氯丙嗪和氯氮平维持治疗期精神分裂症患者脑白质完整性比较研究-东南大学学报医学版

氯丙嗪和氯氮平维持治疗期精神分裂症患者脑白质完整性比较研究

作者：吴韬¹ 张向荣¹ 2 唐小伟³ 张洪英⁴ 于淼¹ 廖文象¹ 张晓斌³ 沙维伟³ 吴晶涛⁴ 张志珺¹

单位：1. 东南大学附属中大医院神经精神医学科, 江苏南京 210009;
2. 南京医科大学附属脑科医院老年精神科, 江苏南京 210029;
3. 江苏省扬州五台山医院精神科, 江苏扬州 225003;
4. 江苏省苏北人民医院医学影像科, 江苏扬州 225001

关键词：氯丙嗪氯氮平精神分裂症脑白质纤维示踪

分类号：R749.3

出版年·卷·期（页码）：2015·34·第二期（211-217）

摘要：

目的:比较以氯丙嗪和氯氮平维持治疗的精神分裂症病情稳定期患者脑白质完整性差异特征.方法:选择氯丙嗪和氯氮平维持治疗的病情稳定的精神分裂症患者以及正常对照组各24例,入组患者采用阳性和阴性症状量表(PANSS)以及住院精神病人社会功能评定量表(SSPI)进行评估.所有被试者以美国GE HDx3.0T磁共振扫描仪进行扩散张量成像(DTI)扫描,基于纤维示踪的空间统计方法(TBSS)分析3组脑白质完整性(各向异性分数FA、轴向弥散率DA、径向弥散率DR和平均弥散率MD值)差异区域及其与临床症状的相关性.结果:氯氮平和氯丙嗪组间PANSS和SSPI量表评分差异无统计学意义,两组间FA、DA、DR和MD值差异也无统计学意义.与正常对照组比较,氯丙嗪组胼胝体体部和膝部、左侧扣带回和右侧前放射冠FA值显著降低;氯氮平组胼胝体体部、膝部及压部、左右前放射冠、左右丘脑后辐射、左侧上纵束和双侧扣带回FA值显著降低;氯氮平组穹窿和左侧内囊后肢DA值显著增高;氯氮平组胼胝体体部、膝部及压部、左右前放射冠和左右丘脑后辐射DR值显著增高;氯氮平组胼胝体体部和膝部、左右前放射冠和左侧丘脑后辐射MD值显著增高.氯氮平组丘脑后辐射FA值与PANSS阳性分呈负相关(r=-0.697,P <0.01).结论:精神分裂症患者维持治疗期仍存在脑白质完整性损伤,氯氮平治疗患者更为广泛,这可能是患者病情较难控制的病理因素之一.

Objective: To compare white-matter integrities between schizophrenic patients maintained treated with chlorpromazine and clozapine by tract-based spatial statistics. Methods: The patients with schizophrenia in stable condition that received maintenance treatment with chlorpromazine and clozapine and normal control subjects were recruited(n=24 per groups). DTI data were acquired using a 3T MR system(GE HDx, Milwaukee, WI). The differences in white-matter integrities were analyzed by TBSS(tract-based spatial statistics), while their correlations to clinical symptoms were also investigated. Results: There was no statistical significances in PANSS and SSPI and white-matter values(FA, DA, DR and MD) between the chlorpromazine and clozapine treated groups. Compared with control group, FA was significantly lower in Body of corpus callosum, Genu of corpus callosum, Cingulum L, and Cingulum L in chlorpromazine group. FA was remarkably lower in Body of corpus callosum, Genu of corpus callosum, Splenium of corpus callosum, Superior corona radiata L&R, Posterior thalamic radiation L&R, Superior longitudinal fasciculus L, Cingulum L&R in clozapine group. Compared with control group, clozapine group had the significant higher DA in Fornix and Posterior limb of internal capsule L; the significant higher DR in Body of corpus callosum, Genu of corpus callosum, Splenium of corpus callosum, Superior corona radiata L&R, Posterior thalamic radiation L&R; and the significant higher MD in Body of corpus callosum, Genu of corpus callosum, Superior corona radiata L&R, and Posterior thalamic radiation L. The FA value of Posterior thalamic radiation was negatively correlated with PANSS positive score in clozapine group (r=-0.697,P <0.01). Conclusions: Schizophrenic patients have deficits of white-matter integrities in the period of maintenance treatment. The severer impairments of white-matter integrities in clozapine treated patients might be one of pathological mechanism underlying their refractory symptoms.

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