Cahn Wiepke, Hulshoff Pol Hilleke E, Lems Elleke B T E, van Haren Neeltje E M, Schnack Hugo G, van der Linden Jeroen A, Schothorst Patricia F, van Engeland Herman, Kahn René S
Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
Arch Gen Psychiatry. 2002 Nov;59(11):1002-10. doi: 10.1001/archpsyc.59.11.1002.
Imaging studies of patients with schizophrenia have demonstrated that brain abnormalities are largely confined to decreases in gray matter volume and enlargement of the lateral and third ventricles. Global gray matter volume has been reported to progressively decrease in childhood-onset and chronic schizophrenia. Global gray matter volumes have not been examined longitudinally in patients with first-episode schizophrenia. One would expect global gray matter to decrease progressively, particularly in first-episode patients, because clinical deterioration is greatest in the early stages of the disease.
Patients with first-episode schizophrenia who had taken antipsychotic medication for 0 to 16 weeks (n = 34) and matched healthy comparison subjects (n = 36) were included in the study. For all subjects, magnetic resonance imaging scans of the whole brain were obtained at inclusion and after 1 year (mean [SD], 12.7 [1.1] months). Outcome was measured 2 years after inclusion. To compare morphological changes over time between patients and healthy comparison subjects, multiple repeated-measures analyses of variance were conducted with intracranial volume as a covariate. Outcome and cumulative antipsychotic medication were related to changes in patients' brain volumes.
Total brain volume (-1.2%) and gray matter volume of the cerebrum (-2.9%) significantly decreased and lateral ventricle volume significantly increased (7.7%) in patients. The decrease in global gray matter volume significantly correlated with outcome and, independently of that, with higher cumulative dosage of antipsychotic medication.
The loss of global gray matter in schizophrenia is progressive, occurs at an early stage of the illness, and is related to the disease process and antipsychotic medication.
对精神分裂症患者的影像学研究表明，脑部异常主要局限于灰质体积减少以及侧脑室和第三脑室扩大。据报道，儿童期起病的慢性精神分裂症患者的全脑灰质体积会逐渐减少。尚未对首发精神分裂症患者的全脑灰质体积进行纵向研究。人们预计全脑灰质会逐渐减少，尤其是首发患者，因为疾病早期临床恶化最为严重。
本研究纳入了服用抗精神病药物0至16周的首发精神分裂症患者（n = 34）以及匹配的健康对照者（n = 36）。对所有受试者，在入组时和1年后（平均[标准差]，12.7 [1.1]个月）进行全脑磁共振成像扫描。在入组2年后测量结果。为了比较患者和健康对照者随时间的形态学变化，以颅内体积作为协变量进行多次重复测量方差分析。结果与累积抗精神病药物使用情况与患者脑体积变化相关。
患者的全脑体积（-1.2%）和大脑灰质体积（-2.9%）显著减少，侧脑室体积显著增加（7.7%）。全脑灰质体积的减少与结果显著相关，并且独立于此，与更高的抗精神病药物累积剂量相关。
精神分裂症患者全脑灰质的丢失是渐进性的，发生在疾病早期，并且与疾病进程和抗精神病药物有关。
