Ćurčić-Blake Branislava, Bais Leonie, Sibeijn-Kuiper Anita, Pijnenborg Hendrika Maria, Knegtering Henderikus, Liemburg Edith, Aleman André
Department of Neuroscience, University of Groningen, University Medical Center Groningen, A. Deusinglaan 2, 9713 AW Groningen, The Netherlands.
Department of Neuroscience, University of Groningen, University Medical Center Groningen, A. Deusinglaan 2, 9713 AW Groningen, The Netherlands; Lentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands.
Prog Neuropsychopharmacol Biol Psychiatry. 2017 Aug 1;78:132-139. doi: 10.1016/j.pnpbp.2017.05.020. Epub 2017 May 22.
Glutamatergic models of psychosis propose that dysfunction of N-methyl-d-aspartate (NMDA) receptors, and associated excess of glutamate, may underlie psychotic experiences in people with schizophrenia. However, little is known about the specific relation between glutamate and auditory verbal hallucinations (AVH) in patients with psychosis. In this study, levels of glutamate+glutamine (Glx) in the left lateral prefrontal lobe were determined using proton magnetic resonance spectroscopy (H MRS) to calculate their association with AVH.
Sixty-seven patients with schizophrenia and thirty healthy control participants (HC) underwent magnetic resonance spectroscopy (MRS) to estimate levels of Glx in the white matter of the left prefrontal lobe. The spectrum was estimated from an 8mm voxel placed in the left lateral prefrontal region, belonging to both the cingulum and forceps minor. Patients with lifetime AVH (AVH group; n=45) and patients without lifetime AVH were compared (NoAVH group; n=22) to control participants.
Levels of Glx were significantly different between the groups (F(2,94)=5.27, p=0.007). Planned comparisons showed that higher Glx levels were found in control participants than in the total patient group (p=0.010). However, patients with lifetime AVH had higher levels of Glx compared to patients without lifetime AVH (p=0.019). Creatin levels were similar in all three groups. We found no association between Glx and the severity of symptoms (item P3 of the PANSS or PANSS positive subscale).
The higher Glx levels in patients with lifetime AVH as compared to patients without lifetime AVH suggest a mediating role for Glx in AVH. Our results are consistent with a previous study that found similar decreased levels of Glx in patients with schizophrenia, and increased levels in an AVH group as compared to a NoAVH group. The role of the glutamatergic system deserves further investigation, for example in different brain regions and in relation to clinical variables.
精神病的谷氨酸能模型提出，N-甲基-D-天冬氨酸（NMDA）受体功能障碍以及相关的谷氨酸过量可能是精神分裂症患者出现精神病性体验的基础。然而，关于精神病患者中谷氨酸与幻听（AVH）之间的具体关系知之甚少。在本研究中，使用质子磁共振波谱（H MRS）测定左侧前额叶谷氨酸+谷氨酰胺（Glx）水平，以计算它们与AVH的关联。
67例精神分裂症患者和30名健康对照参与者（HC）接受磁共振波谱（MRS）检查，以估计左侧前额叶白质中Glx的水平。波谱是从置于左侧前额叶区域、同时属于扣带束和小钳的一个8mm体素中估计出来的。将有终生AVH的患者（AVH组；n = 45）和无终生AVH的患者（无AVH组；n = 22）与对照参与者进行比较。
各组之间Glx水平存在显著差异（F(2,94)=5.27，p = 0.007）。计划比较显示，对照参与者中的Glx水平高于总患者组（p = 0.010）。然而，有终生AVH的患者与无终生AVH的患者相比，Glx水平更高（p = 0.019）。三组中的肌酸水平相似。我们未发现Glx与症状严重程度（PANSS的P3项或PANSS阳性分量表）之间存在关联。
与无终生AVH的患者相比，有终生AVH的患者中较高的Glx水平表明Glx在AVH中起中介作用。我们的结果与先前一项研究一致，该研究发现精神分裂症患者中Glx水平同样降低，且与无AVH组相比，AVH组中的水平升高。谷氨酸能系统的作用值得进一步研究，例如在不同脑区以及与临床变量的关系方面。
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