Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Psychiatry and Oncology, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
JAMA Psychiatry. 2015 Jul;72(7):678-86. doi: 10.1001/jamapsychiatry.2015.0505.
Accumulating evidence supports the hypothesis that cerebral white matter abnormalities are involved in the pathophysiology of schizophrenia; however, findings from in vivo neuroimaging studies have been inconsistent. Besides confounding factors, including age, illness duration, and medication effects, an additional cause for the inconsistent results may be heterogeneity in the nature of white matter alterations associated with the disorder.
To investigate whether different patterns of white matter abnormalities exist in a large cohort of medication-naive patients with first-episode schizophrenia and the relationship between such patterns and clinical parameters.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional diffusion tensor imaging study of 113 medication-naive patients with first-episode schizophrenia and 110 demographically matched healthy control individuals. The study was conducted in the mental health center of West China Hospital, Sichuan University, Chengdu, China, from January 2006 to June 2014.
The patterns of white matter abnormalities revealed by tract-specific analysis in conjunction with hierarchical clustering.
With diffusion features extracted from 18 fiber tracts, cluster analysis revealed 2 patterns of abnormalities. One pattern (42.5% of patient sample) showed widespread white matter abnormalities compared with matched healthy control individuals, while another pattern (57.5% of patient sample) only showed circumscribed regional white matter abnormalities, mainly in the left superior longitudinal fasciculus. Patients in these subgroups did not differ in demographic features; however, negative symptoms were more severe in patients with widespread white matter abnormalities.
Two distinct patterns of white matter abnormalities exist at the early phase of schizophrenia, with those having global abnormalities experiencing more severe negative symptoms. The finding that distinct subgroups of patients with schizophrenia have different forms of white matter pathology may reflect qualitatively distinct genetic influences or neurodevelopmental alterations and thus represents a promising strategy for resolving neurobiological heterogeneity in the schizophrenia syndrome.
越来越多的证据支持这样一种假说，即脑白质异常与精神分裂症的病理生理学有关；然而，来自体内神经影像学研究的结果并不一致。除了混杂因素，包括年龄、疾病持续时间和药物效应，导致结果不一致的另一个原因可能是与该疾病相关的白质改变的性质存在异质性。
研究首发精神分裂症的未经药物治疗的大样本患者是否存在不同模式的白质异常，以及这些模式与临床参数之间的关系。
设计、地点和参与者：这是一项横断面扩散张量成像研究，纳入了 113 名首发精神分裂症的未经药物治疗的患者和 110 名年龄、性别相匹配的健康对照者。该研究于 2006 年 1 月至 2014 年 6 月在中国四川大学华西医院的精神卫生中心进行。
基于纤维束特异性分析与层次聚类的白质异常模式。
通过 18 条纤维束提取扩散特征，聚类分析显示存在 2 种异常模式。一种模式（患者样本的 42.5%）与匹配的健康对照组相比，表现为广泛的白质异常，而另一种模式（患者样本的 57.5%）仅表现为局限性的区域性白质异常，主要位于左侧上纵束。这两个亚组患者在人口统计学特征上没有差异；然而，广泛性白质异常患者的阴性症状更为严重。
在精神分裂症早期阶段存在两种不同的白质异常模式，具有广泛异常的患者经历更严重的阴性症状。精神分裂症患者存在不同形式的白质病理，这一发现可能反映了不同的遗传影响或神经发育改变，因此代表了一种解决精神分裂症综合征神经生物学异质性的有前途的策略。
