National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
Psychiatry Clin Neurosci. 2019 Jul;73(7):386-393. doi: 10.1111/pcn.12850. Epub 2019 May 23.
The purpose of this study was to examine treatment-related neurochemical changes in 28 unmedicated obsessive-compulsive disorder (OCD) patients using H-magnetic resonance spectroscopy ( H-MRS).
We included subjects diagnosed with OCD (n = 28), each with a total duration of illness of less than 5 years, as a study group and age- and sex-matched healthy controls (n = 26). The inclusion criteria for the OCD group were right-handed individuals aged 18 years or older who had not been on any specific treatment for OCD for the last at least 8 weeks and who had no other psychiatric comorbidity. A pre-post and case-control design was employed in which OCD patients underwent H-MRS at baseline and 12 weeks after treatment with escitalopram (n = 21). Clinical assessment was carried out using a semi-structured pro forma Yale-Brown Obsessive Compulsive Scale and the World Health Organization Disability Assessment Scale 2.0 before and after treatment. Volume-localized H-MRS was carried out with a 3-Tesla Philips MR scanner.
Our data suggested higher levels of myoinositol (mI), total choline (tCho), and glutamate+glutamine (Glx) in the medial thalamus at pre-assessment in OCD subjects as compared to healthy controls and a significant reduction in tCho and Glx after treatment in OCD subjects. The mI levels in the caudate nucleus and Glx levels in the anterior cingulate cortex were significantly correlated with disease severity on the Yale-Brown Obsessive Compulsive Scale.
Our study supports the hypothesis of a hyper-glutaminergic state (as suggested by increased Glx levels) and neurodegeneration (as suggested by increased tCho and mI in the thalamus) in cortico-striato-thalamocortical circuitry in OCD patients as suggested by previous studies using MRS as well as other functional imaging studies.
本研究旨在使用 H 磁共振波谱（ H-MRS）检查 28 名未经治疗的强迫症（OCD）患者的治疗相关神经化学变化。
我们纳入了被诊断为 OCD 的受试者（n=28），每位患者的疾病总病程均少于 5 年，作为研究组，并纳入了年龄和性别匹配的健康对照者（n=26）。OCD 组的纳入标准为：右利手，年龄 18 岁或以上，至少 8 周内未接受任何特定的 OCD 治疗，且无其他精神共病。采用前后对照和病例对照设计，在基线和 escitalopram 治疗 12 周后，对 21 名 OCD 患者进行 H-MRS。在治疗前后，使用半结构式耶鲁-布朗强迫症量表和世界卫生组织残疾评估量表 2.0 进行临床评估。使用 3T 飞利浦 MR 扫描仪进行容积定位 H-MRS。
我们的数据表明，与健康对照组相比，OCD 患者在评估前内侧丘脑的肌醇（mI）、总胆碱（tCho）和谷氨酸+谷氨酰胺（Glx）水平较高，且在治疗后 tCho 和 Glx 水平显著降低。尾状核的 mI 水平和前扣带皮层的 Glx 水平与耶鲁-布朗强迫症量表的疾病严重程度显著相关。
我们的研究支持了皮质纹状体丘脑皮质回路中存在高谷氨酸能状态（如 Glx 水平升高所提示）和神经退行性变（如丘脑 tCho 和 mI 升高所提示）的假说，这与之前使用 MRS 以及其他功能成像研究的研究结果一致。
