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首发精神分裂症未治疗精神病持续时间与脑皮质形态学关系的磁共振研究

An MRI Study of the Relationship Between Duration of Untreated Psychosis and Morphology of Cerebral Cortex in First-episode Schizophrenia

  • 摘要:
      目的  从多角度对精神分裂症患者脑结构分析以探讨患者精神病未治疗持续时间(duration of untreated psychosis,DUP)与临床结局间的关系。
      方法  对85例患者及86例对照,进行临床症状和认知功能评估,通过磁共振扫描(magnetic resonance imaging, MRI)并采用free surfer分析提取脑区皮层厚度、表面积和体积等皮层结构值,基于患者组DUP的分布及中位数,以3个月、6个月、2年为界将患者分为4组,对上述指标进行组间比较及相关分析。
      结果  DUP与左岛叶、眶部和右海马旁回、额上回、额颞极的表面积有关联;与左后扣带回、中央后回,右外侧枕叶皮质、岛盖部、内侧眶额皮质和双侧中央前回的皮质厚度有关;对皮质体积,DUP主要影响左中央后回,右楔前叶、外侧枕叶皮质、岛盖部、舌回、颞上回,双侧半球的楔叶、距状旁回、中央前回、顶上小叶和岛叶;发病后前三月是脑皮层结构和临床功能恶化的关键期。
      结论  首发精神分裂症的DUP与颞叶、中央前回、眶额区皮质及枕叶内侧面的大部分脑区的皮质形态改变有关,对患者进行早期干预是非常重要的。

     

    Abstract:
      Objective  We analyzed the brain structure of schizophrenia patients from multiple perspectives to explore the relationship between the duration of untreated psychosis (DUP) and clinical outcomes.
      Methods  For 85 patients and 86 controls, clinical symptoms and cognitive function were evaluated, magnetic resonance imaging (MRI) and free surfer analysis were used to extract the cortical indicator, such as brain cortex thickness, surface area, volume, and so on. The patients were divided into four subgroups according to the boundary of March, June and two year due to the distribution and median of DUP. Finally multi-group comparison and correlation analysis for above indicators were analysed.
      Results  DUP was associated with the surface area of the left insula, parsorbitalis, right hippocampus, superior frontal gyrus, frontal pole, and temporal pole; DUP mainly influenced the cortical thickness of left posterior cingulate gyrus, postcentral gyrus, right lateral occipital cortex, parsopercularis, medial orbitofrontal cortex, and the bilateral precentral gyrus. For cortical volume, DUP significantly affected left postcentral gyrus, right precuneus, lateral occipital cortex, parsopercularis, lingual gyrus, superior temporal gyrus, bilateral cuneus, pericalcarine cortex, precentral gyrus,superior parietal lobule, and insula.The first three months after onset is a critical period for the deterioration of cortical morphology and clinical function.
      Conclusion  DUP in first-episode schizophrenia is associated with cortical morphological changes of temporal lobe, precentral, orbitofrontal cortex and the majority of medial regions of occipital lobe, it is very important to conduct early intervention for patients.

     

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