首发未用药精神分裂症患者脑内神经生化代谢物与认知功能的相关性

Correlation of neurobiochemical metabolites and cognitive function in first-episode drug-naive schizophrenia patients

目的探讨首发未经治疗的精神分裂症患者用药前脑内神经生化代谢物质的特点及其与认知功能之间的相关性。方法纳入首发未治精神分裂症患者33例（男性19例、女性14例）作为研究组，对照组为符合纳入标准的健康成人33人（男性14名、女性19名）。采用单体素氢质子磁共振波谱（1H-MRS）检测左侧前额叶和丘脑N-乙酰基天门冬氨酸（NAA）、胆碱复合物（Cho）、肌酸复合物（Cr）与磷酸化肌酸复合物（Cr2）的水平，并计算NAA／Cr值、Cho／Cr值、Cr2／Cr值、NAA／Cho值。选取剑桥神经心理自动化成套测试（CANTAB）中的图形识别记忆（PRM）延迟再识别正确率评定其认知功能。结果研究组左侧前额叶Cr2／Cr值（1．15±0．87）高于对照组（0．72±0．46），差异有统计学意义（P〈0．05）。左侧前额叶NAA／Cr值、Cho／Cr值、NAA／Cho值以及丘脑NAA／Cr值、Cho／Cr值、Cr2／Cr值、NAA／Cho值与对照组比较差异均无统计学意义（P〉0．05）。CANTAB认知测试中PRM正确率，研究组为（82．81±15．44）％低于对照组的（95．20±6．26）％，差异有统计学意义（P〈0．05）。Pearson相关分析发现，研究组左侧前额叶Cho／Cr值与PRM正确率呈负相关（r=-0．424，P〈0．05），NAA／Cho值与PRM正确率呈正相关（r=0．473，P〈0．01）。研究组左侧前额叶NAA／Cr值、Cho／Cr值与PANSS总分呈正相关（r=0．538、0．450，P〈0．01）。结论首发未治精神分裂症患者用药前存在认知功能缺陷，其左侧前额叶部分神经生化代谢物质神经元细胞膜磷酸化水平在用药前就出现了异常。提示首发未治精神分裂症患者用药前的认知功能损害与前额叶神经生化代谢功能异常存在一定的相关性。

Objective To investigate the characteristics of neurobiochemical metabolites in the forebrain of patients with first-episode drug-naive schizophrenia and their correlation with cognitive function. Methods The study group included 33 patients （19 males and 14 females） of the first-episode drug-naive schizophrenic patients. The control group recruited 33 healthy adults （14 males and 19 females） who met the inclusion criteria. The levels of N-acetyl aspartate （NAA）, choline complex （Cho）, creatine （Cr） in the left prefrontal and thalamus were measured by hydrogen-proton magnetic resonance spectroscopy （1H-MRS） The level of complex （Cr） and phosphorylated creatine complex （Cr2）, and calculate the NAA/Cr value, Cho/Cr value, Cr2/Cr value, NAA/Cho value. The Cognitive Function was evaluated by a Graphic Recognition Memory （PRM） test module in the Cambridge Neuropsychologieal Automated Complete Test （CANTAB）. Results The Cr2 / Cr value （1.15 ± 0.87） in the left frontal lobe of the study group was higher than that in the control group （0.72± 0.46）, and the difference was statistically difference （P 〈 0.05）. There were no significant differences in NAA/Cr value, Cho/Cr value, NAMCho value, and NAA/Cho value, Cho/Cr value, Cr2/Cr value, NAA/Cho value （P 〉 0.05）. The correct rate of PRM in CANTAB cognitive test was lower in patients （82.81 ± 15.44）% than in controls （95.20± 6.26）%, with significant difference （P 〈 0.05）. Pearson correlation analysis showedthat the PRM correct rate was negatively correlated with the left frontal lobe Cho/Cr value （r=-0.424, P 〈 0.05） and positively correlated with the left prefrontal NAA/Cho value （r=0.473, P 〈 0.01）. PANSS total score was positively correlated with the left frontal lobe NAA/Cr value （r=0.538, P 〈 0.01） and positively correlated with the left prefrontal Cho/Cr value （r=0.450, P 〈 0.01）. Conclusions The left frontal lobe part of the neurobiochemical metabolites were lower than the normal control group, suggesting that patients with first- episode schizophrenia neuronal cell membrane phospholylation before treatment appeared abnormal. Correlation analysis further confirmed that the cognitive function of patients with first-episode schizophrenia before medication was correlated with the presence of prefrontal-related brain function.