目的 采用弥散张量成像(diffusion tensor imaging,DT1)探讨首发儿童少年精神分裂症患者脑白质完整性与认知功能的关系.方法 选择于2017年9月至2021年6月在新乡医学院第二附属医院儿童少年精神科住院的84例首发儿童少年精神分裂症患者作为研究组,选取与研究组相匹配的35例健康儿童少年为对照组;采用阳性与阴性症状量表(positive and negative syndrome scale,PANSS)评估患者精神症状;进行DTI扫描,采用基于纤维束骨架的空间统计学方法(tract-based spa-tial statistics,TBSS)测量脑白质纤维结构完整性,指标为各向异性分数(fractional anisotropy,FA);采用中文版精神分裂症认知功能成套测验-共识版(measurement and treatment research to improve cognition in schizophrenia consensus cognitive battery,MCCB)和 Stroop 色-词测验评估所有被试的认知功能.采用SPSS 26.0软件进行方差分析、独立样本t检验、Mann-Whitney U检验、Pearson相关分析.结果 (1)研究组右上纵束(MNI:x=49,y=-40,z=31)和左皮质脊髓束(MNI:x=-27,y=-22,z=-19)FA值高于对照组,研究组两侧扣带回(MNI:x=-7,y=25,z=14;x=20,y=-50,z=25)和胼胝体辐射线枕部(MNI:x=-19,y=-50,z=21)FA值低于对照组,且均差异具有统计学意义(均P＜0.05).(2)研究组的连线测验分高于对照组(t=4.344,P＜0.01);符号编码、霍普金斯词语学习测验-修订版(Hopkins verbal learning test-revised,HVLT-R)、简易视觉空间记忆(brief visuospatial memory test-revised,BVMT-R)、词语流畅性试验、数字广度、迷宫、Stroop单词、Stroop颜色及Stroop色词均低于对照组(t=-13.041～-3.204,均P＜0.05).(3)右扣带回(海马体)FA值与数字广度呈负相关(r=-0.269,P=0.023);胼胝体辐射线枕部FA值与符号编码呈正相关(r=0.237,P=0.047);左下纵束FA值与Stroop颜色和迷宫得分呈负相关(r=-0.289,-0.275,P=0.010,0.020);右下纵束FA值与迷宫得分呈负相关(r=-0.254,P=0.032).胼胝体辐射线枕部FA值与阳性症状分呈正相关(r=0.170,P=0.040).结论 首发儿童少年精神分裂症患者认知功能障碍可能与大脑白质完整性异常有关.
Diffusion tensor imaging study on the relationship between white matter and cognitive function in children and adolescents with first-episode schizophrenia
Objective To explore the relationship between white matter integrity and cognitive func-tion in first-episode children and adolescents with schizophrenia by diffusion tensor imaging(DTI).Methods Totally 84 children and adolescents with first-episode schizophrenia who were hospitalized in the Department of Child and Adolescent Psychiatry at the Second Affiliated Hospital of Xinxiang Medical University from September 2017 to June 2021 were selected as the study group,and 35 healthy children and adolescents matched with the study group were selected as the control group.Positive and negative symptom scale(PANSS)was used to assess the patient's mental symptoms.Diffusion tensor imaging(DTI)scans were performed,and the structural integrity of white matter fibers in the brain was measured by tract-based spatial statistics(TBSS),with the indicators including fractional anisotropy(FA).The Chinese version of measure-ment and treatment research to improve cognition in schizophrenia consensus cognitive battery(MCCB)and the Stroop color-word test were used to evaluate the cognitive function of all subjects.SPSS 26.0 software was used to analyse the data by analysis of variance,independent sample t-test,Mann Whitney U-test and Pearson correlation analysis.Results(1)The FA values of the right superior longitudinal tract(MNI;x=49,y=-40,z=31)and the left corticospinal tract(MNI:x=-27,y=-22,z=-19)in the study group were higher than those in the control group(both P＜0.05).The FA values of the bilateral cingulate gyrus(MNI:x=-7,y=25,z=14;x=20,y=-50,z=25)and the occipital part of the corpus callosum radiation line(MNI:x=-19,y=-50,z=21)in the study group were lower than those in the control group(both P＜0.05).(2)The trail making test score of the study group was higher than that of the control group(t=4.344,P＜0.01),and the scores of the symbol coding,Hopkins verbal learning test-revised(HVLT-R),brief visuospatial memory test-revised(BVMT-R),word fluency test,number span,maze,Stroop word,Stroop color and Stroop color words were lower than those in the control group(t=-13.041--3.204,all P＜0.05).(3)The FA value of right cingulate gyrus(hippocampus)was negatively correlated with the number span(r=-0.269,P=0.023).The FA value in occipital part of the corpus callosum radiation line was positively corre-lated with the symbol code(r=0.237,P=0.047).The FA value of the left lower longitudinal bundle was negatively correlated with the Stroop color and maze(r=-0.289,-0.275;P=0.010,0.020).The FA value of the right inferior longitudinal fasciculus was negatively correlated with the score of maze(r=-0.254,P=0.032).The FA value of occipital part of the corpus callosum radiation line was positively correlated with positive symptom score(r=0.170,P=0.040).Conclusion Cognitive dysfunction in children and adoles-cent with first-episode schizophrenia may be related to abnormal white matter integrity in the brain.
Diffusion tensor imagingWhite matter integrity of the brainCognitive functionChildren and adolescentsSchizophrenia
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