Iritani Shuji
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2013 Feb;75(1-2):11-28.
Studies that seek to determine the etiology of schizophrenia through pathological images and morphological abnormalities of the brain have been conducted since the era of E. Kraepelin, and pioneers in neuropathology such as A. Alzheimer have also eagerly pursued such studies. However, there have been no disease-specific findings, and there was a brief era in which it was said that "schizophrenia is the graveyard of neuropathologists." However, since the 1980s, neuroimaging studies with CT and MRI etc., have been used in many reports of cases of schizophrenia with abnormal brain morphology, thus generating renewed interest in developments within brain tissue and leading to new neuropathological studies. There are now many reports in which, in addition to morphological observations, cell distribution and the like are image-processed and statistically processed through computers. Due to methodological problems in making progress in the field of cerebral pathology, we have not yet been able to observe disease-specific findings, although there are several findings with high certainty. However, the neurodevelopmental hypothesis has been supported as being able to reasonably explain the accumulated findings of previous studies. At the same time, results of recent molecular-biological studies have revealed the risk genes for this disease, and because many of those genes are associated with functions related to nerve differentiation, development, and plasticity, there is growing interest in their correlations with cerebral pathology. We are now on the verge of uncovering the etiology of this disease by integrating cerebral neuroimaging, molecular genetics, and cerebral neuropathology. In that sense, neuropathological studies of this disease from new viewpoints have become essential.
自E. 克雷佩林时代起,就有研究试图通过大脑的病理图像和形态异常来确定精神分裂症的病因,神经病理学的先驱如A. 阿尔茨海默也热切地进行了此类研究。然而,尚未发现疾病特异性的结果,曾有一个短暂的时期,有人说“精神分裂症是神经病理学家的坟墓”。然而,自20世纪80年代以来,CT和MRI等神经影像学研究已被用于许多精神分裂症病例报告,这些病例存在大脑形态异常,从而重新引发了对脑组织内发育情况的兴趣,并催生了新的神经病理学研究。现在有许多报告,除了形态学观察外,还通过计算机对细胞分布等进行图像处理和统计处理。由于脑病理学领域在取得进展方面存在方法问题,尽管有一些高度确定的发现,但我们尚未能够观察到疾病特异性的结果。然而,神经发育假说已得到支持,因为它能够合理地解释先前研究积累的结果。与此同时,最近分子生物学研究的结果揭示了这种疾病的风险基因,而且其中许多基因与神经分化、发育和可塑性相关的功能有关,人们对它们与脑病理学的相关性越来越感兴趣。我们现在即将通过整合脑神经影像学、分子遗传学和脑神经病理学来揭示这种疾病的病因。从这个意义上说,从新的视角对这种疾病进行神经病理学研究变得至关重要。