无抽搐电休克疗法对精神分裂症患者的治疗效果和脑内及不同脑区神经递质水平的影响研究

Modified Electroconvulsive Therapy in Patients with Schizophrenia:Curative Effect and Responses of Neurotransmitters in Brain and Different Brain Regions

背景目前,采用脑涨落图仪分析精神分裂症患者多个脑区神经递质功能特点的研究较多,也有关于无抽搐电休克疗法(MECT)对精神分裂症患者脑内神经递质影响的研究,但关于MECT对精神分裂症患者具体脑区神经递质影响的研究较少。目的观察精神分裂症患者MECT治疗前后脑内及不同脑区神经递质水平变化而探讨其可能的神经生物学机制。方法选取2019年1月至2020年12月常州市德安医院收治的签署MECT治疗同意书的精神分裂症患者51例,均接受MECT治疗且在治疗期间所用抗精神疾病药物剂量保持不变。比较所有患者首次MECT治疗前24 h和MECT治疗结束后24 h阳性和阴性症状量表(PANSS)新5因子模型(20项版)评分、脑内和不同脑区神经递质水平。结果与首次MECT治疗前24 h相比,所有患者MECT治疗结束后24 h阳性因子、阴性因子、敌对兴奋、焦虑抑郁、认知功能损伤因子评分及总分,脑内γ-氨基丁酸(GABA)水平及左后脑区GABA、谷氨酸(Glu)水平均降低,脑内及右前脑区多巴胺(DA)水平升高(P<0.05)。结论MECT对精神分裂症患者精神症状有一定治疗效果,并可能通过影响脑内GABA和DA、左后脑区GABA和Glu、右前脑区DA等神经递质水平而发挥神经生物学机制。

Background Neurotransmitters in multiple brain regions in schizophrenia patients have been extensively studied using encephal of luctuograph in terms of functional features,and also been explored using modified electroconvulsive therapy(MECT)regarding their responses to MECT,but responses of neurotransmitters in a specific region to MECT have been rarely examined.Objective To examine pre-and post-treatment changes of neurotransmitters in brain and different brain regions in patients with schizophrenia with MECT,and to investigate the possible neurobiological mechanism of MECT.Methods Fifty-one schizophrenia patients were recruited from Changzhou Dean Hospital from January 2019 to December 2020.All of them had signed the written informed consent form of receiving MECT prior to the participation in the study,and received MECT with unchanged antipsychotic medications during the study period.Scores of new 5-factor model of the PANSS(20 items),neurotransmitters in brain and different brain regions 24 hours before the first MECT and 24 hours after the end of MECT were compared among all patients.Results Compared with those 24 hours before the first MECT,scores of positive factor,negative factor,hostile excitement,anxiety and depression,cognitive and total PANSS score,as well as gamma-aminobutyric acid(GABA)in brain and left posterior brain region,and glutamate(Glu)in left posterior brain region significantly decreased,but dopamine(DA)in brain and right frontal brain region significantly increased 24 hours after the end of MECT(P<0.05).Conclusion MECT has certain anti psychotic effect in patients with schizophrenia,its neurobiological mechanism may be related with the influence on GABA and DA in brain,GABA and Glu in left posterior brain region,as well as DA in right frontal brain region.