genetic factors.