一氧化二氮滥用致精神症状患者脑血流灌注特征

Characteristics of cerebral blood flow in patients with psychiatric symptoms caused by nitrous oxide abuse

目的探讨滥用一氧化二氮(N2O)致精神症状患者的神经心理和局部脑血流(regional cerebral blood flow,rCBF)特点。方法纳入2018年2月至2020年2月在中日友好医院和清华大学第一附属医院神经内科就诊的N2O滥用致精神症状患者12例。采用简明精神病评定量表(the brief psychiatric rating scale,BPRS),汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA),简易精神状态检查(MMSE),蒙特利尔认知评估量表(MoCA)对患者进行神经心理评估。采集患者SPECT/CT图像,图像重建后采用Database Comparison软件自动处理分析,估算各个脑区总体平均摄取值与正常相同年龄段相应感兴趣区的总体平均值的差异统计值。结果(1)12例N2O滥用患者临床表现为焦虑、抑郁、幻觉、被害妄想等精神症状,7例伴有认知功能下降。(2)神经心理测查:BPRS评分为(57.83±11.15)分,其中焦虑忧郁因子分为(3.94±0.47)分,缺乏活力因子分为(3.25±0.85)分,思维障碍因子分为(3.21±1.27)分,激活性因子分为(2.28±0.56)分,敌对性因子分为(3.14±1.24分);自知力障碍评分为(2.92±1.08)分,工作不能评分为(4.50±1.17)分,HAMD评分为(32.75±10.13)分,HAMA评分为(18.67±5.80)分,MMSE评分为(27.67±2.50)分,MoCA评分为(24.58±3.78)分。(3)脑SPECT显示,与正常相同年龄段相应感兴趣区的总体平均值比较,7例(58.30%)患者的额叶、8例(66.70%)患者的颞叶局部脑血流灌注明显减低。结论滥用N2O对局部脑血流灌注有重要影响,可出现焦虑、抑郁、幻觉、被害妄想等精神病学症状,严重影响工作学习能力。SPECT脑灌注显像能够清晰的显示N2O滥用致脑局部血流灌注改变,从而提示该处局部脑功能活动的改变,对诊断具有重要的价值。

Objective:To investigate the clinical,neuropsychological and regional cerebral blood flow(rCBF)characteristics in patients with psychiatric symptoms caused by nitrous oxide abuse.Methods:Twelve patients with psychiatric symptoms caused by nitrous oxide abuse were enrolled from February 2018 to February 2020 in the Department of Neurology,China-Japan Friendship Hospital and the First Hospital of Tsinghua University.All patients were scored with the brief psychiatric rating scale(BPRS),Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA),mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA).The SPECT/CT images were collected with low-energy and high-resolution collimator.After the pictures were reconstructed,18 brain regions were automatically sketched and calculated by Database Comparison software.The statistical value of the difference between the general mean value of each brain region and that of the corresponding region of interest in the same age group was estimated.Results:(1)The clinical manifestations of 12 patients were anxiety,depression,hallucination,delusion,and 7 patients were accompanied by cognitive decline.(2)Neuropsychological examination:BPRS score was 57.83±11.15(anxiety depression factor was 3.94±0.47;lacking active factor was 3.25±0.85;thinking disturbance factor was 3.21±1.27;activity factor was 2.28±0.56;hostility factor was 3.14±1.24).The score of self-knowledge impairment was 2.92±1.08,the score of inability to work was 4.50±1.17,the score of HAMD was 32.75±10.13,the score of HAMA was 18.67±5.80,the score of MMSE was 27.67±2.50,and the score of MoCA was 24.58±3.78.(3)SPECT showed that compared with the general mean value of the corresponding regions of interest of normal people,the patients showed hypoperfusion in the frontal lobe(7 patients,58.30%)and the temporal lobe(8 patients,66.70%).Conclusion:Nitrous oxide abuse has an obvious effect on rCBF.The psychiatric symptoms include anxiety,depression,hallucination,delusion and so on,which affect the ability to work and learn.SPECT has important value in the diagnosis of nitrous oxide abuse,and indicates changes in local brain functional activity.