目的:采用静息态功能磁共振成像探究精神分裂症患者在不同频段静息态脑功能活动.方法:选取符合DSM-Ⅳ精神分裂症诊断标准39例患者和年龄、性别相匹配的31例正常对照.采用阳性和阴性症状量表(PANSS)评估患者临床症状的严重程度.应用SPM12及RESTplus对静息态功能磁共振成像数据处理,在Slow-5和Slow-4频段计算低频振幅(ALFF)/比率低频振幅(fALFF),评估大脑自发性活动.结果:在Slow-5频段,精神分裂症患者右侧舌回的ALFF值低于对照组,左侧豆状壳核的ALFF/fALFF高于对照组;在Slow-4频段,患者左侧锯状裂、右侧舌回和右侧枕下回的ALFF值低于对照组,右侧豆状壳核的ALFF值和左侧颞下回的fALFF值高于对照组(P＜0.001).在Slow-5频段左侧豆状壳核的fALFF和PANSS量表总分(r=0.35,P＜0.05)、阳性评分(r=0.38,P＜0.05)呈正相关.结论:精神分裂症患者静息态脑活动在不同频段均存在异常.

Objective:To explore the risk factors of the incidence of arrhythmia and the prediction of baseline ventricular late potential in patients with first depression episode.Methods:The cohort study was used to observe the relationship between the baseline status of ventricular late potential, the severity of baseline depression symptoms, the extent of remission of depressive symptoms within the treatment duration and arrhythmia incidence in the 3 years progress. For the assessment of the severity of depression symptoms, 17 version of Hamilton depression scale was used to evaluate the baseline ventricular late potential, and DMS lab3.0 ECG platform late potential analysis system was used to determine the assessment (CardioScan 12 NET version). The first depression patients with positive ventricular late potential were followed up for 3 years. The changes of the severity of ventricular late potential and depression symptoms were investigated, and the correlation with the subsequent course of arrhythmia was investigated.SPSS 20.0 software package was used for statistical distraction, chi square test was used for count data, independent samples t test was used for normal distribution measurement data, Mann-Whitney U test was used for non-normal distribution count data, and logistic regression method was used to calculate relative risk( RR). Results:According to the 3-year follow-up of 400 first-episode depression patients, 22.25% (89/400) had malignant arrhythmia. The incidence of malignant arrhythmia was 39.46% (58/147) in ventricular late potential positive group and 12.25% (31/253) in ventricular late potential negative group, and the difference was statistically significant(χ 2=9.578, P<0.01). Logistic regression analysis showed that positive ventricular late potential at baseline (compared with negative ventricular late potential at baseline, RR=10.78, 95% CI=8.34-13.80), having a family history of arrhythmia (compared with no family history of arrhythmia, RR=5.23, 95% CI=2.41-9.85), had a higher severity of depression at baseline (compared with lower severity of depression at baseline, RR=1.73, 95% CI=1.25-2.85), poor first-time efficacy and more repeated hospitalizations (compared with good first-time efficacy and less hospitalizations, RR=1.11, 95% CI=1.04-1.17), and age of onset< 20 (compared with age of onset≥20, RR=1.07, 95% CI=1.02-1.93) were the risk factors of malignant arrhythmia in patients with first-episode depression(all P<0.05). Conclusion:The incidence of arrhythmia is very high in those patients with baseline positive late ventricular potential. Positive late ventricular potential, family history of arrhythmia, younger onset age and poor therapeutic effect were the relative risk of arrhythmia in the patients with depression.

难治性强迫症的治疗是临床亟待解决的问题,发病机制和病理特征不明是难以获得有效治疗的关键瓶颈.目前公认的神经病理特征为皮层-纹状体-丘脑-皮层(CSTC)环路/眶额叶(OFC)等脑区的神经环路异常,功能结构影像也发现了上述环路存在脑区结构异常,5-羟色胺转运体基因及谷氨酸转运体基因在难治性强迫症神经递质调控的神经环路中起重要作用.难治性强迫症目前尚无规范的治疗指南,扩大药物治疗策略及非药物治疗的尝试为难治性强迫症的治疗带来一线曙光,影像遗传学可能为难治性强迫症的病理特征提供依据,将成为新的研究方向.