缺陷型精神分裂症患者静息态局部一致性与注意功能的相关分析

The abnormalities of regional homogeneity in the resting-state functional magnetic resonance imaging were associated with impairment of attention function in deficit schizophrenia

目的探讨缺陷型精神分裂症（deficit schizophrenia，DS）患者静息态脑功能活动局部一致性（regional homogeneitv，ReHo）特征，及其与注意功能的相关分析。方法入组符合DSM．1V精神分裂症诊断标准的患者，按缺陷型精神分裂症诊断量表进一步分为DS患者与非缺陷型精神分裂症（non-deficit schizophrenia，NDS）患者，共人组男性Ds患者30例（DS组）、NDS患者38例（NDS组），同时纳入年龄、性别及利手匹配的38名健康对照者（对照组），使用简明精神病评定量表、阳性症状量表和阴性症状量表评估患者精神症状，Stroop测验评估所有受试者注意功能，利用3．0T磁共振扫描仪采集受试者静息态脑功能数据，计算ReHo指标并进行组间差异比较，采用偏相关分析分析DS组与NDS组差异性脑区ReHo值与注意功能的相关性。结果（1）DS组与NDS组Stroop颜色、单词、色词干扰测验评分均低于对照组（F=28．615、39．516、21．898，均P〈O．01），DS组Stroop颜色[（26．5±12．9）分与（35．6±11．5）分]、单词[（43．5±19．4）分与（58．0±15．2）分]评分均显著低于NDS组（t=-2．949，P=O．012；t=-3．507，P=O．002）。（2）与NDS组相比，DS组ReHo值增高有统计学意义的脑区：右侧舌回、左侧舌回、左侧颞下回、右侧颞中回顾上回、右侧枕中回（t=4．70，3．96，4．22，3．50，4．44，均P〈O．01，AlphaSim校正）；ReHo值降低的脑区：左侧内侧额上回，前扣带回、右侧额下回三角部颅中回、左侧额下回三角部（t=-3．24，-4．48，-3．47，均P〈O．Ol，AlphaSim校正）。（3）Ds组左侧三角部额下回ReHo值与Stroop单词（r=0．451，P=0．016）、色词干扰（r=O．504，P=O．006）测验评分显著正相关，与Stroop颜色测验评分相关不显著（r=0．345，P=0．072）；其他差异性脑区ReHo值与Stroop测验评分均未见显著相关性。NDS组差异性脑区ReHo值与Stroop测验未见显著相关性。结论Ds患者较NDS患者存在更为显著的持续注意功能障碍，左侧额下回三角部可能是其关键受损脑区。

Objective To identify the characteristics of regional homogeneity （ReHo） of resting state brain activity and explore the association with the attention function in patients with deficit schizophrenia （DS）. Method The patients were recruited with the diagnosis of schizophrenia according to DSM-IV criteria and divided into DS and non-deficit schizophrenia （NDS） sub-groups according to the Chinese version of the Schedule for the Deficit Syndrome （SDS）. Thirty DS patients and 38 NDS patients, accompanying with 38 healthy controls （HC） who were age-, gender- and handedness-matched with the patients were enrolled. The severity of schizophrenic symptoms was evaluated by the Brief Psychiatric Rating Scale （BPRS）, Scale for the Assessment of Negative Symptoms （SANS）, and Scale for the Assessment of Positive Symptoms （SAPS）. The Stroop color-word test were used to assess the attention function of subjects. All participants were scanned using a 3.0 T MRI system （GE HDx） for the resting-state fMRI data. The ReHo was calculated and compared between 3 groups. A partial correlation analysis was further performed to explore the relationships between these difference ReHo and attention function within the specific group. Results The Stroop colors, Stroop words, Stroop interference test scores were lower in both DS and NDS groups than HC group （F=28.615, 39.516, 21.898, all P〈0.01）. DS patients showed lower scores in Stroop colors （26.5 ± 12.9 vs. 35.6± 11.5 ）, Stroop word （43.5 ± 19.4 vs. 58.0±15.2） test than NDS patients （t=- 2.949, P=0.012; t=-3.507, P=0.002）. Compared with NDS patients, DS patients showed significant increased ReHo in left and right lingual gyms, left inferior temporal gyms, right middle temporal gyms/superior temporal gyms, right middle occipital gyms （t=4.70, 3.96, 4.22, 3.50, 4.44, all P〈0.01, AlphaSim correction）, and the significant decreased ReHo in left medial superior frontal gyms/anterior cingulate gyms, right triangular part of inferior frontal gyms/middle frontal gyms, left triangular part of inferior frontal gyms （t=-3.24,-4.48,-3.47, all P〈0.01, AlphaSim correction）. The ReHo of left inferior frontal gyms triangular was positively correlated with Stroop words test （r=0.451, P=0.016） and Stroop interference test （r=0.504, P=-0.006） and showed no significant correlation with Stroop colors test （r=0.345, P=0.072）. There was no significant correlation between the ReHo and Stroop test scores in other areas. NDS patients showed a negative result in correlation analysis. Conclusion Compared with NDS patients, DS patients may have more serious in sustained attention function, which might be related to brain activity regional homogeneity in left triangular part of inferior frontal gyrus.