未服药的强迫障碍患者脑灰质体积异常的MRI研究

摘要

目的:应用脑磁共振成像(MRI)基于体素的形态测量学(VBM)比较未服药的强迫障碍患者脑灰质体积与正常人群间的差异,并探讨强迫障碍患者脑灰质体积的改变与临床现象之间的相关性.方法:纳入符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的20例未服药的强迫障碍门诊患者,以及20名性别、年龄和受教育程度相匹配的健康对照.所有被试均接受头部磁共振扫描.采用VBM的分析方法,比较强迫障碍患者与健康对照之间脑灰质体积的差异.采用耶鲁-布郎强迫量表(Y-BOCS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)评估临床症状.在控制焦虑、抑郁症状的前提下,分析强迫障碍患者异常的脑灰质体积与临床现象之间的关系.结果:与对照组相比,强迫障碍组的眶额回、颞上回、颞下回、小脑、楔前叶、辅助运动区及中央后回的灰质体积减少(P＜0.05,AlphaSim校正);眶额回灰质体积的减少与Y-BOCS量表总分呈负相关(r=-0.49,P＜0.05).结论:本研究结果提示眶额-纹状体-丘脑环路中的眶额回在强迫障碍的发生中起重要的作用,其他脑区如颞叶和小脑灰质体积减少,可能也参与了强迫障碍的发生.%Objective: To explore the gray matter volume in non-medicated patients with obsessive-compulsive disorder (OCD), and to investigate the correlations between abnormal gray matter volume and clinical symptoms. Methods: Twenty non-medicated patients with OCD and twenty gender-, age-, education-matched healthy subjects participated in the magnetic resonance imaging (MRI) scan. Voxel-based morphometry (VBM) was used to analyze the MRI data. The Yale-Brown Obsessive-Compulsive Scale (YBOCS), Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) were used to assess clinical symptoms. Total HAMA and HAMD score were taken as covariates to control for comorbid symptoms, and then the partial correlation analysis was performed to assess the association between the abnormal gray matter volume and the clinical symptoms. Results: Compared with healthy controls, significantly decreased gray matter volume in patients were discovered in orbitofrontal cortex (OFC), superior temporal gyrus, inferior temporal gyrus, cerebellum, precuneus, supplementary motor area and the postcentral gyrus (P <0. 05, corrected). The decreased gray matter volume in the OFC was negatively correlated with the total score in YBOCS (r = - 0. 49, P < 0. 05). Conclusion: It suggests that the OFC in the orbitofrontal-striato-thalamic circuitry has an important role in OCD, and other brain regions such as temporal gyrus and cerebellum also have a decreased gray matter volume, and may be involved the pathophysiology of OCD.