中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
12期
925-928
,共4页
段惠峰%甘景梨%连亚军%史振娟%高存友%张毅%高延伦
段惠峰%甘景梨%連亞軍%史振娟%高存友%張毅%高延倫
단혜봉%감경리%련아군%사진연%고존우%장의%고연륜
精神分裂症,早发%前额叶%丘脑%非典型抗精神病药物%磁共振波谱学
精神分裂癥,早髮%前額葉%丘腦%非典型抗精神病藥物%磁共振波譜學
정신분렬증,조발%전액협%구뇌%비전형항정신병약물%자공진파보학
Early onset schizophrenia%Prefrontal lobe%Thalamus%Atypical antipsychotics%Magnetic resonance spectroscopy
目的 探讨青少年精神分裂症首发患者前额叶和丘脑神经生化代谢物质的药物治疗变化特点.方法 纳入符合美国精神障碍诊断与统计手册中精神分裂症诊断标准的青少年患者42例(早发未用药精神分裂症患者,研究组),应用单一非典型抗精神病药物治疗前和治疗4周后,应用质子磁共振波谱(1 H-MRS)多体素分析技术检测患者前额叶和丘脑N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr)水平.40例健康同龄青少年(健康对照组)于入组时进行相同指标的检测.研究组每次1 H-MRS检测的同时应用阳性与阴性症状量表(PANSS)评估临床症状.结果 研究组治疗前左侧及右侧前额叶、左侧丘脑NAA/Cr值均低于健康对照组,差异均有统计学意义(1.45 ±0.26比1.60±0.34,t=2.251,P=0.027;1.43±0.26比1.60±0.35,t=2.505,P=0.014;1.48 ±0.27比1.65 ±0.35,t =2.470,P=0.016);与治疗前比较,研究组治疗后左侧前额叶和左侧丘脑的NAA/Cr值明显增加,差异均有统计学意义(1.58±0.30比1.45±0.26,=2.122,P=0.037;1.62 ±0.32比1.48 ±0.27,t=2.167,P=0.033).与治疗前比较,研究组治疗后PANSS总分、阳性症状分、阴性症状分、一般病理分及临床总体印象量表(CGI)总分均明显降低,差异均有统计学意义(59.1 ±10.2比82.0±13.2,t =8.896,P =0.000;15.3 ±5.1比22.9 ±7.1,t =5.634,P =0.000;16.4 ±5.2比21.1±7.8,t=3.249,P =0.002:27.4 ±7.6比38.1±8.8,t=5.963,P =0.000;3.6 ±0.4比4.4 ±0.5,t =8.097,P=0.000).研究组治疗前后双侧前额叶和丘脑NAA/Cr值、Cho/Cr值变化值与PANSS总分及各因子分、CGI评分变化值均无相关性(P均＞0.05).结论 青少年精神分裂症首发患者双侧前额叶和左侧丘脑的NAA/Cr值降低,非典型抗精神病药物治疗4周可以升高左侧前额叶和左侧丘脑的NAA/Cr值,但其治疗变化与临床症状的改善不一致.
目的 探討青少年精神分裂癥首髮患者前額葉和丘腦神經生化代謝物質的藥物治療變化特點.方法 納入符閤美國精神障礙診斷與統計手冊中精神分裂癥診斷標準的青少年患者42例(早髮未用藥精神分裂癥患者,研究組),應用單一非典型抗精神病藥物治療前和治療4週後,應用質子磁共振波譜(1 H-MRS)多體素分析技術檢測患者前額葉和丘腦N-乙酰基天門鼕氨痠(NAA)、膽堿複閤物(Cho)與肌痠複閤物(Cr)水平.40例健康同齡青少年(健康對照組)于入組時進行相同指標的檢測.研究組每次1 H-MRS檢測的同時應用暘性與陰性癥狀量錶(PANSS)評估臨床癥狀.結果 研究組治療前左側及右側前額葉、左側丘腦NAA/Cr值均低于健康對照組,差異均有統計學意義(1.45 ±0.26比1.60±0.34,t=2.251,P=0.027;1.43±0.26比1.60±0.35,t=2.505,P=0.014;1.48 ±0.27比1.65 ±0.35,t =2.470,P=0.016);與治療前比較,研究組治療後左側前額葉和左側丘腦的NAA/Cr值明顯增加,差異均有統計學意義(1.58±0.30比1.45±0.26,=2.122,P=0.037;1.62 ±0.32比1.48 ±0.27,t=2.167,P=0.033).與治療前比較,研究組治療後PANSS總分、暘性癥狀分、陰性癥狀分、一般病理分及臨床總體印象量錶(CGI)總分均明顯降低,差異均有統計學意義(59.1 ±10.2比82.0±13.2,t =8.896,P =0.000;15.3 ±5.1比22.9 ±7.1,t =5.634,P =0.000;16.4 ±5.2比21.1±7.8,t=3.249,P =0.002:27.4 ±7.6比38.1±8.8,t=5.963,P =0.000;3.6 ±0.4比4.4 ±0.5,t =8.097,P=0.000).研究組治療前後雙側前額葉和丘腦NAA/Cr值、Cho/Cr值變化值與PANSS總分及各因子分、CGI評分變化值均無相關性(P均＞0.05).結論 青少年精神分裂癥首髮患者雙側前額葉和左側丘腦的NAA/Cr值降低,非典型抗精神病藥物治療4週可以升高左側前額葉和左側丘腦的NAA/Cr值,但其治療變化與臨床癥狀的改善不一緻.
목적 탐토청소년정신분렬증수발환자전액협화구뇌신경생화대사물질적약물치료변화특점.방법 납입부합미국정신장애진단여통계수책중정신분렬증진단표준적청소년환자42례(조발미용약정신분렬증환자,연구조),응용단일비전형항정신병약물치료전화치료4주후,응용질자자공진파보(1 H-MRS)다체소분석기술검측환자전액협화구뇌N-을선기천문동안산(NAA)、담감복합물(Cho)여기산복합물(Cr)수평.40례건강동령청소년(건강대조조)우입조시진행상동지표적검측.연구조매차1 H-MRS검측적동시응용양성여음성증상량표(PANSS)평고림상증상.결과 연구조치료전좌측급우측전액협、좌측구뇌NAA/Cr치균저우건강대조조,차이균유통계학의의(1.45 ±0.26비1.60±0.34,t=2.251,P=0.027;1.43±0.26비1.60±0.35,t=2.505,P=0.014;1.48 ±0.27비1.65 ±0.35,t =2.470,P=0.016);여치료전비교,연구조치료후좌측전액협화좌측구뇌적NAA/Cr치명현증가,차이균유통계학의의(1.58±0.30비1.45±0.26,=2.122,P=0.037;1.62 ±0.32비1.48 ±0.27,t=2.167,P=0.033).여치료전비교,연구조치료후PANSS총분、양성증상분、음성증상분、일반병리분급림상총체인상량표(CGI)총분균명현강저,차이균유통계학의의(59.1 ±10.2비82.0±13.2,t =8.896,P =0.000;15.3 ±5.1비22.9 ±7.1,t =5.634,P =0.000;16.4 ±5.2비21.1±7.8,t=3.249,P =0.002:27.4 ±7.6비38.1±8.8,t=5.963,P =0.000;3.6 ±0.4비4.4 ±0.5,t =8.097,P=0.000).연구조치료전후쌍측전액협화구뇌NAA/Cr치、Cho/Cr치변화치여PANSS총분급각인자분、CGI평분변화치균무상관성(P균＞0.05).결론 청소년정신분렬증수발환자쌍측전액협화좌측구뇌적NAA/Cr치강저,비전형항정신병약물치료4주가이승고좌측전액협화좌측구뇌적NAA/Cr치,단기치료변화여림상증상적개선불일치.
Objective To study the features of treatment on neurochemical metabolites in prefrontal lobe and thalamus by proton magnetic resonance spectroscopy (1H-MRS) in first-episode drug-naive patients with early-onset schizophrenia (EOS).Methods Forty-two EOS (study group) met with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-Ⅳ) were recruited.Prefrontal lobe and thalamus were evaluated by multi-voxel 1H-MRS before and 4-week after treatment with a single atypical antipsychotic.The levels of N-acetylaspartate (NAA),creatine compounds (Cr) and choline-containing compounds (Cho) were measured.The patients also received Positive and Negative Syndrome Scale (PANSS).Forty normal controls (normal control group) underwent the same 1H-MRS detection.Results Before treatment,the NAA/Cr ratios in left prefrontal lobe,right prefrontal lobe and lefi thalamus in study group were lower than those in normal control group (1.45 ± 0.26 vs 1.60 ± 0.34,t =2.251,P =0.027;1.43 ±0.26 vs 1.60 ±0.35,t =2.505,P=0.014;1.48 ±0.27 vs 1.65 ±0.35,t =2.470,P =0.016).After 4-week treatment,the NAA/Cr ratios in both left prefrontal lobe and left thalamus of study group were significantly increased compared with those before treatment (1.58 ± 0.30 vs 1.45 ± 0.26,t =2.122,P =0.037;1.62 ± 0.32 vs 1.48 ± 0.27,t =2.167,P =0.033).After 4-week treatment in study group,the total score,positive symptom score,negative symptom score and general pathologic score of PANSS,and the total score of Clinical Global Impression (CGI) were significantly lower compared with those before treatment (59.1 ± 10.2 vs 82.0 ± 13.2,t =8.896,P=0.000;15.3 ±5.1 vs 22.9 ±7.1,t =5.634,P =0.000;16.4 ±5.2 vs 21.1 ±7.8,t =3.249,P =0.002;27.4 ±7.6 vs 38.1 ± 8.8,t =5.963,P =0.000;3.6 ± 0.4 vs 4.4 ± 0.5,t =8.097,P =0.000).There was no correlation between the changes of neurochemical metabolite levels such as NAA/Cr and Cho/Cr both in prefrontal lobe and left thalamus,and the clinical symptoms changes,such as total score and every score of PANSS,the total score of CGI in study group after treatment (all P ＞ 0.05).Conclusions The ratios of NAA/Cr are decreased not only in bilateral prefrontal lobe,but also in left thalamus,and the ratios may increase both in left prefrontal lobe and left thalamus after 4 weeks' treatment with atypical antipsychotics in EOS.The treatment outcomes of NAA/Cr do not agree with the improvement of the clinical symptoms.
