脑部MRI联合CT在首发精神分裂症诊断中的应用价值研究

Study on the Application Value of Brain MRI Combined with CT in the Diagnosis of First-episode Schizophrenia

目的 探讨脑部磁共振成像(MRI)联合电子计算机断层扫描仪器(CT)在首发精神分裂症(FES)诊断中的应用价值。方法 选取2021年5月至2021年11月唐山市第五医院FES患者83例为观察组,同期选取83例健康体检者为对照组。比较两组一般资料及MRI、CT参数,Logistic回归分析FES影响因素,分析FES患者脑萎缩、额叶CT值、ACC NAA/Cr、Glu/Cr、T2信号值与认知功能评分的相关性,受试者工作特征曲线(ROC)分析MRI、CT参数对FES的诊断价值。结果观察组认知功能评分、额叶CT值、ACC Glu/Cr低于对照组,脑萎缩比例、ACC NAA/Cr、ACC T2信号值高于对照组(P<0.05);Logistic回归分析显示,脑萎缩、额叶CT值、ACC Glu/Cr、认知功能评分降低及ACC NAA/Cr、ACC T2信号值升高均为FES独立危险因素(PP<0.05);脑萎缩FES患者认知功能评分低于无脑萎缩患者(P<0.05);FES患者额叶CT值、ACC Glu/Cr与认知功能评分呈正相关,ACC NAA/Cr、T2信号值与认知功能评分呈负相关(P<0.05);ROC结果显示,MRI、CT参数联合诊断FES的AUC值为0.933,高于脑萎缩、额叶CT值、ACC NAA/Cr、ACC Glu/Cr、左侧ACC T2信号值、右侧ACC T2信号值单独诊断(χ^(2)_(1)=4.615,P1<0.001;χ^(2)_(2)=3.296,P_(2)=0.001;χ^(2)_(3)=2.417,P_(3)=0.016;χ^(2)_(4)=4.793,P_(4)<0.001;χ^(2)_(5)=4.434,P_(5)<0.001;χ^(2)_(6)=5.000,P_(6)<0.001)。结论 脑萎缩、额叶CT值、ACC Glu/Cr降低及ACC NAA/Cr、ACC T2信号值升高均为FES独立危险因素,可为FES早期诊断提供新的思路,且各参数均与认知功能损伤密切相关。

Objective To explore the application value of brain magnetic resonance imaging(MRI)combined with computer tomography(CT)in the diagnosis of first-episode schizophrenia(FES).Methods A total of 83 patients with FES in Tangshan fifth hospital from May 2021 to November 2021 were selected as the observation group,and 83 healthy patients were selected as the control group during the same period.The general information and MRI and CT parameters were compared between the two groups.Logistic regression was used to analyze the influencing factors of FES.The correlation between brain atrophy,frontal lobe CT value,ACC NAA/Cr,Glu/Cr,T2 signal value and cognitive function score in FES patients were analyzed.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of MRI and CT parameters for FES.Results The cognitive function score,frontal lobe CT value,and ACC Glu/Cr of the observation group were lower than those of the control group,and the brain atrophy ratio,ACC NAA/Cr,and ACC T2 signal values were higher than those of the control group(P<0.05).Logistic regression analysis showed that brain atrophy,frontal lobe CT values,ACC Glu/Cr,decreased cognitive function scores,and increased ACC NAA/Cr and ACC T2 signal values were independent risk factors for FES(P<0.05).The cognitive function scores of FES patients with brain atrophy were lower than those without brain atrophy(P<0.05).Frontal lobe CT values and ACC Glu/Cr were positively correlated with cognitive function scores in FES patients,and ACC NAA/Cr and T2 signal values were negatively correlated with cognitive function scores(P<0.05).ROC results showed that the AUC value of the combined diagnosis of MRI and CT parameters for FES was 0.933,which was higher than brain atrophy,frontal lobe CT value,ACC NAA/Cr,ACC Glu/Cr,left ACC T2 signal value,and right ACC T2 signal value Separate diagnosis(χ^(2)_(1)=4.615,P1<0.001;χ^(2)_(2)=3.296,P_(2)=0.001;χ^(2)_(3)=2.417,P_(3)=0.016;χ^(2)_(4)=4.793,P_(4)<0.001;χ^(2)_(5)=4.434,P_(5)<0.001;χ^(2)_(6)=5.000,P_(6)<0.001).Conclusion Brain atrophy,frontal lobe CT value,ACC Glu/Cr decrease,and ACC NAA/Cr,ACC T_(2) signal value increase are independent risk factors for FES.It can provide new ideas for early diagnosis of FES,and all parameters are closely related to cognitive impairment.