青少年女性边缘型人格障碍脑灰质体积及功能连接异常与情绪失调的关系

Differences of brain gray matter volume and functional connectivity in adolescent female borderline personality disorder and correlation with dysregulation

目的分析青少年女性边缘型人格障碍(borderline personality disorder,BPD)患者脑结构和功能连接的异常特征,探索其与情绪失调严重程度之间的关系。方法选取12~17岁女性BPD患者18例(BPD组)和性别、年龄、受教育程度与之相匹配的健康对照者18名(对照组)进行静息态功能磁共振成像(functional magnetic resonance imaging,fMRI)检查,使用基于体素的形态计量学测量(voxel-based morphometry,VBM)和功能连接方法比较2组灰质体积和功能连接的差异,组间比较采用t检验。采用Spearman相关分析,分析灰质体积异常脑区及功能连接差异脑区与23项边缘症状清单(Borderline Symptom List,BSL-23)量表评分的相关性。结果与对照组相比,BPD组左颞下回(t=4.23)、右颞下回(t=4.85)和左眶额叶(t=4.16)的灰质体积显著增大(GRF校正,体素P<0.005,团块水平P<0.05双尾)。BPD组左颞下回与右颞中回功能连接减弱(t=-6.20),左颞下回与右梭状回(t=5.75)、左颞下回与左顶下缘角回功能连接增强(t=4.38;GRF校正,体素P<0.005,团块水平P<0.05双尾)。BPD组眶额叶灰质体积增加与BSL-23量表中情感条目BSL9感受到紧张(r=-0.523,P=0.023)、BSL14情绪的快速变化(r=-0.549,P=0.018),认知条目BSL15忍受痛苦(r=-0.589,P=0.010)、BSL17易受伤害(r=-0.554,P=0.017),行为条目BSL5自我伤害(r=-0.616,P=0.006)、BSL18自杀吸引(r=-0.661,P=0.003)评分呈负相关。结论青少年女性BPD患者颞下回和眶额叶灰质体积增大,左颞下回与右颞中回、颞下回与梭状回、颞下回与顶下缘角回的功能连接异常,尤其是眶额叶灰质体积的改变可能参与了BPD患者情绪调节损伤的病理机制。

ObjectiveTo analyze the abnormal features of brain structure and functional connection(FC)in adolescent female patients with borderline personality disorder(BPD)and to explore the relationship between brain structure and clinical severity.MethodEighteen female patients with BPD and 18 healthy controls matched with sex,age and education level aged 12—17 were examined by resting functional magnetic resonance imaging(fMRI).The differences of gray matter volume(GMV)and functional connection between the two groups were compared by voxel-based morphometric measurement and functional connection method,and t-test was used to compare the differences between the two groups.Spearman correlation analysis was used to analyze the correlation between abnormal brain regions,brain regions with different functional connections and Borderline Symptom List(BSL-23)scores.ResultThe GMV of the left inferior temporal gyrus(t=4.23),the right inferior temporal gyrus(t=4.85),and the left middle orbital frontal gyrus(t=4.16)were significantly larger in the BPD group than those in the healthy controls(GRF corrected voxel P<0.005,cluster P<0.05 two-tails).FC decreased in left inferior temporal gyrus and right middle temporal gyrus(t=-6.20),increased in the left inferior temporal gyrus and the right fusiform gyrus(t=5.75),the left inferior temporal gyrus and the left inferior parietal marginal angular gyrus(t=4.38;GRF corrected voxel P<0.005,cluster P<0.05,two-tailed).In the BPD group,the increase in orbital frontal gray matter volume was negatively correlated with the emotional items BSL9(tension;r=-0.523,P=0.023),BSL14(rapid emotional changes;r=-0.549,P=0.018),BSL15(tolerated pain;r=-0.589,P=0.010),BSL17(vulnerable;r=-0.554,P=0.017),BSL5(self-injury;r=-0.616,P=0.006)and BSL18(suicide attraction;r=-0.661,P=0.003)in the BSL-23.ConclusionThere are differences in the GMV of the inferior temporal and the left middle orbital frontal lobe in adolescent female patients with BPD.The FC abnormalities of the left inferior temporal and right middle temporal gyrus,the left inferior temporal gyrus and the right fusiform gyrus,the left inferior temporal gyrus and the left inferior parietal marginal angular gyrus,especially the changes of GMV in the orbital frontal brain structure might participate in the pathological mechanism of emotion regulation injury in patients with BPD.