唐文新 朱齐丰 龚向阳 朱丞 王奕權 陈树林

●论 著

强迫症患者全脑灰质与静息态功能影像研究

唐文新 朱齐丰 龚向阳 朱丞 王奕權 陈树林

目的 探讨强迫症患者脑结构及脑功能异常以及治疗前后的变化。方法 采用3.0T核磁共振仪对18例未服药强迫症患者治疗前后进行全脑扫描，获得高分辨率3D-T结构后，采用优化的基于体素的形态测量学方法（VBM）计算全脑灰质容积；静息态功能磁共振成像（fMRI）数据采用低频振幅（ALFF）方法处理，并与16例年龄、性别相匹配的正常人群相对照。结果 与对照组相比，强迫症组右侧丘脑、双侧扣带回左侧尾状核及右侧苍白球体灰质容积减少（P＜0.05）；小脑前叶、左侧眶额上回、右侧额中回、左侧颞中回、左楔前叶、中央前回、中央后回等皮质结构灰质容积增加（P＜0.05）；右侧小脑与右侧顶叶静息态fMRI过度激活，左侧扣带回、豆状核与尾状核激活减弱（P＜0.05）；药物治疗反应良好的强迫症患者左侧丘脑、左侧豆状核、左侧壳核、左侧前、后扣带回灰质容积均较治疗前明显增加（均P＜0.05）；静息态fMRI结果提示治疗前后无统计学差异（P＞0.05）。结论 强迫症患者存在多个脑区灰质容积和静息态脑功能异常，有效的药物治疗可部分逆转这种异常状态。

强迫症 基于体素的形态测量学方法 静息态功能磁共振 灰质 容积

【 Abstract】 Objective To study whole brain gray matter and resting state functional image with MRI scan in obsessive-compulsive disorder(OCD)patients. Methods Brain magnetic resonance imaging(MRI)and resting state functional MRI(fMRI)were performed in 18 OCD patients and 16 healthy subjects.High-resolution three-dimensional images were processed using the voxel-based morphometry method.Resting state function image data was processed by ALFF method. Results There was a decrease in gray matter volume in the right thalamus,bilateralcingulate cortex,left caudate nucleus and right globus pallidus(P＜0.05),and an increase in gray matter volume in the cerebellum anterior lobe,left orbitofrontalgyrus,right middle frontal gyrus,left middle temporal gyrus,left precuneus,precentral gyrus and postcentral gyrus (P＜0.05)in OCD patients.OCD patients had overactivation of the right cerebellum and right parietal lobe and reduced activation of the left cingulate gyrus, putamen and caudate nucleus on resting fMRI(P＜0.05).OCD patients whose symptoms were improved after drug treatment had a significant increase in gray matter volume in the left thalamus,left putamen,left shell nucleus,left posterior and anterior cingulate gyrus(P＜0.05),but no significant differences were found on resting fMRI before and after treatment(P＞0.05). Conclusion There are abnormalities of the gray matter volume and resting fMRI in a number of brain regions in OCD patients,and the abnormalities can be partially reversed after effective drug treatment.

【 Key words】 Obsessive-compulsive disorder Voxel-based morphometry Resting state functional magnetic resonance imaging Gray matterVolume

强迫症是临床上很常见且难以治愈的一类精神障碍。20世纪80年代以来，随着神经影像学技术的快速发展，越来越多的证据表明“皮层-纹状体-丘脑-皮层”（cortical-striato-thalamo-cortical，CSTC）环路功能异常是强迫症发生的主要病理基础[1-2]。……