中华精神科杂志
中華精神科雜誌
중화정신과잡지
CHINESE JOURNA OF PSYCHIATRY
2015年
4期
232-238
,共7页
陈诚%王高华%王惠玲%蒋田仔%周媛%吴士豪%黄欢%邹寄林
陳誠%王高華%王惠玲%蔣田仔%週媛%吳士豪%黃歡%鄒寄林
진성%왕고화%왕혜령%장전자%주원%오사호%황환%추기림
精神分裂症%磁共振成像%幻听%比率低频振荡振幅
精神分裂癥%磁共振成像%幻聽%比率低頻振盪振幅
정신분렬증%자공진성상%환은%비솔저빈진탕진폭
Schizophrenia%Magnetic resonance imaging%Auditory hallucinations%Fraction amplitude of low-frequency fluctuation
目的 探讨有无幻听的精神分裂症患者静息态fMRI比率低频振荡振幅(fraction amplitude of low-frequency fluctuation,fALFF)的特征及幻听产生的神经影像机制.方法 采用静息态功能磁共振fALFF研究方法,对49例有幻听的患者(幻听组)、23例无幻听的患者(非幻听组)及81名健康对照者(对照组),进行静息态fMRI扫描.计算fALFF的值,3组进行方差分析得出有差异的脑区,并分别进行两组之间的独立样本t检验,最后将幻听评分与差异脑区fALFF值进行相关分析.结果 (1)3组fALFF值存在差异的脑区:双侧小脑后叶、左侧尾状核和豆状核、双侧额中回及前扣带回(AlphaSim校正,P＜0.05,体素个数＞21);(2)有差异脑区fALFF值的组间比较:右侧和左侧小脑后叶:与对照组(-1.10±0.35、-1.26±0.38)相比,幻听组(-0.83±0.40、-0.98±0.50)和非幻听组(-0.55±0.41、-0.62±0.40)fALFF值升高(t=-4.009、-3.603,均P＜0.05);而幻听组与非幻听组相比,幻听组fALFF值降低(t=-2.782、-2.958,均P＜0.05);左侧尾状核:与对照组相比,幻听组和非幻听组fALFF值增高(t=-4.51、-1.81,均P＜0.05);左侧豆状核:与对照组(-0.32±0.40)相比,幻听组(0.05±0.52)fALFF值增高(t=-6.614,P＜0.01)而非幻听组(-0.15±0.38)与对照组比较差异无统计学意义;左侧和右侧额中回:与非幻听组相比,幻听组(t=-4.051、-3.154)和对照组(t=-6.645、-5.535)fALFF值增高(均P＜0.05);左侧和右侧前扣带回:与对照组相比,幻听组(t=3.898、5.004)和非幻听组(t=4.616、5.860)fALFF值降低(均P＜0.05);(3)相关分析:幻听严重程度与左右侧小脑后叶fALFF值呈负相关(r=-0.401、-0.547,均P＜0.01);与左侧豆状核fALFF值呈正相关(r=0.311,P＜0.05)但与左侧尾状核、双侧额中回及前扣带回无明显相关性.结论 精神分裂症患者存在多个脑区的自发功能活动异常.伴有幻听的精神分裂症患者可能存在显著双侧小脑后叶及左侧豆状核的功能活动异常,为进一步揭示幻听产生的病理生理机制提供了神经影像基础.
目的 探討有無幻聽的精神分裂癥患者靜息態fMRI比率低頻振盪振幅(fraction amplitude of low-frequency fluctuation,fALFF)的特徵及幻聽產生的神經影像機製.方法 採用靜息態功能磁共振fALFF研究方法,對49例有幻聽的患者(幻聽組)、23例無幻聽的患者(非幻聽組)及81名健康對照者(對照組),進行靜息態fMRI掃描.計算fALFF的值,3組進行方差分析得齣有差異的腦區,併分彆進行兩組之間的獨立樣本t檢驗,最後將幻聽評分與差異腦區fALFF值進行相關分析.結果 (1)3組fALFF值存在差異的腦區:雙側小腦後葉、左側尾狀覈和豆狀覈、雙側額中迴及前釦帶迴(AlphaSim校正,P＜0.05,體素箇數＞21);(2)有差異腦區fALFF值的組間比較:右側和左側小腦後葉:與對照組(-1.10±0.35、-1.26±0.38)相比,幻聽組(-0.83±0.40、-0.98±0.50)和非幻聽組(-0.55±0.41、-0.62±0.40)fALFF值升高(t=-4.009、-3.603,均P＜0.05);而幻聽組與非幻聽組相比,幻聽組fALFF值降低(t=-2.782、-2.958,均P＜0.05);左側尾狀覈:與對照組相比,幻聽組和非幻聽組fALFF值增高(t=-4.51、-1.81,均P＜0.05);左側豆狀覈:與對照組(-0.32±0.40)相比,幻聽組(0.05±0.52)fALFF值增高(t=-6.614,P＜0.01)而非幻聽組(-0.15±0.38)與對照組比較差異無統計學意義;左側和右側額中迴:與非幻聽組相比,幻聽組(t=-4.051、-3.154)和對照組(t=-6.645、-5.535)fALFF值增高(均P＜0.05);左側和右側前釦帶迴:與對照組相比,幻聽組(t=3.898、5.004)和非幻聽組(t=4.616、5.860)fALFF值降低(均P＜0.05);(3)相關分析:幻聽嚴重程度與左右側小腦後葉fALFF值呈負相關(r=-0.401、-0.547,均P＜0.01);與左側豆狀覈fALFF值呈正相關(r=0.311,P＜0.05)但與左側尾狀覈、雙側額中迴及前釦帶迴無明顯相關性.結論 精神分裂癥患者存在多箇腦區的自髮功能活動異常.伴有幻聽的精神分裂癥患者可能存在顯著雙側小腦後葉及左側豆狀覈的功能活動異常,為進一步揭示幻聽產生的病理生理機製提供瞭神經影像基礎.
목적 탐토유무환은적정신분렬증환자정식태fMRI비솔저빈진탕진폭(fraction amplitude of low-frequency fluctuation,fALFF)적특정급환은산생적신경영상궤제.방법 채용정식태공능자공진fALFF연구방법,대49례유환은적환자(환은조)、23례무환은적환자(비환은조)급81명건강대조자(대조조),진행정식태fMRI소묘.계산fALFF적치,3조진행방차분석득출유차이적뇌구,병분별진행량조지간적독립양본t검험,최후장환은평분여차이뇌구fALFF치진행상관분석.결과 (1)3조fALFF치존재차이적뇌구:쌍측소뇌후협、좌측미상핵화두상핵、쌍측액중회급전구대회(AlphaSim교정,P＜0.05,체소개수＞21);(2)유차이뇌구fALFF치적조간비교:우측화좌측소뇌후협:여대조조(-1.10±0.35、-1.26±0.38)상비,환은조(-0.83±0.40、-0.98±0.50)화비환은조(-0.55±0.41、-0.62±0.40)fALFF치승고(t=-4.009、-3.603,균P＜0.05);이환은조여비환은조상비,환은조fALFF치강저(t=-2.782、-2.958,균P＜0.05);좌측미상핵:여대조조상비,환은조화비환은조fALFF치증고(t=-4.51、-1.81,균P＜0.05);좌측두상핵:여대조조(-0.32±0.40)상비,환은조(0.05±0.52)fALFF치증고(t=-6.614,P＜0.01)이비환은조(-0.15±0.38)여대조조비교차이무통계학의의;좌측화우측액중회:여비환은조상비,환은조(t=-4.051、-3.154)화대조조(t=-6.645、-5.535)fALFF치증고(균P＜0.05);좌측화우측전구대회:여대조조상비,환은조(t=3.898、5.004)화비환은조(t=4.616、5.860)fALFF치강저(균P＜0.05);(3)상관분석:환은엄중정도여좌우측소뇌후협fALFF치정부상관(r=-0.401、-0.547,균P＜0.01);여좌측두상핵fALFF치정정상관(r=0.311,P＜0.05)단여좌측미상핵、쌍측액중회급전구대회무명현상관성.결론 정신분렬증환자존재다개뇌구적자발공능활동이상.반유환은적정신분렬증환자가능존재현저쌍측소뇌후협급좌측두상핵적공능활동이상,위진일보게시환은산생적병리생리궤제제공료신경영상기출.
Objective Using the fraction amplitude of low-frequency fluctuation (fALFF) of reststating fMRI to explore the characteristics of fALFF in schizophrenia with/without auditory hallucination and understand the pathological mechanism of brain function in schizophrenia with auditory hallucinations.Methods 49 schizophrenic patients (APG) with and 23 without auditory hallucination (NPG),81 healthy volunteers (NC) were included in the study.All subjects underwent rest-stating fMRI.Values of fALFF were calculated in the tape limit ranging from 0.01 Hz to 0.08 Hz.A one-way analysis of covariance,with group as fixed factor (whole-brain corrected),was conducted and followed by post hoc pairwise comparisons.Meanwhile,pearson correlation analyses were performed to further assess the relationships between these different regions of fALFF values and the Hoffman scores in patients with auditory hallucinations.Result (1) There were different on fALFF values among 3 groups in bilateral cerebellum posterior lobe,the left caudate,the left lentiform nucleus,bilateral middle frontal gyrus,bilateral anterior cingulate (AlphaSim corrected,P＜0.05,voxel＞21).(2)The fALFF values:Bilateral cerebellum posterior lobe:compared with NC (-1.10±0.35,-1.26±0.38),both APG(-0.83±0.40,-0.98±0.50) and NPG(-0.55±0.41,-0.62±0.40)showed increased fALFF (t=-4.009,-3.603,both P＜0.05),but APG showed decreased fALFF (t=-2.782,-2.958,both P＜0.05) than NPG;The left caudate:compared with NC,both APG and NPG showed increased fALFF (t=-4.51,-1.81,both P＜0.05);The left lentiform nucleus:compared with NC (-0.32±0.40),APG (0.05±0.52) showed increased fALFF(t=-6.614,P＜0.01),but NPG (-0.15±0.38) showed no difference;Bilateral middle frontal gyrus:compared with NPG,both APG (t=-4.051,-3.154)and NC (t=-6.645,-5.535)showed increased fALFF (all P＜0.05);Bilateral anterior cingulate:Compared with NC,both APG (t=3.898,5.004)and NPG (t=4.616,5.860)showed decreased fALFF (all P＜0.05).(3) Pearson correlation analyses showed that Hoffman score showed negatively correlated with bilateral cerebellum posterior lobe (r=-0.401,-0.547;both P＜0.01)and positively correlated with the left lentiform nucleus (r=0.311,P＜0.05),but no relationship with bilateral middle frontal gyrus,bilateral anterior cingulate and the left caudate nucleus.Conclusion This study confirmed schizophrenia patients had abnormal spontaneous activity in multiple regions.Schizophrenia with auditory hallucinations may show abnormal activity in bilateral cerebellum posterior lobe and the left lentiform nucleus,which can help us to reveal the neuroimaging mechanism of auditory hallucinations.
