不同用药依从性Wilson病患者的跨期决策偏好特征

Characteristics of Intertemporal Decision Preferences in Wilson Patients with Different Medication Compliance

目的:探讨不同用药依从性下Wilson病(Wilson's disease,WD)患者病变脑区对跨期决策偏好的影响。方法:选取58例WD患者为研究对象,根据Morisky用药依从性问卷(Morisky Medication Adherence Scale-8,MMAS-8)评分标准将其分为用药依从性高、低2组;比较2组患者津巴多时间洞察力问卷(Zimbardo Time Perspective Inventory,ZTPI)、一般未来时间洞察力量表(Future Time Perspective,FTP)、跨期决策范式(Intertemporal decision task paradigm)的即时奖励百分比值。根据颅脑磁共振(MRI)1.5T检查结果记录病变脑区及累及频次。采用线性回归分析(stepwise法)分析影响WD患者跨期决策偏好及时间感知觉的相关病变脑区。结果:2组在ZTPI中现在享乐时间观、未来时间观及FTP总分、行为承诺、目的意识比较差异具有统计学意义(P<0.05)。即时奖励百分比与ZTPI中未来时间观呈负相关,与FTP中目的意识呈正相关(P<0.05)。回归分析显示尾状核、壳核、丘脑、额叶、脑干病变脑区参与影响ZTPI、FTP中不同因子分(P<0.05)。结论:不同用药依从性WD患者的跨期决策偏好存在差异,且与未来时间感知觉有关。WD患者用药依从性差可能与前额叶-纹状体环路上尾状核、壳核、丘脑、额叶、脑干病变脑区引发的跨期决策偏好异常有关。

Objective:To investigate the effect of diseased brain region on intertemporal decision preference in patients with Wilson's disease(WD)with different medication compliance.Methods:Fifty-eight patients with WD were selected as subjects and divided into two groups of low Medication Adherence and high medication adherence according to Morisky medication adherence Scale-8(MMAS-8).The Zimbardo Time Perspective Inventory(ZTPI)and the general Future Time Perspective(FTP)and the percentage value of immediate reward were compared between the two groups.According to the results of brain magnetic resonance imaging(MRI)1.5T examination,the pathological brain area and the frequency of involvement were recorded.Linear regression analysis(stepwise method)was used to analyze the brain lesions that affected WD patients'intertemporal decision preference and time perception.Results:In ZTPI,there were significant differences between the two groups in present enjoyment time view,future time view,FTP total score,behavioral commitment and purpose consciousness(P<0.05).The percentage of immediate reward was negatively correlated with future time view in ZTPI and positively correlated with purpose sense in FTP(P<0.05).Regression analysis showed that caudate nucleus,putamen,frontal lobe,thalamus and brainstem affected different factors in ZTPI and FTP(P<0.05).Conclusion:WD patients with different medication compliance had different preferences for intertemporal decision making,which was related to the perception of future time.The poor medication compliance of WD patients may be related to the abnormal intertemporal decision preference caused by the pathological brain regions of caudate nucleus,putamen,thalamus,frontal lobe and brain stem in the prefrontal striatal circuit.