van den Heuvel Odile A, Remijnse Peter L, Mataix-Cols David, Vrenken Hugo, Groenewegen Henk J, Uylings Harry B M, van Balkom Anton J L M, Veltman Dick J
Department of Psychiatry, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Brain. 2009 Apr;132(Pt 4):853-68. doi: 10.1093/brain/awn267. Epub 2008 Oct 24.
Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder characterized by multiple, temporally stable symptom dimensions. Preliminary functional neuroimaging studies suggest that these symptom dimensions may have distinct neural substrates. Whole-brain voxel-based morphometry was used to examine the common and distinct neuroanatomical (structural) substrates of the major symptom dimensions of OCD. First, we compared 55 medication-free patients with OCD and 50 age-matched healthy control subjects. Multiple regression analyses were then used to examine the relationship between global and regional grey matter (GM) and white matter (WM) volumes and symptom dimension scores within the patient group. OCD patients showed decreased GM volume in left lateral orbitofrontal (BA47), left inferior frontal (BA44/45), left dorsolateral prefrontal (BA9) and right medial prefrontal (BA10) cortices and decreased bilateral prefrontal WM volume. Scores on the 'symmetry/ordering' dimension were negatively correlated with 'global' GM and WM volumes. Scores on the 'contamination/washing' dimension were negatively correlated with 'regional' GM volume in bilateral caudate nucleus and WM volume in right parietal region. Scores on the 'harm/checking' dimension were negatively correlated with regional GM and WM volume in bilateral temporal lobes. Scores on the 'symmetry/ordering' dimension were negatively correlated with regional GM volume in right motor cortex, left insula and left parietal cortex and positively correlated with bilateral temporal GM and WM volume. The results remained significant after controlling for age, sex, educational level, overall illness severity, global WM and GM volumes and excluding patients with comorbid depression. The reported symptom dimension-specific GM and WM alterations support the hypothesis that OCD is an etiologically heterogeneous disorder, with both overlapping and distinct neural correlates across symptom dimensions. These results have clear implications for the current neuroanatomical model of OCD and call for a substantial revision of such model which takes into account the heterogeneity of the disorder.
强迫症（OCD）是一种临床异质性疾病，其特征在于多个时间上稳定的症状维度。初步的功能神经影像学研究表明，这些症状维度可能具有不同的神经基质。基于体素的全脑形态测量学被用于检查强迫症主要症状维度的共同和不同的神经解剖学（结构）基质。首先，我们比较了55名未服用药物的强迫症患者和50名年龄匹配的健康对照者。然后使用多元回归分析来检查患者组中全局和区域灰质（GM）及白质（WM）体积与症状维度评分之间的关系。强迫症患者左侧眶额外侧（BA47）、左侧额下回（BA44/45）、左侧背外侧前额叶（BA9）和右侧内侧前额叶（BA10）皮质的GM体积减少，双侧前额叶WM体积减少。“对称/排序”维度的评分与“全局”GM和WM体积呈负相关。“污染/清洗”维度的评分与双侧尾状核的“区域”GM体积和右侧顶叶区域的WM体积呈负相关。“伤害/检查”维度的评分与双侧颞叶的区域GM和WM体积呈负相关。“对称/排序”维度的评分与右侧运动皮质、左侧岛叶和左侧顶叶皮质的区域GM体积呈负相关，与双侧颞叶GM和WM体积呈正相关。在控制年龄、性别、教育水平、总体疾病严重程度、全局WM和GM体积并排除合并抑郁症的患者后，结果仍然显著。所报告的症状维度特异性GM和WM改变支持了这样的假设，即强迫症是一种病因异质性疾病，在症状维度上具有重叠和不同的神经关联。这些结果对当前的强迫症神经解剖学模型具有明确的启示，并呼吁对该模型进行实质性修订，以考虑到该疾病的异质性。
