CAJ | 학술논문

目的探讨无抽搐电休克治疗(MECT)对精神分裂症患者前额叶和丘脑神经生化代谢物质的影响.方法 2010年11月至2011年6月期间在解放军第九十一中心医院全军精神疾病防治研究所住院的31例精神分裂症患者,给予8次MECT.治疗前和治疗后采用多体素磁共振质子波谱(1 H-MRS)分析指标为N-乙酰基天冬氨酸/肌酸复合物(NAA/Cr)、胆碱复合物/肌酸复合物(Cho/Cr),同时进行阳性与阴性症状量表(PANSS)评定.结果 (1)治疗后左侧前额叶、左侧和右侧丘脑NAA/Cr值,均显著高于治疗前(1.50 ±0.31比1.35 ±0.30,t=2.07,P＜0.05;1.53 ±0.31比1.38 ±0.27,t =2.03,P＜0.05;1.51 ±0.29比1.36±0.26,t=2.14,P＜0.05).(2)影响左侧前额叶NAA/Cr变化值的主要因素是发病年龄、PANSS减分率、治疗前PANSS总分和病程;影响左侧丘脑NAA/Cr变化值的主要因素是发病年龄、病程;影响右侧丘脑NAA/Cr变化值的主要因素是治疗前PANSS总分.结论无抽搐电休克治疗对精神分裂症患者前额叶和丘脑可能具有增加NAA相对浓度、修复神经元功能等作用,而这些作用可能主要与患者的发病年龄大小、病程长短和病情严重程度等有关.
목적 탐토무추휵전휴극치료(MECT)대정신분렬증환자전액협화구뇌신경생화대사물질적영향.방법 2010년11월지2011년6월기간재해방군제구십일중심의원전군정신질병방치연구소주원적31례정신분렬증환자,급여8차MECT.치료전화치료후채용다체소자공진질자파보(1 H-MRS)분석지표위N-을선기천동안산/기산복합물(NAA/Cr)、담감복합물/기산복합물(Cho/Cr),동시진행양성여음성증상량표(PANSS)평정.결과 (1)치료후좌측전액협、좌측화우측구뇌NAA/Cr치,균현저고우치료전(1.50 ±0.31비1.35 ±0.30,t=2.07,P＜0.05;1.53 ±0.31비1.38 ±0.27,t =2.03,P＜0.05;1.51 ±0.29비1.36±0.26,t=2.14,P＜0.05).(2)영향좌측전액협NAA/Cr변화치적주요인소시발병년령、PANSS감분솔、치료전PANSS총분화병정;영향좌측구뇌NAA/Cr변화치적주요인소시발병년령、병정;영향우측구뇌NAA/Cr변화치적주요인소시치료전PANSS총분.결론 무추휵전휴극치료대정신분렬증환자전액협화구뇌가능구유증가NAA상대농도、수복신경원공능등작용,이저사작용가능주요여환자적발병년령대소、병정장단화병정엄중정도등유관.
Objective To explore the potential effects of modified electroconvulsive therapy (MECT) in prefrontal lobe and thalamus in patients with schizophrenia by proton magnetic resonance spectroscopy (1H-MRS).Methods From November 2010 to June 2011,a total of 31 schizophrenics fulfilling the third edition of the Chinese Classification of Mental Disorders (CCMD-Ⅲ) were recruited.And prefrontal lobe and thalamus were evaluated by multi-voxel 1H-MRS before and after 8 sessions of MECT.The subjects were evaluated by the positive and negative syndrome scale (PANSS).And the Nacetylaspartate ( NAA),choline-containing compounds (Cho) and creatine compounds (Cr) were measured and the ratios of NAA/Cr and Cho/Cr determined.Results ( 1 ) In left prefrontal lobe and bilateral thalamus,the NAA/Cr ratio at post-treatment demonstrated higher than that at pre-treatment ( 1.50 ± 0.31 vs1.35±0.30,t=2.07,P＜0.05; 1.53 ±0.31 vs 1.38 ±0.27,t=2.03,P＜0.05; 1.51 ±0.29 vs 1.36 ± 0.26,t =2.14,P ＜ 0.05 ).( 2 ) The major influencing factors of the changes of NAA/Cr in left prefrontal lobe were age of onset,decrease rate of PANSS,baseline PANSS total score and duration of illness.And the major influencing factors for left thalamus were age of onset and duration of illness while a major influencing factor for right thalamus was baseline PANSS total score.Conclusion MECT may modify brain metabolism as measured by 1 H-MRS.The pattern of changes suggests possible neuroprotective effects in schizophrenics.And these effects are correlated with age of onset,duration and severity of illness.