首发精神分裂症脑部钩束损伤与认知功能障碍的相关性分析

Correlation Analysis between Uncinate Fasciculus Injury and Cognitive Function Disorder in Patients with First-episode Schizophrenia

目的探讨首发精神分裂症患者与健康者认知功能的差异及其与脑部钩束损伤的相关性。方法选取武汉市精神卫生中心收治的45例首发精神分裂症患者(试验组)和36例健康志愿者(对照组),进行认知功能测验及脑部磁共振弥散张量成像(DTI)扫描,测量双侧钩束的各向异性分数(FA)和平均弥散率(MD),试验组患者接受阳性和阴性症状量表(PANSS)评定。比较两组认知功能测验各项目得分及FA值、MD值的差异,并进一步分析试验组认知功能测验成绩与PANSS量表各项目得分、FA值的相关性。结果试验组认知功能测验9个维度的评分均显著差于对照组(均P<0.01);试验组PANSS阳性症状值、阴性症状值、一般精神病理值及总分值分别为(25.59±4.83)、(21.17±5.03)、(39.42±5.57)、(89.24±9.31)。试验组双侧钩束FA值均显著低于对照组(均P<0.01),而试验组自身两侧钩束FA值无显著差异(P>0.05)。两组双侧钩束的MD值均无显著差异(均P>0.05)。相关性分析显示,试验组认知功能测验9个维度评分与PANSS阳性症状、阴性症状、一般精神病理得分及总分均无显著相关性(均P>0.05)。试验组左侧钩束FA值与符号编码、BVMT-R、ST-1~3、空间测试呈正相关,右侧钩束FA值与TMTA呈负相关,与HVLT-R、迷宫、范畴流畅、CPT及空间测试呈正相关。结论首发精神分裂症患者脑部双侧钩束存在损伤,双侧钩束损伤与患者的认知功能障碍存在显著相关性。

Objective To investigate the difference in cognitive function between first-episode schizophrenia patients and healthy subjects and their correlation with brain uncinate fasciculus injury.Methods Forty-five patients admitted to Wuhan Mental Health Center with first-episode schizophrenia(experimental group)and 36 healthy controls(control group)underwent cognitive function tests and brain magnetic resonance diffusion tensor imaging(DTI)scans to measure the uncinate fasciculus anisotropy(FA)and mean diffusion rate(MD)scores of the uncinate fasciculus.The patients in the experimental group were assessed by the Positive and Negative Symptoms Scale(PANSS).The scores of each item of cognitive function test and the difference of FA value and MD value were compared,and the correlation between the scores of the cognitive function test of the experimental group and the scores and FA values of each item of PANSS scale were further analyzed.Results The nine dimensions of the cognitive function test were significantly worse in the experimental group than in the control group(P<0.01).The PANSS positive symptom value,negative symptom value,general pathological value and total score of the experimental group were(25.59±4.83),(21.17±5.03),(39.42±5.57),(89.24±9.31).The FA values of the uncinate fasciculus on both sides of the experimental group were significantly lower than those of the control group(P<0.01).There was no significant difference in the FA value on both sides of the experimental group(P>0.05).There was no significant difference in the MD value between the two groups(P>0.05).Correlation analysis showed that there were no significant correlations between the nine dimensions of the cognitive function test and the positive PANSS symptoms,negative symptoms,general pathological scores and total scores(P>0.05).The FA value of the uncinate fasciculus on the left side of the experimental group was positively correlated with the symbol code,BVMT-R,ST1-3,and space test.The FA value of the right uncinate fasciculus was negatively correlated with TMTA,and the FA value of the right uncinate fasciculus was positively correlated with HVLT-R,maze,category fluency,CPT and space test.Conclusion There is a lesion in the uncinate fasciculus of the first-episode schizophrenia patients.And there is a significant correlation between uncinate fasciculus injury and cognitive dysfunction.