Carey P D, Warwick J, Harvey B H, Stein D J, Seedat S
MRC Research Unit for Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, Cape Town, South Africa.
Metab Brain Dis. 2004 Jun;19(1-2):125-34. doi: 10.1023/b:mebr.0000027423.34733.12.
Inositol, a glucose isomer and second messenger precursor, regulates numerous cellular functions and has demonstrated efficacy in obsessive-compulsive disorder (OCD) through mechanisms that remain unclear. The effect of inositol treatment on brain function in OCD has not been studied to date. Fourteen OCD subjects underwent single photon emission computed tomography (SPECT) with Tc-99m HMPAO before and after 12 weeks of treatment with inositol. Whole brain voxel-wise SPM was used to assess differences in perfusion between responders and nonresponders before and after treatment as well as the effect of treatment for the group as a whole. There was 1) deactivation in OCD responders relative to nonresponders following treatment with inositol in the left superior temporal gyrus, middle frontal gyrus and precuneus, and the right paramedian post-central gyrus; 2) no significant regions of deactivation for the group as a whole posttreatment; and 3) a single cluster of higher perfusion in the left medial prefrontal region in responders compared to nonresponders at baseline. Significant reductions in the YBOCS and CGI-severity scores followed treatment. These data are only partly consistent with previous functional imaging work on OCD. They may support the idea that inositol effects a clinical response through alternate neuronal circuitry to the SSRIs and may complement animal work proposing an overlapping but distinct mechanism of action.
肌醇是一种葡萄糖异构体和第二信使前体，可调节多种细胞功能，并已通过尚不清楚的机制在强迫症（OCD）中显示出疗效。迄今为止，尚未研究肌醇治疗对OCD患者脑功能的影响。14名OCD受试者在接受肌醇治疗12周前后，用Tc-99m HMPAO进行单光子发射计算机断层扫描（SPECT）。采用全脑体素水平的统计参数映射（SPM）来评估治疗前后反应者与无反应者之间的灌注差异以及整体治疗效果。结果发现：1）与无反应者相比，肌醇治疗后，OCD反应者的左侧颞上回、额中回和楔前叶以及右侧中央后回旁正中区域出现失活；2）治疗后整体组无明显失活区域；3）与基线时的无反应者相比，反应者左侧内侧前额叶区域有一个灌注较高的单一簇。治疗后，耶鲁布朗强迫症量表（YBOCS）和临床总体印象量表严重程度（CGI-severity）评分显著降低。这些数据仅部分与先前关于OCD的功能成像研究一致。它们可能支持这样一种观点，即肌醇通过与选择性5-羟色胺再摄取抑制剂（SSRI）不同的神经回路产生临床反应，并可能补充动物研究中提出的重叠但不同的作用机制。
