强迫症患者感觉运动网络功能异常与临床症状的关系研究

Relation between sensorimotor network dysfunction and clinical symptoms in patients with obsessive-compulsive disorder

目的联合低频振幅(ALFF)和格兰杰因果分析(GCA)评估强迫症患者异常自发性脑活动及全脑脑区效应连接的改变,探讨二者与临床症状的关系。方法选择新乡医学院第二附属医院精神科自2020年1月至2023年9月收治的49例强迫症患者作为强迫症组,另外同期招募与强迫症组患者性别、年龄和受教育年限相匹配的50例健康志愿者作为健康对照组。采用耶鲁布朗强迫量表(Y-BOCS)评估强迫症患者的强迫症状及其严重程度。采集2组受试者全脑静息态功能磁共振成像(rs-fMRI)数据,比较2组受试者间ALFF的差异。以ALFF差异脑区为种子点,采用GCA分析强迫症组与健康对照组受试者全脑脑区与种子点效应连接的差异。采用偏相关分析评价强迫症组患者差异脑区ALFF、效应连接与Y-BOCS量表总分、强迫思维因子评分和强迫行为因子评分的相关性。结果(1)与健康对照组相比,强迫症组患者右侧辅助运动区、右侧海马、左侧尾状核、右侧梭状回和右侧脑岛ALFF增强,左侧枕下回ALFF减弱,差异均有统计学意义(P<0.05)。(2)与健康对照组比较,强迫症组患者右侧背外侧额上回至右侧辅助运动区效应连接减弱,左侧枕上回至右侧辅助运动区效应连接增强,右侧梭状回至右侧中央前回效应连接减弱,右侧海马至左侧颞中回效应连接增强,差异均有统计学意义(P<0.05)。(3)强迫症组患者左侧尾状核ALFF与强迫思维因子评分呈正相关关系(r=0.357,P=0.027),右侧背外侧额上回至右侧辅助运动区的效应连接与强迫思维因子评分呈负相关关系(r=-0.312,P=0.029)。结论强迫症患者感觉运动网络功能异常与其临床症状密切相关。

Objective To investigate the changes of abnormal spontaneous brain activity and whole-brain effector connectivity in patients with obsessive-compulsive disorder(OCD)by combining low frequency amplitude(ALFF)and Granger causality analysis(GCA),and explore their relations with clinical symptoms.Methods Forty-nine patients with OCD admitted to Department of Psychiatry,Second Affiliated Hospital of Xinxiang Medical College from January 2020 to September 2023 were selected as OCD group;50 healthy volunteers matched with gender,age and years of education were enrolled as healthy control(HC)group.Obsessive-compulsive symptoms and severities in the OCD group were assessed by Yale Brown obsessive-compulsive scale(Y-BOCS).All subjects underwent whole-brain resting-state functional magnetic resonance imaging scanning(rs-fMRI).ALFF differences between the 2 groups were compared.Brain regions with ALFF differences were used as seed points,and effector connectivity changes in seed points were compared with those in whole-brain by GCA.Correlations of ALFF and effector connectivity in brain regions with ALFF differences with total scores,obsession scores and compulsion scores of Y-BOCS were analyzed by partial correlation analysis.Results(1)Compared with that in the HC group,ALFF was significantly enhanced in the right supplementary motor area,right hippocampus,left caudate nucleus,and right fusiform gyrus,and statistically attenuated in the left suboccipital gyrus in the OCD group(P<0.05).(2)Compared with that in the HC group,effector connectivity from the right dorsolateral superior frontal gyrus to right supplementary motor area was significantly attenuated,and effector connectivity from the left superior occipital gyrus to right supplementary motor area was significantly enhanced in the OCD group(P<0.05);compared with that in the HC group,effector connectivity from the right fusiform gyrus to right precentral gyrus was significantly attenuated,and effector connectivity from the right hippocampus to left mesial temporal gyrus was significantly enhanced in the OCD group(P<0.05).(3)In OCD patients,altered ALFF in the left caudate nucleus was positively correlated with obsession scores(r=0.357,P=0.027),and altered effector connectivity from the right dorsolateral superior frontal gyrus to right supplementary motor area was negatively correlated with obsession scores(r=-0.312,P=0.029).Conclusion Abnormalities in sensorimotor network function are closely related to clinical symptoms in patients with OCD.