青少年精神分裂症首发患者的脑神经生化代谢物质研究

摘要

目的 探讨青少年精神分裂症首发患者前额叶和丘脑神经生化代谢物质的药物治疗变化特点.方法 纳入符合美国精神障碍诊断与统计手册中精神分裂症诊断标准的青少年患者42例(早发未用药精神分裂症患者,研究组),应用单一非典型抗精神病药物治疗前和治疗4周后,应用质子磁共振波谱(1 H-MRS)多体素分析技术检测患者前额叶和丘脑N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr)水平.40例健康同龄青少年(健康对照组)于入组时进行相同指标的检测.研究组每次1 H-MRS检测的同时应用阳性与阴性症状量表(PANSS)评估临床症状.结果 研究组治疗前左侧及右侧前额叶、左侧丘脑NAA/Cr值均低于健康对照组,差异均有统计学意义(1.45 ±0.26比1.60±0.34,t=2.251,P=0.027;1.43±0.26比1.60±0.35,t=2.505,P=0.014;1.48 ±0.27比1.65 ±0.35,t =2.470,P=0.016);与治疗前比较,研究组治疗后左侧前额叶和左侧丘脑的NAA/Cr值明显增加,差异均有统计学意义(1.58±0.30比1.45±0.26,=2.122,P=0.037;1.62 ±0.32比1.48 ±0.27,t=2.167,P=0.033).与治疗前比较,研究组治疗后PANSS总分、阳性症状分、阴性症状分、一般病理分及临床总体印象量表(CGI)总分均明显降低,差异均有统计学意义(59.1 ±10.2比82.0±13.2,t =8.896,P =0.000;15.3 ±5.1比22.9 ±7.1,t =5.634,P =0.000;16.4 ±5.2比21.1±7.8,t=3.249,P =0.002:27.4 ±7.6比38.1±8.8,t=5.963,P =0.000;3.6 ±0.4比4.4 ±0.5,t =8.097,P=0.000).研究组治疗前后双侧前额叶和丘脑NAA/Cr值、Cho/Cr值变化值与PANSS总分及各因子分、CGI评分变化值均无相关性(P均＞0.05).结论 青少年精神分裂症首发患者双侧前额叶和左侧丘脑的NAA/Cr值降低,非典型抗精神病药物治疗4周可以升高左侧前额叶和左侧丘脑的NAA/Cr值,但其治疗变化与临床症状的改善不一致.%Objective To study the features of treatment on neurochemical metabolites in prefrontal lobe and thalamus by proton magnetic resonance spectroscopy (1H-MRS) in first-episode drug-naive patients with early-onset schizophrenia (EOS).Methods Forty-two EOS (study group) met with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-Ⅳ) were recruited.Prefrontal lobe and thalamus were evaluated by multi-voxel 1H-MRS before and 4-week after treatment with a single atypical antipsychotic.The levels of N-acetylaspartate (NAA),creatine compounds (Cr) and choline-containing compounds (Cho) were measured.The patients also received Positive and Negative Syndrome Scale (PANSS).Forty normal controls (normal control group) underwent the same 1H-MRS detection.Results Before treatment,the NAA/Cr ratios in left prefrontal lobe,right prefrontal lobe and lefi thalamus in study group were lower than those in normal control group (1.45 ± 0.26 vs 1.60 ± 0.34,t =2.251,P =0.027;1.43 ±0.26 vs 1.60 ±0.35,t =2.505,P=0.014;1.48 ±0.27 vs 1.65 ±0.35,t =2.470,P =0.016).After 4-week treatment,the NAA/Cr ratios in both left prefrontal lobe and left thalamus of study group were significantly increased compared with those before treatment (1.58 ± 0.30 vs 1.45 ± 0.26,t =2.122,P =0.037;1.62 ± 0.32 vs 1.48 ± 0.27,t =2.167,P =0.033).After 4-week treatment in study group,the total score,positive symptom score,negative symptom score and general pathologic score of PANSS,and the total score of Clinical Global Impression (CGI) were significantly lower compared with those before treatment (59.1 ± 10.2 vs 82.0 ± 13.2,t =8.896,P=0.000;15.3 ±5.1 vs 22.9 ±7.1,t =5.634,P =0.000;16.4 ±5.2 vs 21.1 ±7.8,t =3.249,P =0.002;27.4 ±7.6 vs 38.1 ± 8.8,t =5.963,P =0.000;3.6 ± 0.4 vs 4.4 ± 0.5,t =8.097,P =0.000).There was no correlation between the changes of neurochemical metabolite levels such as NAA/Cr and Cho/Cr both in prefrontal lobe and left thalamus,and the clinical symptoms changes,such as total score and every score of PANSS,the total score of CGI in study group after treatment (all P ＞ 0.05).Conclusions The ratios of NAA/Cr are decreased not only in bilateral prefrontal lobe,but also in left thalamus,and the ratios may increase both in left prefrontal lobe and left thalamus after 4 weeks' treatment with atypical antipsychotics in EOS.The treatment outcomes of NAA/Cr do not agree with the improvement of the clinical symptoms.