Mané Anna, Falcon Carles, Mateos J Javier, Fernandez-Egea Emilio, Horga Guillermo, Lomeña Francisco, Bargalló Nuria, Prats-Galino Alberto, Bernardo Miguel, Parellada Eduard
Programa Esquizofrenia Clinic, Department of Psychiatry, Institute of Neuroscience, Hospital Clinic, Barcelona, Spain.
Schizophr Res. 2009 Oct;114(1-3):136-43. doi: 10.1016/j.schres.2009.07.014. Epub 2009 Aug 15.
Schizophrenia is a disabling illness, characterized by a heterogeneous course including clinical deterioration and poor outcome. Accumulating findings in schizophrenia suggest that it might involve two pathophysiologic processes, one early in life (neurodevelopmental), and one after onset of the illness (neurodegenerative). Longitudinal imaging studies after onset of the illness may help to clarify these pathophysiological aspects of schizophrenia, but so far, probably due to methodological differences, there have been no conclusive results. The present study sets out to investigate longitudinal gray matter changes in patients with first-episode schizophrenia relative to healthy subjects over the first 4 years of the illness and the relation of gray matter changes in patients with functional outcome, using an objective automatic method not biased to one particular structure to analyze gray matter changes.
We included 28 first-episode neuroleptic-naïve patients with DSM-IV diagnosis of schizophreniform disorder or schizophrenia, and 17 controls. 15 patients and 11 controls completed the longitudinal study and were reevaluated after four years. Gray matter changes over time were measured with voxel-based morphometry (VBM) using SPM5. Functional outcome was measured with the global assessment functioning scale (GAF).
Excessive decrease in gray matter was found in patients as compared to healthy individuals in the left superior temporal gyrus and right orbitofrontal gyrus, and excessive increase in the bilateral lingual gyrus and right cuneus. Additionally, gray matter changes in patients in the left lingual gyrus, right insula and right cerebellum, were inversely related to functional outcome (p<0.001 uncorrected at voxel level, p<0.05 family-wise-error corrected at cluster level).
There are differing longitudinal gray matter changes in patients with schizophrenia during the first years of the illness as compared to healthy individuals. Some progressive gray matter changes in patients are related to functional outcome.
精神分裂症是一种致残性疾病，其病程具有异质性，包括临床恶化和不良预后。精神分裂症中越来越多的研究结果表明，它可能可能涉及它可能涉及两个病理生理过程，一个在生命早期（神经发育），另一个在疾病发作后（神经退行性变）。疾病发作后的纵向影像学研究可能有助于阐明精神分裂症的这些病理生理方面，但到目前为止，可能由于方法学上的差异，尚无定论。本研究旨在调查首发精神分裂症患者在疾病的前4年相对于健康受试者的纵向灰质变化，以及患者灰质变化与功能结局的关系，使用一种不偏向于特定结构的客观自动方法来分析灰质变化。
我们纳入了28例首次发作、未使用过抗精神病药物且符合DSM-IV精神分裂症样障碍或精神分裂症诊断标准的患者，以及17名对照。15例患者和11名对照完成了纵向研究，并在4年后进行了重新评估。使用SPM5通过基于体素的形态测量法（VBM）测量随时间的灰质变化。使用总体功能评估量表（GAF）测量功能结局。
与健康个体相比，患者左侧颞上回和右侧眶额回灰质过度减少，双侧舌回和右侧楔叶灰质过度增加。此外，患者左侧舌回、右侧岛叶和右侧小脑的灰质变化与功能结局呈负相关（在体素水平未校正p<0.001，在簇水平经家族性错误校正p<0.05）。
与健康个体相比，精神分裂症患者在疾病的最初几年有不同的纵向灰质变化。患者的一些进行性灰质变化与功能结局有关。
