精神分裂症与抑郁症失匹配负波异常的对照研究

doi:10.3969/j.issn.1674-8115.2021.08.007

摘要/Abstract

摘要：

目的·比较精神分裂症首发患者和抑郁症患者的失匹配负波（mismatch negativity，MMN），及其与临床特征的相关性，探讨前注意加工异常在精神分裂症和抑郁症病理机制中的作用。方法·纳入2014年1月—2016年12月于上海交通大学医学院附属精神卫生中心门诊就诊的精神分裂症首发患者20例和抑郁症患者19例，并同时招募健康对照者，用阳性和阴性精神症状评定量表（Positive and Negative Syndrome Scale，PANSS）评估精神分裂症首发患者的症状，用汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD）、汉密尔顿焦虑量表（Hamilton Anxiety Scale，HAMA）评估抑郁症患者的症状。所有受试者完成MMN检测和临床量表的评估。对频率偏差刺激（frequency MMN，FMMN）和持续时间偏差刺激（duration MMN，DMMN）的波幅和潜伏期采用重复测量方差分析，组间因素为组别，中线导联的组内因素为电极（Fz、Fcz），左右半球导联的组内因素为区域（F、Fc）和左右半球（左：1；右：2），性别为协变量。DMMN、FMMN与临床特征之间的相关性采用偏相关分析。结果·① 精神分裂症组DMMN波幅［（-2.70±2.46）μV］较抑郁症组［（-5.06±0.46）μV］和正常对照组［（-5.15±0.43）μV］降低（均P≤0.001）。3组的DMMN潜伏期在前额叶中线和左右半球导联处差异均无统计学意义（均P>0.05）。② FMMN波幅在中线导联处组间差异无统计学意义（P >0.05），在左右半球导联处组间差异有统计学意义（P =0.040）。3组的FMMN潜伏期在前额叶中线和左右半球导联处差异均无统计学意义（均P >0.05）。③ 精神分裂症组F2、Fz 电极处的DMMN波幅与PANSS一般精神病理症状评分呈负相关（F2：P=0.042；Fz：P=0.032）。抑郁症组MMN潜伏期及波幅与临床特征均无相关性。结论·精神分裂症首发患者有DMMN波幅的异常，而抑郁症患者DMMN波幅正常，提示DMMN波幅可能为鉴别精神分裂症和抑郁症的生物学指标。

关键词: 精神分裂症, 抑郁症, 失匹配负波, 事件相关电位

Abstract:

Objective·To compare the difference of mismatch negativity (MMN) between first-episode schizophrenia and depression and its correlation with clinical characteristics, and explore the role of pre-attention processing in the mechanisms of schizophrenia and depression.

Methods·Twenty patients with schizophrenia and 19 patients with depression were selected in the outpatient department of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine from January 2014 to December 2016. Healthy controls were also recruited. The Positive and Negative Syndrome Scale (PANSS) was used to measure the clinical symptoms of schizophrenia. Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to measure the clinical symptoms of depression. All patients and healthy controls completed MMN detection and clinical scale assessments. The amplitudes and latencies of duration MMN (DMMN) and frequency MMN (FMMN) were analyzed by repeated measures analysis of variance with group as the between-group factors. The midline electrodes (Fz, Fcz) were used as the with-in group factor; meanwhile, region (F, Fc) and laterality (1 for left, 2 for right) were used as the within-group factors for lateral electrodes and the factor sex was used as covariate. Partial correlations was performed to find the correlation between MMN and clinical characteristics.

Results·① The amplitude of DMMN in patients with schizophrenia 2 for [(-2.70±2.46) μV)] was lower than that in patients with depression [(-5.06±0.46) μV] and healthy controls [(-5.15±0.43) μV] (both P≤0.001). No significant group differences of DMMN latency were observed at midline or lateral electrodes (All P>0.05). ② There was no significant group difference of FMMN amplitudes at midline electrodes (P>0.05) but a significant between-group difference at lateral electrodes (P=0.040). No significant group differences of FMMN latency were observed at midline or lateral electrodes (All P>0.05). ③ There was a significant correlation between DMMN amplitudes at F2 (P=0.042) or Fz (P=0.032) and general scores of PANSS in schizophrenia patients. There was no correlation in depression patients.

Conclusion·Abnormality of DMMN exists in the patients with first episode schizophrenia but not in the patients with depression, suggesting that DMMN amplitudes may work as a biological marker to distinguish schizophrenia and depression.

Key words: schizophrenia, depression, mismatch negativity, event-related potential

中图分类号:

R749.3

沈梦婷, 张选红, 钱禛颖, 李惠, 盛建华, 王继军, 唐莺莹. 精神分裂症与抑郁症失匹配负波异常的对照研究[J]. 上海交通大学学报(医学版), 2021, 41(8): 1041-1045.

Meng-ting SHEN, Xuan-hong ZHANG, Zhen-ying QIAN, Hui LI, Jian-hua SHENG, Ji-jun WANG, Ying-ying TANG. Comparison of mismatch negativity in patients with schizophrenia and depression[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(8): 1041-1045.

图/表 3

表1 3组受试的一般资料比较

Tab 1 General information of the three groups

Group	Sample size/n	Age/year	Education/year	Male/n（%）	Female/n（%）
Control group	21	34.14±6.69	12.86±2.97	7 （33.3）	14 （66.7）
Depression group	19	38.00±11.04	11.05±4.34	4 （21.1）	15 （78.9）
Schizophrenia group	20	35.55±4.59	12.60±3.05	13 （65.0）	7 （35.0）
F/ χ²	‒	1.232	1.535	8.439
P value	‒	0.299	0.224	0.015

图1 3组DMMN和FMMN的地形图及波幅比较Note：DP—depression group; HC—control group; SZ—schizophrenia group. ①P=0.000, ②P=0.001, compared with the schizophrenia group.

Fig 1 Scalp topography maps and waveforms for DMMN and FMMN of three groups

图2 精神分裂症组的DMMN与临床特征的相关性Note：G—general psychopathology scores of PANSS (a total of 19 patients with schizophrenia were included except 1 patient).

Fig 2 Correlation between DMMN and clinical scores of the schizophrenia group

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