Iritani Shuji
Department of Psychiatry, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Brain Nerve. 2007 Jun;59(6):605-16.
Over 100 years ago, Kreapelin had supposed that the etiology of schizophrenia (dementia praecox) was owing to the brain pathology. Afterwards, the pioneers including Dr. Alois Alzheimer had been pursued the peculiarity of neuropathological findings of this disease. But the neuropathology of schizophrenia remains obscure. While remarkable progress has been made in the neuropathological study of neurodegenerative diseases including Alzheimer's disease, progress in studying the neuropathological entity of schizophrenia has not keep pace; the phrase "schizophrenia is the graveyard of neuropathologists" has been stated in the field. By means of CT or MRI and with advanced functional brain image technology such as PET or SPECT since the 1980's, many studies of the morphological or functional abnormalities in the brains of schizophrenia patients have been reported. These neuroimaging researches have stimulated the neuropathological investigation of the schizophrenic brain again. Not only the classical microscopic observation of neuropathology, but also the measurement and the statistical analysis using computer imaging software or using histological techniques including immunocytochemistry or in situ hybridization etc, has been performed. Based on the neuropathological studies of schizophrenia over the last 20 years, it is clear that schizophrenia is not a pure functional disease without organic factors. Reports of neuropathological abnormalities in the post mortem schizophrenic brain indicated they were found in stated almost all areas of the brain, and especially more reports concerning the temporal lobe and frontal lobe. These observed neuropathological abnormalities are explained rationally by the hypothesis of a neurodevelopmental disorder. In recent genetic studies, several putative candidate genes in this disease were reported, and some of these genes might have the role of neurodevelopment or making neuronal networks. It is important to consider together these findings with morphometric studies in neuropathological observation, neuroimaging studies and genome studies to pursue the etiology of schizophrenia from various perspectives.
100多年前,克雷佩林曾认为精神分裂症(早发性痴呆)的病因是脑部病变。此后,包括阿洛伊斯·阿尔茨海默医生在内的先驱们一直在探寻这种疾病神经病理学发现的特殊性。但精神分裂症的神经病理学仍不明确。虽然在包括阿尔茨海默病在内的神经退行性疾病的神经病理学研究方面取得了显著进展,但精神分裂症神经病理学实体的研究进展却未能跟上步伐;该领域有这样一种说法:“精神分裂症是神经病理学家的坟墓”。自20世纪80年代以来,借助CT或MRI以及PET或SPECT等先进的脑功能成像技术,已有许多关于精神分裂症患者大脑形态或功能异常的研究报告。这些神经影像学研究再次激发了对精神分裂症患者大脑的神经病理学研究。不仅进行了经典的神经病理学显微镜观察,还使用计算机成像软件或包括免疫细胞化学或原位杂交等组织学技术进行了测量和统计分析。基于过去20年对精神分裂症的神经病理学研究,很明显精神分裂症并非没有器质性因素的纯粹功能性疾病。对死后精神分裂症患者大脑神经病理学异常的报告表明,这些异常几乎在大脑的所有区域都有发现,尤其是关于颞叶和额叶的报告更多。这些观察到的神经病理学异常可以通过神经发育障碍的假说来合理解释。在最近的遗传学研究中,报告了该疾病的几个假定候选基因,其中一些基因可能具有神经发育或构建神经网络的作用。将这些发现与神经病理学观察中的形态计量学研究、神经影像学研究和基因组研究结合起来,从不同角度探寻精神分裂症的病因很重要。