CAJ | 학술논문

目的检测强迫症(OCD)患者大脑结构及局部脑血流(rCBF),分析其与治疗疗效关系.方法选择2010年10月至2011年6月至中山大学附属第三医院精神心理医学科就诊30例临床诊断为强迫症患者及30名正常对照者,应用SPECT/CT进行脑rCBF显像和CT显像.统计参数图( SPM)分析强迫症患者大脑rCBF变化特点.并在氟伏沙明或氯丙咪嗪治疗前及治疗后3个月,分别应用Y-BOCS量表评价其强迫程度变化.结果 30例强迫症患者中CT均未发现大脑结构异常.与正常对比的SPM分析显示强迫症患者的基底节和枕叶rCBF增高(Z＞3.29,P＜0.001).30例患者经过治疗后Y-BOCS量表总分明显降低[(24±7)分vs(11±6)分,P＜0.001],但治疗前基底节及枕叶rCBF同时增高患者,治疗后Y-BOCS量表总分显著高于仅有基底节或枕叶rCBF增高者(P＜0.05).结论强迫症患者一般大脑无器质性病变,但存在基底节及枕叶rCBF增高,基底节和枕叶rCBF同时受损者的治疗疗效较差.
목적 검측강박증(OCD)환자대뇌결구급국부뇌혈류(rCBF),분석기여치료료효관계.방법 선택2010년10월지2011년6월지중산대학부속제삼의원정신심리의학과취진30례림상진단위강박증환자급30명정상대조자,응용SPECT/CT진행뇌rCBF현상화CT현상.통계삼수도( SPM)분석강박증환자대뇌rCBF변화특점.병재불복사명혹록병미진치료전급치료후3개월,분별응용Y-BOCS량표평개기강박정도변화.결과 30례강박증환자중CT균미발현대뇌결구이상.여정상대비적SPM분석현시강박증환자적기저절화침협rCBF증고(Z＞3.29,P＜0.001).30례환자경과치료후Y-BOCS량표총분명현강저[(24±7)분vs(11±6)분,P＜0.001],단치료전기저절급침협rCBF동시증고환자,치료후Y-BOCS량표총분현저고우부유기저절혹침협rCBF증고자(P＜0.05).결론 강박증환자일반대뇌무기질성병변,단존재기저절급침협rCBF증고,기저절화침협rCBF동시수손자적치료료효교차.
Objective To explore the change characteristics of regional cerebral blood flow (rCBF) and its correlation with curative efficacy in patients with obsessive-compulsive disorder (OCD).Methods The images of rCBF and computed tomography (CT) were acquired from 30 OCD and 30 normal controls by single photon emission computed tomography (SPECT) and CT.The tomographic data of rCBF were normalized,smoothed and statistically processed with the statistical parametric mapping (SPM) software with two-sample Z-test.And the OCD grade was evaluated with the Y-BOCS at pre- and post-medication.Results The abnormal results of CT were not found.The SPM Z-test showed that the sections of higher rCBF in the OCD patients were predominantly located in basal ganglia and occipital lobe compared with the normal controls ( P ＜ 0.001 ).The scores of Y-BOCS in 30 patients were markedly lower at post-medication than those at pre-medication (24 ± 7 vs 11 ± 6,P ＜ 0.001 ).At post-medication,the scores of Y-BOCS with higher rCBF in basal ganglia and occipital lobe were higher than those in basal ganglia or occipital lobe (P ＜ 0.05 ).Conclusion The OCD patients have higher rCBF in basal ganglia and occipital lobe.The curative efficacy of OCD with higher rCBF in basal ganglia and occipital lobe is worse than that in basal ganglia or occipital lobe.