首发儿童少年精神分裂症患者幻听与脑功能磁共振局部一致性的关系

Relationship between auditory hallucination and regional homogeneity of functional magnetic resonance imaging in first-episode childhood and adolescence-onset schizophrenia

目的调查首发儿童少年精神分裂症患者静息态功能磁共振(fMRI)局部一致性(ReHo)的特点,分析幻听症状与ReHo的关系。方法收集新乡医学院第二附属医院2017年10月至2019年12月的住院部或门诊10~16岁患者(首发精神分裂症患者)79例(病例组),其中男28例,女51例,年龄(14.1±1.3)岁。同时,选取32名年龄性别等基线资料与病例组匹配的健康儿童作为健康对照。根据阳性症状量表(SAPS)中幻听评分结果将患者分为3组,无幻听组(0~1分)20例、轻中度幻听组(2~3分)36例、重度幻听组(4~5分)23例。采用阳性与阴性症状量表(PANSS)评估患者的精神症状。对所有被试者fMRI扫描数据进行ReHo分析。年龄作协变量,病例组与对照组之间,3组病例组之间进行协方差分析得出有差异的脑区,将差异脑区ReHo值与PANSS量表评分及幻听评分进行相关分析。结果病例组较对照组ReHo降低的脑区主要位于左侧额上回、右侧颞上回、左中央前回、右中央前回(均P<0.05)。3组患者之间ReHo差异的脑区主要位于右侧颞上回、左侧额中回、楔前叶、左中央前回(均P<0.05);与无幻听组比较,重度幻听组楔前叶ReHo值降低(全脑体素46)(P<0.05);与轻中度幻听组比较,重度幻听组左侧额中回、左中央前回ReHo值降低(均P<0.05)。幻听评分与右侧颞上回、左中央前回ReHo值呈负相关(rs=-0.34,-0.32,P<0.05);阳性症状评分与右侧颞上回ReHo值呈负相关(r=-0.23,P<0.05)。结论首发儿童少年精神分裂症存在多个脑区功能降低,静息状态下局部神经元自发活动异常可能与患者幻听的产生有关。脑功能异常可能是首发儿童少年精神分裂症的潜在神经基础。

Objective To investigate the characteristics of regional homogeneity(ReHo)of the resting-state magnetic resonance imaging(fMRI)in first-episode childhood and adolescence-onset schizophrenia(CAOS)and to analyze the relationship between the severity of auditory hallucinations and ReHo.Methods Seventy-nine cases of first-episode CAOS patients(case group)aged 10 to 16 were collected from October 2017 to December 2019 in the Second Affiliated Hospital of Xinxiang Medical University.There were 28 males and 51 females with a mean age of(14.1±1.3)years.And meantime,32 healthy children matched with the patients in baseline data were selected as healthy controls(HCs).The patients with CAOS were divided into three groups according to the auditory verbal hallucinations(AVH)assessment of positive symptoms scale(SAPS):non-AVH group(0-1 point),20 cases;mild-to-moderate AVH group(2-3 points),36 cases;severe AVH group(4-5 points),23 cases.The severity of psychiatric symptoms was evaluated using the Positive and Negative Syndrome Scale(PANSS).ReHo analysis was performed on the resting state fMRI scan data of all subjects.Covariance analysis(ages was used as a covariate)was performed between the case group and the HCs,and the three case groups were analyzed to find the different brain areas.Finally,covariance analysis(ages as a covariate)was performed on ReHo values between the case group and the HCs,and among the three groups of patients.Correlation analysis was conducted between the ReHo values in different brain regions and PANSS scores,as well as AVH scores.Results Compared with the HCs,the decreased ReHo of patients were mainly located in the left superior frontal gyrus,right superior temporal gyrus,left central anterior gyrus,and right central anterior gyrus(all P<0.05).Besides,the ReHo deficits were in the right superior temporal gyrus,left middle frontal gyrus,precuneus lobe,and left central anterior gyrus among the three groups(all P<0.05).Moreover,the severe-AVH group showed decreased ReHo values in precuneus lobe compared with the non-AVH group(P<0.05),and showed decreased ReHo values in left middle frontal gyrus and left central anterior gyrus compared with the mild-to-moderate AVH group(both P<0.05).Furthermore,the ReHo in the right superior temporal gyrus and the left anterior central gyrus were negatively correlated with the AVH score(rs=-0.34,-0.32,P<0.05);and the positive symptom score was negatively correlated with the ReHo in the right superior temporal lobe(r=-0.23,P<0.05).Conclusion Firstly,decreased ReHo is found in multiple brain regions in CAOS.Secondly,the occurrence of auditory hallucinations may be related to the abnormal activity of local neurons in the resting state.Consequently,Abnormal brain function may be the underlying neural basis for the first-episode CAOS.