青少年首发未用药精神分裂症患者药物治疗前后脑灰质体积的变化

Cerebral grey matter changes of pre- and post-treatment in first-episode drug.naive adolescents schizophrenia

目的探讨首发未用药青少年精神分裂症患者大脑灰质体积及抗精神病药物治疗8周后灰质体积的变化。方法对2015年4月至2016年6月在新乡医学院第二附属医院住院的35例首发未用药青少年精神分裂症患者（患者组）和同时期在社区招募的35名性别、年龄、受教育年限相匹配的健康志愿者（健康对照组）用3．0T磁共振成像仪进行头颅结构MRI扫描，其中患者组在基线和抗精神病药物治疗8周后分别进行结构MRI扫描和PANSS评估，运用VBM方法对全脑灰质体积及其变化进行分析，并进一步分析患者组基线有统计学意义脑区灰质体积与PANSS各项分值的相关性。结果与健康对照组相比，患者组左侧额上回[MIN坐标（x、y、z）：-13．5、36、46．5]、左侧顶上小叶[MIN坐标（x、y、z）：-52．5、-42、52．5]和左侧顶下小叶[MIN坐标（x、y、z）：-31．5、-45、69]、右侧中央前回[MIN坐标（x、y、z）：9、21、61．5]的灰质体积显著减少（t值分别为：-4．3840、-4．5562、-6．4309、-4．3139，P〈0．001）；患者组内比较，8周治疗后（20例）PANSS各项分值较治疗前均显著降低（P〈0．001），各脑区灰质体积较治疗前无明显变化（P〉0．05）；相关分析未发现患者组基线有统计学意义脑区的灰质体积与PANSS评分的各项分值存在相关（P〉0．05）。结论首发青少年精神分裂症患者存在局部脑区灰质体积的减少，且这些灰质体积减少的脑区可能独立于患者的精神症状。

Objective To investigate the gray matter（ GM ） volume and the change of GM volume after antipsychotic treatment for 8 weeks in first-episode drug-naive adolescents with schizophrenia. Methods Tl-weighted brain MRIs were obtained on a 3T scanner in 35 controls and 35 subjects with adolescents schizophrenia who were admitted to the Second Affiliated Hospital of Xinxiang Medical College from April 2015 to June 2016 and not given antipsyehotic medication, the schizophrenia patients received second scan after 8 weeks of antipsyehotic treatment. Positive and negative syndrome scale （PANSS） assessments were performed in patients pre- and post-treatment; voxel-based morphometry （VBM） was used to analyze changes of GM volume and the correlation between the baseline GM volume and the PANSS scores was further analyzed. Results GM volumes in the left frontal gyrus （MIN（x,y,z） ： - 13.5,36,46. 5） , left superior parietal lobule （ MIN （ x, y, z） ： - 52. 5, - 42,52.5 ） , left inferior parietal lobule （ MIN （ x, y, z） ： - 31.5, - 45, 69） and left central anterior （ MIN （ x, y, z） ： 9,21,61.5 ） were significantly smaller than those in the normal control group （t = - 4. 384 0, - 4. 556 2, - 6. 430 9, - 4. 313 9 respectively,P 〈0. 001 ） ; after treatment for 8 weeks PANSS scores were significantly lower than those of baseline （ P 〈 0. 001 ）, however, there was no significant difference in regional GM volume between the pre-and post- treatment （P 〉 0. 05 ） and no significant correlation was found between GM volume and PANSS scores. Conclusion There are local GM volume reductions in subjects with adolescents schizophrenia and these regions may be independent to mental symptoms of patients.