上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (09): 1222-1228.doi: 10.3969/j.issn.1674-8115.2020.09.010

• 论著·临床研究 • 上一篇    下一篇

额叶-边缘系统功能连接特征对精神病临床高危综合征患者转归的预测作用

朱田园1，沈梦婷1，徐丽华1，张天宏1，张建业2#，王继军1，唐莺莹1#   

  1. 1.上海交通大学医学院附属精神卫生中心脑电影像研究室，上海 200030；2.上海交通大学医学院附属精神卫生中心放射科，上海 200030
  • 出版日期:2020-09-28 发布日期:2020-11-04
  • 通讯作者: 张建业，电子信箱：zjy690905@163.com。唐莺莹，电子信箱：yytang0522@gmail.com。#为共同通信作者。
  • 作者简介:朱田园(1993—)，男，硕士生；电子信箱：doctortyzhu@163.com。
  • 基金资助:
    国家自然科学基金面上项目(81871050, 81971251)；上海市科学技术委员会“科技创新行动计划”临床医学领域项目(17411953100)；上海市教育委员会高峰高原学科建设计划（20191836）。

Prediction of functional connectivity of fronto-limbic network in the outcome of subjects with clinical high-risk for psychosis

ZHU Tian-yuan1, SHEN Meng-ting1, XU Li-hua1, ZHANG Tian-hong1, ZHANG Jian-ye2#, WANG Ji-jun1, TANG Ying-ying1#   

  1. 1. Department of EEG and Neuroimaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; 2. Department of Radiology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2020-09-28 Published:2020-11-04
  • Supported by:
    National Natural Science Foundation of China (81871050, 81971251); Scientific Innovation Program-Clinical Medicine Grant Support of Shanghai Science and Technology Committee (17411953100); Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20191836).

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摘要： 目的·探索额叶-边缘系统的功能连接特征在预测精神病临床高危综合征（clinical high-risk for psychosis, CHR）患者转化为精神分裂症中的作用。方法·募集CHR被试164例和健康对照89例，采集静息态功能性磁共振成像，计算基线时额叶（内侧前额叶、双侧眶额）和边缘系统（双侧海马、双侧杏仁核）脑区之间的功能连接强度。CHR组根据1年随访的临床结局被细分为3个亚组，即转化组（CHR-C组，转为精神分裂症）、症状组（CHR-S组，仍符合CHR诊断标准）和缓解组（CHR-R组，症状缓解）。比较额叶-边缘系统功能连接的组间及亚组间差异，分析其与脑区的交互作用，以及与阳性、阴性症状的相关性。结果·额叶-边缘系统功能连接的组别主效应不显著（P=0.110），但分亚组时存在显著的亚组与脑区交互作用（P=0.049）。CHR-C组双侧眶额-双侧杏仁核的功能连接强度显著低于健康对照组和CHR-R组（均P<0.05），3个CHR亚组左侧眶额-左侧海马功能连接强度均显著低于健康对照组（均P<0.05）。CHR-C组左侧眶额-右侧杏仁核功能连接异常与阴性症状严重程度呈显著正相关（P<0.05），而左侧眶额-双侧海马及右侧眶额-左侧海马功能连接异常与阳性症状严重程度呈显著负相关（均P<0.05）。结论·CHR患者可能普遍存在眶额-海马功能连接降低，而眶额-杏仁核功能连接低下可能对CHR患者后期转化为精神分裂症有一定的预测作用。

关键词: 精神病临床高危综合征, 额叶-边缘系统网络, 脑功能连接, 精神分裂症

Abstract:

Objective · To explore the role of functional connectivity (FC) within the fronto-limbic network in predicting the onset of psychosis in the subjects with clinical high-risk for psychosis (CHR). Methods · A total of 164 CHR subjects and 89 healthy controls (HC) who underwent resting-state functional MRI were recruited. FCs between frontal [medial prefrontal cortex and bilateral orbitofrontal cortex (OFC)] and limbic (bilateral hippocampus and bilateral amygdala) brain regions at baseline were calculated. CHR subjects were further divided into 3 subgroups, i.e., CHR converters (CHR-C) group, symptomatic CHR (CHR-S) group and remitted CHR (CHR-R) group according to clinical outcome after one-year follow-up. The FCs of fronto-limbic network were compared between the groups and among the subgroups, and their interaction with brain regions, as well as their correlations with positive and negative symptoms were analyzed. Results · There was no significant main effect of group (P=0.110), but a significant interaction of subgroups and brain regions (P=0.049). CHR-C group had lower FC between bilateral OFC and bilateral amygdala than HC group and CHR-R group (all P<0.05). The FCs between left OFC and left hippocampus in the three CHR subgroups were all lower than that in HC group (all P<0.05). In addition, the FC between left OFC and right amygdala was positively correlated with the severity of negative symptoms in CHR-C group, while the FCs between left OFC and bilateral hippocampus and between right OFC and left hippocampus were negatively correlated with the severity of positive symptoms in CHR-C group. Conclusion · The decrease of OFC-hippocampus connectivity may be common in the subjects with CHR, while the decrease of OFC-amygdala connectivity may predict CHR subjects will convert to schizophrenia in the later stage.

Key words: clinical high-risk for psychosis (CHR), fronto-limbic network, functional connectivity, schizophrenia

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