首次发病儿童青少年精神分裂症患者脑白质弥散张量成像特点与认知功能的研究

A diffusion tensor imaging study of brain white matter and cognitive function in first-episode of childhood and adolescence-onset schizophrenia

目的 探讨首次发病儿童青少年精神分裂症患者脑白质纤维结构及其与认知功能的关系.方法 本研究为病例对照研究,对40例10～16岁首次发病儿童青少年精神分裂症患者（患者组）和35名性别、年龄、受教育程度、种族均与之相匹配的健康对照者（对照组）进行弥散张量成像（diffusion tensor imaging,DTI）扫描,采用磁共振图像处理软件FSL（funtional MRI software library）工具包进行分析.通过基于纤维束的空间统计分析（tract-based spatial statistics,TBSS）方法比较2组之间脑白质纤维的各向异性（fractional anisotropy,FA）图,采用独立样本t检验比较2组全脑白质DTI的FA值,得到差异脑区.采用中文版精神分裂症认知功能成套测验-共识版评估认知功能,Pearson相关分析分析2组脑白质差异脑区FA值与认知功能之间的相关关系.结果 与对照组（n=34）比较,患者组（n=35）胼胝体体部、胼胝体膝部、胼胝体压部、扣带束、右上放射冠、左上放射冠FA值降低（t=4.726、2.855、2.547、2.943、3.178、2.969,均P〈0.05）.患者组胼胝体体部FA值与符号编码、颜色、色词评分（r=0.34、0.38、0.36）,扣带束FA值与霍普金斯词汇学习测验修订版评分（r=0.34）、左上放射冠FA值与词语流畅性评分（r=0.37）呈正相关（均P〈0.05）;对照组胼胝体体部（r=0.34,P〈0.05）及胼胝体膝部FA值（r=0.51,P〈0.05）与霍普金斯词汇学习测验修订版评分呈正相关.结论 首次发病儿童青少年精神分裂症患者存在大脑白质纤维结构异常,其认知功能损害的病理生理机制可能与大脑白质纤维结构异常有关.

Objective To explore the microstructural changes of brain white matter in first-episode of childhood and adolescence-onset schizophrenia and the relationship between the fractional anisostrapy （FA）values and cognitive function in patients.Methods This study was a case-control study,40 childhood and adolescence-onset schizophrenia patients aged 10-16 years 35 healthy children with sex,age,education and race matched to controls were chosen. All the subjects were conducted diffusion tensor imaging （DTI） scans, then using tract-based spatial statistics （TBSS） method to compare FA values of white matter fiber. The cognitive function was assessed with the （MATRICS Consensus Cognitive Battery,MCCB）. The relationship between the FA values of different white matter and the cognitive function in the two group was analysed by using Pearson correlation analysis. Results Compared with the controls（n=34）, FA values of patients（n=35） in the body of corpus callosum, genu of corpus callosum, splenium of corpus callosum, cingulum bundle, right upper corona radiate, upper left corona radiate significantly decreased （t=4.726, 2.855,2.547,2.943,3.178,2.969,all P〈0.05）.The FA values of the body of corpus callosum were positively correlated with the symbol coding, color, color words（r=0.34, 0.38, 0.36, all P〈0.05） in patients. The FA value of the cingulum bundle were positively correlated with the Hapkins Verbal Learning Test-Revised （HVLT-R）,the FA value of the upper left corona radiate were positively correlated with the Word fluency（r=0.34,0.37,both P〈0.05）.In the controls FA value of white matter in the body and genu of corpus callosum were positively correlated with the HVLT-R（r=0.34,0.51,both P〈0.05）.Conclusions The childhood and adolescence-onset schizophrenia showed microstructural changes in the brain regional white matter, the pathophysiological mechanism of cognitive impairment may be related to the abnormalities of the brain white matter microstructural structure.