CAJ | 학술논문

目的：比较以氯丙嗪和氯氮平维持治疗的精神分裂症病情稳定期患者脑白质完整性差异特征。方法：选择氯丙嗪和氯氮平维持治疗的病情稳定的精神分裂症患者以及正常对照组各24例，入组患者采用阳性和阴性症状量表（PANSS）以及住院精神病人社会功能评定量表（SSPI）进行评估。所有被试者以美国GE HDx3.0T磁共振扫描仪进行扩散张量成像（ DTI）扫描，基于纤维示踪的空间统计方法（ TBSS）分析3组脑白质完整性（各向异性分数FA、轴向弥散率DA、径向弥散率DR和平均弥散率MD值）差异区域及其与临床症状的相关性。结果：氯氮平和氯丙嗪组间PANSS和SSPI量表评分差异无统计学意义，两组间FA、DA、DR和MD值差异也无统计学意义。与正常对照组比较，氯丙嗪组胼胝体体部和膝部、左侧扣带回和右侧前放射冠FA值显著降低；氯氮平组胼胝体体部、膝部及压部、左右前放射冠、左右丘脑后辐射、左侧上纵束和双侧扣带回FA值显著降低；氯氮平组穹窿和左侧内囊后肢DA值显著增高；氯氮平组胼胝体体部、膝部及压部、左右前放射冠和左右丘脑后辐射DR值显著增高；氯氮平组胼胝体体部和膝部、左右前放射冠和左侧丘脑后辐射MD值显著增高。氯氮平组丘脑后辐射FA值与PANSS阳性分呈负相关（r＝－0.697，P＜0.01）。结论：精神分裂症患者维持治疗期仍存在脑白质完整性损伤，氯氮平治疗患者更为广泛，这可能是患者病情较难控制的病理因素之一。
목적：비교이록병진화록담평유지치료적정신분렬증병정은정기환자뇌백질완정성차이특정。방법：선택록병진화록담평유지치료적병정은정적정신분렬증환자이급정상대조조각24례，입조환자채용양성화음성증상량표（PANSS）이급주원정신병인사회공능평정량표（SSPI）진행평고。소유피시자이미국GE HDx3.0T자공진소묘의진행확산장량성상（ DTI）소묘，기우섬유시종적공간통계방법（ TBSS）분석3조뇌백질완정성（각향이성분수FA、축향미산솔DA、경향미산솔DR화평균미산솔MD치）차이구역급기여림상증상적상관성。결과：록담평화록병진조간PANSS화SSPI량표평분차이무통계학의의，량조간FA、DA、DR화MD치차이야무통계학의의。여정상대조조비교，록병진조변지체체부화슬부、좌측구대회화우측전방사관FA치현저강저；록담평조변지체체부、슬부급압부、좌우전방사관、좌우구뇌후복사、좌측상종속화쌍측구대회FA치현저강저；록담평조궁륭화좌측내낭후지DA치현저증고；록담평조변지체체부、슬부급압부、좌우전방사관화좌우구뇌후복사DR치현저증고；록담평조변지체체부화슬부、좌우전방사관화좌측구뇌후복사MD치현저증고。록담평조구뇌후복사FA치여PANSS양성분정부상관（r＝－0.697，P＜0.01）。결론：정신분렬증환자유지치료기잉존재뇌백질완정성손상，록담평치료환자경위엄범，저가능시환자병정교난공제적병리인소지일。
Objective:To compare white-matter integrities between schizophrenic patients maintained treated with chlorpromazine and clozapine by tract-based spatial statistics.Methods:The patients with schizophrenia in stable condition that received maintenance treatment with chlorpromazine and clozapine and normal control subjects were recruited(n=24 per groups).DTI data were acquired using a 3T MR system(GE HDx, Milwaukee, WI).The differences in white-matter integrities were analyzed by TBSS( tract-based spatial statistics) , while their correlations to clinical symptoms were also investigated.Results:There was no statistical significances in PANSS and SSPI and white-matter values( FA, DA, DR and MD) between the chlorpromazine and clozapine treated groups.Compared with control group, FA was significantly lower in Body of corpus callosum, Genu of corpus callosum, Cingulum L, and Cingulum L in chlorpromazine group.FA was remarkably lower in Body of corpus callosum, Genu of corpus callosum, Splenium of corpus callosum, Superior corona radiata L&R, Posterior thalamic radiation L&R, Superior longitudinal fasciculus L, Cingulum L&R in clozapine group.Compared with control group, clozapine group had the significant higher DA in Fornix and Posterior limb of internal capsule L; the significant higher DR in Body of corpus callosum, Genu of corpus callosum, Splenium of corpus callosum, Superior corona radiata L&R, Posterior thalamic radiation L&R; and the significant higher MD in Body of corpus callosum, Genu of corpus callosum, Superior corona radiata L&R, and Posterior thalamic radiation L.The FA value of Posterior thalamic radiation was negatively correlated with PANSS positive score in clozapine group ( r =-0.697, P <0.01 ) .Conclusions:Schizophrenic patients have deficits of white-matter integrities in the period of maintenance treatment.The severer impairments of white-matter integrities in clozapine treated patients might be one of pathological mechanism underlying their refractory symptoms.