躯体化障碍患者脑区域生化物质代谢的磁共振波谱分析研究

摘要

目的：探讨躯体化障碍患者与正常人脑区域生化物质代谢的差异以及与述情障碍的相关性。方法：采用磁共振波谱分析（MRS）方法，对25例躯体化障碍患者（患者组）和25名正常人（对照组）的左、右丘脑、尾状核进行 MRS 的多体素定位扫描，获得胆碱复合物（ Cho）、肌酸（Cr）、N-乙酰天门冬氨酸（NAA）的波峰下面积，并取相对值 NAA/ Cr、Cho/ Cr 值作为分析指标，进行组间、组内左右部位之间的数据分析。同时对两组进行多伦多述情障碍量表（TAS-20）的评定，将患者组有统计学差异的脑区NAA/ Cr 值与 TAS-20得分进行相关分析。结果：患者组与对照组丘脑 NAA、NAA/ Cr 值的组别效应（F ＝4.078，F ＝5.071）、左右侧效应（F ＝4.969，F ＝5.326）及交互效应（F ＝11.673，F ＝13.992）有统计学意义（P ﹤0.05或 P ﹤0.001）；患者组与对照组尾状核 NAA、NAA/ Cr 值组别效应有统计学意义（F ＝12.343，P ＝0.001；F ＝18.778，P ＝0.000）。患者组左侧丘脑 NAA/ Cr 值与 TAS-20评分呈负相关（r ＝-0.417，P ＝0.038）；左右尾状核 NAA/ Cr 值与 TAS-20评分无相关（ r ＝-0.240，P ＝0.248；r ＝-0.290，P ＝0.159）。结论：躯体化障碍患者左丘脑、左右尾状核存在生化物质代谢异常；其述情障碍与左丘脑生化物质代谢异常相关。%Objective:To study the differences of substance metabolism in brain regions between the pa-tients with somatization disorder and healthy volunteers and investigate the correlation between the substance metabolism and alexithymia. Method:By using magnetic resonance spectroscopy(MRS),the thalamus and caudate nucleus of 25 patients(patient group)with somatization disorder and 25 controls(control group)were scanned,then the level of choline complex(Cho),creatine(Cr)and N-acetyl aspartic acid(NAA)were esti-mated according to the area under the curve(AUC)respectively. And the ratios of NAA/ Cr and Cho/ Cr were compared within-subjects and between-subjects in left and right brain regions. Also Toronto alexithymia scale (TAS-20)was rated by patients and controls. Then the correlation between the ratio of NAA/ Cr which showed significant difference in some brain region of patients’and their TAS-20 scores were analyzed. Results:The between-subjects effects(F = 4. 078,F = 5. 071)and the within-subjects effects(F = 4. 969,F = 5. 326)and the interaction effects(F = 11. 673,F = 13. 992)between patients and controls’thalamus NAA,NAA/ Cr existed significant difference(P ﹤ 0. 05 or P ﹤ 0. 001). Moreover the between-subjects effects of NAA、NAA/ Cr between patients and controls’caudate nucleus existed statistical difference( F = 12. 343,P = 0. 001;F = 18. 778, P = 0. 000). The ratio of NAA/ Cr of patients’left thalamus was negatively correlated with their TAS-20 (r = - 0. 417,P = 0. 038),while the ratio of NAA/ Cr of bilateral caudate nucleus had no correlation with TAS-20(r = - 0. 240,P = 0. 248;r = - 0. 290,P = 0. 159). Conclusion:There were abnormal biochemical metab-olism in left thalamus and bilateral caudate nucleus of patients with somatization disorder. Their alexithymia is correlated to the abnormal biochemical metabolism in left thalamus.