首发儿童少年精神分裂症患者脑灰质体积的改变及其与认知功能的关系

Brain gray matter volume alterations and cognitive function in first-episode childhood-and adolescence-onset schizophrenia

目的探讨首次发病儿童少年精神分裂症患者脑灰质体积的异常改变及其与认知功能的关系.方法收集2014年至2016年在新乡医学院第二附属医院住院的10~16岁首次发病的儿童少年精神分裂症患者39例(病例组)与30名年龄、性别及受教育年限均与之相匹配的健康儿童少年(健康对照组)进行3.0T磁共振结构扫描,通过基于体素的形态学方法(VBM)比较两组脑灰质体积值,得出差异脑区.采用中文版精神分裂症认知功能成套测验评估及Stroop-色词测验对患者进行评估,分析2组研究对象脑灰质差异脑区值与认知功能间的相关关系(Pearson相关分析).结果病例组较健康对照组灰质体积减小的脑区有右侧脑岛、左额下回、左边缘叶(t=-5.303、-5.302、-6.211,均P<0.05).病例组的连线测验分高于健康对照组(t=3.22,P<0.01).符号编码、HVLT-R、BVMT-R、词语流畅性、数字广度、迷宫、单词、颜色、色词得分显著低于健康对照组(t=-6.41,-5.42,-7.77、-5.59、-8.78、-6.99、-6.98、-6.47、4.84,均P<0.01).Pearson相关分析显示,患者组右侧脑岛与BVMT-R、迷宫评分呈正相关,左额下回与迷宫评分呈正相关(r=0.32、0.50、0.45,均P<0.05);对照组左额下回与数字广度评分呈正相关(r=0.46,P<0.05).结论首发儿童少年精神分裂症患者存在大脑灰质体积及认知功能的异常,认知功能广泛缺损的病理生理机制可能与脑灰质体积异常改变有关.

Objective To investigate the abnormal changes of gray matter volume and its relationship with cognitive function in first-episode childhood-and adolescence-onset schizophrenia.Methods A total of 39(aged 10-16 years)first-episode childhood-and adolescence-onset schizophrenia(patient group)were recruited from the inpatient departments of Second Affiliated Hospital of Xinxiang Medical University between 2014 and 2016,meanwhile,30 age-,sex-and education years-matched healthy children and adolescents(control group)were also enrolled.All the subjects underwent 3.0 T magnetic resonance imaging(MRI)scan.The volume of gray matter in two groups was compared by voxel based morphometric method(VBM).MATRICS Consensus Cognitive Battery(MCCB)and the Stroop Color and Word Test(SCWT)were employed to evaluate the cognitive function of the two groups,and the relationship between the abnormal gray matter region and the cognitive function in the two group was analyzed.Results Compared with the control group,brain gray matter volume in the right insula,left inferior frontal gyrus,the left limbic edge were significantly decreased(t=-5.303,-5.302,and-6.211;all P<0.05).Trail making test scores in the patient group were higher than those of the control group(t=3.22,P<0.01).However,scores of symbol coding,HVLT-R,BVMT-R,word fluency,digital span,maze test,word,color and color word were lower than those of the control group(t=-6.41,-5.42,-7.77,-5.59,-8.78,-6.99,-6.98,-6.47 and 4.84,all P<0.01).Pearson correlation analysis showed that the right insula was positively correlated with the BVMT-R and maze test scores,and the left inferior frontal gyrus was positively correlated with the maze scores in the patient group(r=0.32,0.50 and 0.45,all P<0.05).The left inferior frontal gyrus was positively correlated with the digital span in control group(r=0.46,P<0.05).Conclusion The first-episode childhood-and adolescence-onset schizophrenia exhibits abnormal changes of gray matter volume and cognitive function,and the pathophysiological mechanisms of a wide range of cognitive impairments may be related to abnormal volume changes of gray matter.