抗精神病药联合重复经颅磁刺激对精神分裂症患者大脑表面积的影响

The effects of antipsychotics combined with repetitive transcranial magnetic stimulation on brain surface area in schizophrenia

目的:探讨精神分裂症患者接受抗精神病药物及重复经颅磁刺激联合治疗后大脑皮层表面积的纵向改变。方法:纳入39例首发精神分裂症住院患者,患者住院与随访期间的治疗策略和临床评估由临床医生根据标准临床实践确定。所有患者均接受第二代抗精神病药物治疗,其中36名患者住院期间还接受了规范的重复经颅磁刺激联合治疗。在基线和治疗4个月后,患者接受了两次高分辨率T1磁共振扫描。在扫描时,使用阳性与阴性症状量表对患者的症状严重程度进行评估。采用基于表面的形态学分析法分析患者治疗前后皮层表面积的变化,进一步探索脑区表面积变化率同临床量表积分变化率之间的相关性。结果:治疗后患者症状明显改善。与治疗前相比,患者治疗后左侧距状旁回表面积显著增大(t=3.60,P=0.006)。左侧距状旁回表面积变化率与阳性与阴性症状量表中的一般精神病理积分变化呈正相关(r=0.37,P=0.028)。治疗后左侧距状旁回表面积增加越多,患者的一般精神病理积分改善越多。结论:抗精神病药联合重复经颅磁刺激治疗引起精神分裂症患者的左侧距状旁回表面积增大,表面积变化与症状变化存在相关性。

Objective:To investigate the longitudinal changes of cortical surface area in schizophrenia patients treated with antipsychotic drugs and repeated transcranial magnetic stimulation.Methods:Thirty-nine hospitalized patients with first-episode schizophrenia were enrolled in this study,and their treatment strategies and clinical evaluation during hospitalization and follow-up were determined by clinicians based on standard clinical practice.All patients were treated with second-generation antipsychotics,and 36 of them also received standard repetitive transcranial magnetic stimulation during their hospitalization.Patients underwent high-resolution T1 magnetic resonance imaging scans at baseline and 4 months after treatment.Each patient was assessed at the time of scanning using the Positive and Negative Syndrome Scale,which reflects the severity of symptoms.Surface-based morphological analysis was used to analyze the changes of cortical surface area before and after treatment.The correlation between surface area change rate and clinical scale score change rate was further explored.Results:Patients’symptoms improved significantly after treatment.The surface area of the left pericalcarine cortex was significantly increased in schizophrenia patients after treatment(t=3.60,P=0.006).There was a positive correlation between the change rate of the left pericalcarine cortex surface area and the change of general psychopathology score of the Positive and Negative Syndrome Scale(PANSS)(r=0.37,P=0.028).The more the surface area of left pericalcarine cortex increased after treatment,the more the general pathological symptom score improved.Conclusions:The surface area of the left pericalcarine cortex area of schizophrenia patients was increased by antipsychotics combined with repetitive transcranial magnetic stimulation,and the change of surface area was correlated with the change of symptoms.