利培酮治疗有效的精神分裂症患者脑质子波谱和事件相关电位P300变化特点及相关性

摘要

目的 探讨利培酮治疗有效的精神分裂症患者前额叶、丘脑神经生物化学代谢物质和事件相关电位P300(P300)的变化特点及其相关性.方法 对经利培酮口服治疗8周有效的46例精神分裂症患者,治疗前和治疗后采用多体素磁共振质子波谱(1 H-MRS)检测前额叶和丘脑N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr),完成NAA/Cr值、Cho/Cr值的计算；应用阳性和阴性症状量表(PANSS)和P300分别评估临床症状和认知功能.结果 (1)患者治疗前后1 H-MRS各代谢指标均无明显差异(P＞0.05)；与治疗前比较,治疗后P300靶刺激中P2(Pz)、N2 (Cz)、P3(Cz、Pz)潜伏期缩短,P2(Pz)、P3(Cz、Pz)、P4(Pz)波幅升高(P＜0.05)；非靶刺激中P2(Pz)潜伏期缩短,P2(Cz、Pz)波幅升高(P＜0.05).(2)治疗前后左侧前额叶NAA/Cr值变化值与P300中靶刺激P2(Pz)、N2 (Cz)、P3(Cz、Pz)潜伏期变化值呈负相关(r分别为-0.37、-0.32、-0.35、-0.34,P＜0.05),与靶刺激P2(Pz)、P3(Cz、Pz)、P4(Pz)及非靶刺激P2(Cz、Pz)波幅变化值呈正相关(r分别为0.34、0.32、0.36、0.33、0.31、0.35,P＜0.05)；右侧前额叶NAA/Cr值变化值与靶刺激P2(Pz)、N2 (Cz)、P3(Pz)潜伏期变化值呈负相关(r分别为-0.32、-0.33、-0.36,P＜0.05),与靶刺激P2(Pz)、P3(Pz)及非靶刺激P2(Pz)波幅变化值呈正相关(r分别为0.33、0.34、0.32,P＜0.05)；左侧丘脑NAA/Cr值变化值与靶刺激P2 (Pz)、N2 (Cz)潜伏期变化值呈负相关(r分别为-0.31、-0.33,P＜0.05),与靶刺激P2(Pz)、P3( Cz、Pz)及非靶刺激P2(Pz)波幅变化值呈正相关(r值分别为0.36、0.34、0.33、0.35,P＜0.05).结论 利培酮治疗有效的精神分裂症患者治疗前后P300变化较NAA变化更显著,脑质子波谱变化与P300变化显著相关.%Objective To study the potential effects of risperidone tablets on prefrontal lobe and thalamus metabolite ratios and event-related potential P^ (?%? ) in schizophrenia. Methods Forty-six schizophrenics got further efficacy who were treated with risperidone tablets for 8 weeks were examined at prefrontal lobe and thalamus by multi-voxel proton magnetic resonance spectroscopy (' H-MRS) before and after treatment. The N-acetylaspartate ( NAA ) , choline-congtaining compounds (Cho) ,and creatine compounds( Cr) were measured and the ratios of NAA/Cr,Cho/Cr were determined. The patients were also received positive and negative syndrome scale ( PANSS) and P^ before and after treatment respectively. Results (1) There were no significant differences in both the ratios of NAA/Cr and Cho/Cr between pre- and post-treatment(P >0.05). Compared with pre-treatment, latency of target P2 ( Pz) , N2 ( Cz ) , P3 (Cz, Pz) and non-target P2 ( Pz ) shortened, amplitude of target P2 (Pz), P3 (Cz, Pz) , P4 ( Pz) and non-target P2 ( Cz, Pz) heightened after treatment (P < 0. 05). (2) The changes of NAA/Cr on left prefrontal lobe were negatively related with the alterations of latencies of target P2 (Pz) ,N2 (Cz) ,and P3 (Cz, Pz) ( r = - 0. 37, - 0. 32, - 0. 35, - 0. 34, P < 0. 05 ) , and positively related with the alterations of amplitude of target P2 (Pz) ,P3(Cz,Pz) ,P4(Pz) ,and non-target P2(Cz,Pz)(r = 0.34,0.32,0.36,0.33,0.31,0.35,P<0.05). On right prefron-tal lobe,the changes of NAA/Cr were negatively related with the alterations of latencies of target P2 ( Pz), N2 ( Cz) , and P3 ( Pz) (r = - 0. 32, - 0.33, - 0.36, P < 0.05), and positively related with the alterations of amplitude of target P2 ( Pz) and P3 (Pz), and non-target P2 (Pz) (r = 0.33,0.34,0.32, P < 0.05). On left thalamus, the changes of NAA/Cr were negatively related with the alterations of latencies of target P2 (Pz) and N2 (Cz) (r = - 0. 31, -0. 33,P < 0. 05 ) ,and positively related with the alterations of amplitude of target P2 (Pz) and P3 ( Cz, Pz) , and non-target P2 ( Pz ) ( r = 0. 36,0. 34,0. 33,0. 35, P < 0. 05). Conclusion The changes of NAA is more significant than Pj,,, in schizophrenia treated with risperidone tablets, and there is significant correlation between P^ and brain ' H-MRS.