双相情感障碍患者自杀意念与脑灰质体积形态及前额叶各代谢物水平的相关性

The correlation between suicidal ideation and the volume and shape of gray matter and the levels of metabolites in prefrontal lobe in patients with bipolar affective disorder

目的通过分析有自杀意念的双相情感障碍患者脑灰质体积形态及前额叶各代谢物水平的相关性,旨在为临床指导预防患者自杀。方法选取2019年6月-2021年12月在新疆维吾尔自治区人民医院临床心理科门诊及住院诊治BD患者40例,根据自杀意念自评量表(SIOSS)评分为2组,22例BS伴自杀意念患者(SIOSS≥12分)为观察组,18例BS不伴自杀意念患者(SIOSS<12分)为对照组。分析两组患者的脑灰质体积形态及前额叶各代谢物水平的相关性。结果两组的右侧颞中回和右侧颞上回、左侧尾状核和左侧豆状壳核、侧枕中回和左侧枕上回和右侧中央后回、右侧顶上回和右侧楔前叶的脑区的被试灰质体积比较,有统计学意义(P<0.05)。观察组患者的差异脑区提取灰质体积值在脑区右侧颞中回和右侧颞上回、左侧尾状核和左侧豆状壳核、侧枕中回和左侧枕上回均低于对照组,比较无统计学意义(P>0.05)。观察组患者的脑区右侧中央后回和右侧顶上回和右侧楔前叶比值低于对照组(P<0.05)。两组前额叶’H-MRS各代谢物NAA/Cr、Cho/Cr与Glx/Cr比值比较,无统计学意义(P>0.05)。观察组患者的左侧前额叶m I/Cr比值低于对照组,而右侧前额叶mI/Cr比值高于对照组(P<0.05)。前额叶各代谢物NAA/Cr、Cho/Cr、Glx/Cr与SIOSS评分无相关性(P>0.05),而mI/Cr与SIOSS评分呈正相关性(P<0.05)。结论有自杀意念的BD患者右侧前额叶肌醇代谢水平增高,左侧降低,以及mI/Cr与SIOSS评分呈正相关性。

Objective To analyze the correlation between the suicidal ideation of patients with bipolar disorder and the volume and shape of gray matter and the levels of various metabolites in the prefrontal lobe,so as to guide and prevent patients from committing suicide.Methods From June 2019 to December 2021,40 patients with BD who were diagnosed and treated in the outpatient and inpatient departments of clinical psychology of the People's Hospital of Xinjiang Uygur Autonomous Region were selected.According to the score of Suicide Ideation Self-Assessment Scale(SIOSS),they were divided into two groups.22 patients with BS accompanied by suicide ideation(SIOSS≥12 points)were taken as the observation group,and 18 patients with BS without suicide ideation(SIOSS<12 points)were taken as the control group.The correlation between the volume and morphology of cerebral gray matter and the levels of metabolites in the prefrontal lobe was analyzed.Results The volume of gray matter in the right middle temporal gyrus and the right superior temporal gyrus,the left caudate nucleus and the left lenticular putamen,the left middle occipital gyrus and the left superior occipital gyrus,the right posterior central gyrus,the right superior parietal gyrus and the right anterior cuneiform lobe of the two groups was statistically significant(P<0.05).The volume values of gray matter extracted from different brain regions in the observation group were lower than those in the control group in the right middle temporal gyrus and the right superior temporal gyrus,the left caudate nucleus and the left lenticular putamen,the side middle occipital gyrus and the left superior occipital gyrus(P>0.05).The ratio of right posterior central gyrus,right superior parietal gyrus and right anterior cuneiform lobe in the observation group was lower than that in the control group(P<0.05).The ratios of NAA/Cr,Cho/Cr and Glx/Cr of the metabolites of'H-MRS in the prefrontal lobe of the two groups were not statistically significant(P>0.05).The ratio of left prefrontal mI/Cr in the observation group was lower than that in the control group,while the ratio of right prefrontal mI/Cr was higher than that in the control group(P<0.05).The metabolites NAA/Cr,Cho/Cr,Glx/Cr in the prefrontal lobe were not correlated with SIOSS score(P>0.05),while the mI/Cr was positively correlated with SIOSS score(P<0.05).Conclusion In BD patients with suicidal ideation,the level of inositol metabolism in the right prefrontal lobe is increased,while that in the left is decreased.There is a positive correlation between MI/Cr and SIOSS score.