儿童青少年精神分裂症中22q11缺失综合征对精神症状与认知功能的影响

Effects of 22q11 deficit syndrome on mental symptoms and cognitive function in children and adolescents with schizophrenia

目的探讨22q11缺失综合征在儿童青少年精神分裂症中的表达,以及对精神症状与认知功能的影响。方法采用病例-对照的研究方法,选取2016年4月至2018年12月新乡医学院第二附属医院所有确诊为精神分裂症的儿童青少年患者134例作为病例组,并将病例组患者分为存在22q11缺失组和未缺失组,对照组为无精神病史和家族史的健康体检儿童418例。采用原位杂交实验诊断22q11微缺失综合征,并用阳性和阴性症状量表及中文版精神分裂症认知功能成套测验对病例组患者进行评分。结果22q11染色体微缺失状态在患精神分裂症的儿童青少年中表达更显著(χ^2=33.52,P<0.0001)。22q11缺失组患者中阴性症状(P=0.034)、一般状况(P=0.005)、总分(P=0.001)均显著升高。22q11缺失组患者连线测验、言语记忆、空间广度、情绪管理、持续操作五项指标及总分均显著低于未缺失组(P<0.05)。儿童青少年精神分裂症患者中22q11缺失组较未缺失组存在显著各向异性分数(fractional anisotropy,FA)值减低,主要分布在胼胝体体部、膝部和扣带束(P<0.05),其余脑区均未见FA值升高。22q11缺失组患者中胼胝体体部脑白质FA值与视觉记忆、语言流畅呈正相关;胼胝体膝部FA值与语言流畅呈正相关;扣带束FA值与空间广度呈正相关(P<0.05)。结论儿童青少年精神分裂症患者中22q11染色体微缺失状态更为常见,可能通过降低胼胝体体部、膝部和扣带束FA值影响患者视觉记忆、语言流畅和空间广度。

OBJECTIVE To investigate the expression of 22q11 deletion syndrome in children and adolescents with schizophrenia and its effect on mental symptoms and cognitive function.METHODS Case-control method was used.134 cases of children and adolescents diagnosed with schizophrenia in hospital from April 2016 to December 2018 were selected as the case group,and the patients in the case group were divided into the two groups including 22q11 deletion group and the non-deletion group.The control group included 418 healthy children with no history of mental illness or family history.In situ hybridization was used to diagnose 22q11 microdeletion syndrome,and positive and negative symptom scales and Chinese version of schizophrenia cognitive function battery test were used to score the patients in the case group.RESULTS The expression of 22q11 microdeletion was more significant in children and adolescents with schizophrenia(χ^2=33.52,P<0.0001).The negative symptoms(P=0.034),general condition(P=0.005)and total score(P=0.001)were significantly increased in the 22q11 deletion group.The five indicators of attachment test,verbal memory,spatial span,emotional management,continuous operation and total score in the 22q11 deletion group were significantly lower than those in the non-deletion group(P<0.05).Among children and adolescents with schizophrenia,there was a significant decrease in the FA value in the 22q11 deletion group compared with the non-deletion group,mainly distributed in the corpus callosum,the knee and the cingulate tract(P<0.05),and no increase in the FA value was observed in other brain areas.FA value of corpus callosum somatic white matter in the absence group was positively correlated with visual memory and language fluency.FA value of the knee in corpus callosum was positively correlated with language fluency.FA value of the buckle was positively correlated with spatial width(all P values were less than 0.05).CONCLUSION 22q11 microdeletion is more common in children and adolescents with schizophrenia,which may affect visual memory,language fluency and spatial span by reducing FA values in corpus callosum,knee and cingulate tract.