中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (12): 1078-1088. doi: 10.3969/j.issn.1672-6731.2021.12.009

• 神经心理学 • 上一篇    下一篇

2 治疗反应差异精神分裂症患者胼胝体扩散张量成像研究

史晓蒙1, 黄嘉爽2, 高舒展1, 张道强3, 徐西嘉1   

  1. 1 210029 南京医科大学附属脑科医院精神科;
    2 226019 南通大学信息科学技术学院;
    3 211106 南京航空航天大学计算机科学与技术学院
  • 收稿日期:2021-12-14 出版日期:2021-12-25 发布日期:2021-12-27
  • 通讯作者: 徐西嘉,Email:xuxijia@aliyun.com
  • 基金资助:

    国家自然科学基金资助项目（项目编号：81771444）；江苏省重点研发计划（社会发展）项目（项目编号：BE2019707）；第十六批江苏省六大人才高峰高层次人才项目（项目编号：WSN-166）

DTI study of corpus callosum in schizophrenia patients with different treatment response

SHI Xiao-meng1, HUANG Jia-shuang2, GAO Shu-zhan1, ZHANG Dao-qiang3, XU Xi-jia1   

  1. 1 Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China;
    2 School of Information Science and Technology, Nantong University, Nantong 226019, Jiangsu, China;
    3 College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing 211106, Jiangsu, China
  • Received:2021-12-14 Online:2021-12-25 Published:2021-12-27
  • Supported by:

    This study was supported by the National Natural Science Foundation of China (No. 81771444), the Key Research and Development Plan (Social Development) in Jiangsu Province (No. BE2019707), and the 16th Batch of Six Talent Peak Projects in Jiangsu Province (No. WSN-166).

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摘要：

目的 探讨治疗反应差异（难治性和治疗敏感）精神分裂症患者胼胝体各亚区白质纤维束完整性差异及其与临床症状严重程度之间的相关性。方法 纳入2012年12月至2016年3月南京医科大学附属脑科医院收治的19例难治性精神分裂症患者（难治组）、19例治疗敏感精神分裂症患者（治疗敏感组）和25例性别、年龄、受教育程度相匹配的正常对照者（对照组），均行DTI检查以获得胼胝体膝部、体部和压部部分各向异性（FA）、径向扩散系数（AD）、轴向扩散系数（RD）和平均扩散率（MD）。采用Pearson相关分析和偏相关分析探讨胼胝体各亚区FA值、AD值、RD值、MD值与阳性和阴性症状量表（PANSS）总评分、阳性量表评分、阴性量表评分，以及一般精神病理量表评分的相关性。结果 3组受试者胼胝体膝部FA值（F=3.139，P=0.050）、压部FA值（F=3.531，P=0.036）、压部AD值（F=5.261，P=0.006）、压部RD值（F=7.161，P=0.002）和压部MD值（F=8.229，P=0.001）差异均具有统计学意义，其中，难治组胼胝体膝部FA值低于对照组（t=-2.488，P=0.016），治疗敏感组胼胝体压部FA值亦低于对照组（t=-2.491，P=0.016）；治疗敏感组胼胝体压部AD值高于难治组（t=-2.078，P=0.042）和对照组（t=3.334，P=0.001）；难治组和治疗敏感组胼胝体压部RD值（t=2.361，P=0.022；t=3.687，P=0.000）和MD值（t=2.083，P=0.041；t=4.039，P=0.000）高于对照组。相关分析显示，难治性精神分裂症患者胼胝体膝部FA值与一般精神病理量表评分呈正相关（r=0.651，P=0.016），膝部AD值与阳性量表评分呈负相关（r=-0.553，P=0.050），膝部RD值与PANSS总评分（r=-0.645，P=0.017）、阳性量表评分（r=-0.568，P=0.043）和一般精神病理量表评分（r=-0.647，P=0.011）均呈负相关，膝部MD值与阳性量表评分呈负相关（r=-0.640，P=0.018）；体部AD值与阳性量表评分呈负相关（r=-0.639，P=0.019），而与阴性量表评分呈正相关（r=0.686，P=0.010）。结论 难治性精神分裂症患者临床症状更严重，涉及更多的神经生物学基础，胼胝体结构损伤可以作为精神分裂症治疗反应的影像学标记。

关键词: 精神分裂症, 胼胝体, 弥散张量成像

Abstract:

Objective To compare the white matter fiber integrity of corpus callosum in schizophrenia patients with different treatment response with normal controls. And to explore the relationship between DTI index and the severity of the clinical symptoms in patients with schizophrenia. Methods Nineteen patients with treatment-resistant schizophrenia, 19 patients with treatment-responsive schizophrenia and 25 healthy controls were recruited from December 2012 to March 2016 of The Affiliated Brain Hospital of Nanjing Medical University. Fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) values of the genu, body and splenium of corpus callosum were obtained by DTI. One-way ANOVA was used to compare the differences in FA, AD, RD and MD values of the corpus callosum subregions among 3 groups of subjects, and Pearson correlation and partial correlation analyses were performed between FA, AD, RD, MD values and the Positive and Negative Syndrome Scale (PANSS) total score, positive symptom score, negative symptom score and general psychopathology score. Results There were significant differences in FA value of genu (F=3.139, P=0.050), FA value of splenium (F=3.531, P=0.036), AD value of splenium (F=5.261, P=0.006), RD value of splenium (F=7.161, P=0.002) and MD value of splenium (F=8.229, P=0.001) of the corpus callosum among 3 groups. Pairwise comparison showed the FA value of the corpus callosum in the treatment-resistant schizophrenia patients was lower than that of the control group (t=-2.488, P=0.016), and the FA value of the corpus callosum splenium in the treatment-responsive schizophrenia patients was lower than that of the control group (t=-2.491, P=0.016). The AD value of the corpus callosum splenium in the treatment-responsive schizophrenia patients was higher than that of the treatment-resistant schizophrenia group (t=-2.078, P=0.042) and the control group (t=3.334, P=0.001); the RD value of the corpus callosum splenium in the treatment-resistant schizophrenia patients (t=2.361, P=0.022) and treatment-responsive schizophrenia patients (t=3.687, P=0.000) were higher than that of the control group; the MD value of corpus callosum splenium in the treatment-resistant schizophrenia patients (t=2.083, P=0.041) and treatment-responsive schizophrenia patients (t=4.039, P=0.000) were higher than that of the control group. Partial correlation analysis results showed that, in the genu of the corpus callosum in patients with treatment-resistant schizophrenia, FA value was positively correlated with general psychopathological score (r=0.651, P=0.016); AD value was negatively correlated with positive symptom score (r=-0.553, P=0.050); RD value was negatively correlated with PANSS total score (r=-0.645, P=0.017), positive symptom score (r=-0.568, P=0.043) and general psychopathology score (r=-0.647, P=0.011); MD value was negatively correlated with positive symptom score (r=-0.640, P=0.018). In splenium of corpus callosum in treatment-resistant schizophrenia patients, AD value was negatively correlated with positive symptom score (r=-0.639, P=0.019), and positively correlated with negative symptom score (r=0.686, P=0.010). There was no correlation between FA, AD, RD and MD values of genu, body and splenium of corpus callosum and PANSS total score, positive symptom score, negative symptom score and general psychopathology score in patients with treatment-responsive schizophrenia (P > 0.05, for all). Conclusions Patients with treatment-resistant schizophrenia have more severe clinical symptoms involving more neurobiological bases. The corpus callosum injury can be used as an imaging marker of treatment response in schizophrenia.

Key words: Schizophrenia, Corpus callosum, Diffusion tensor imaging

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