Galińska-Skok Beata, Szulc Agata, Małus Aleksandra, Konarzewska Beata, Cwalina Urszula, Tarasów Eugeniusz, Waszkiewicz Napoleon
Department of Psychiatry, Medical University of Białystok, Choroszcz, Poland,
Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Pruszków, Poland.
Neuropsychiatr Dis Treat. 2019 Apr 8;15:839-847. doi: 10.2147/NDT.S196932. eCollection 2019.
Investigation of the longitudinal effect of schizophrenia on changes in various brain-metabolite levels and their relationships with cognitive deficits that have not been fully explained yet.
Five years subsequent to their first examination for their first episode of schizophrenia, eleven patients from an original group of 30 were reexamined. Their cognitive functions were assessed with the Wisconsin Card Sorting Test. Magnetic resonance imaging and proton magnetic resonance spectroscopy were performed on a 1.5 T scanner. Voxels of 8 cm were positioned in the left frontal lobe, left temporal lobe, and the left thalamus. The study had a naturalistic design, and patients were treated with various antipsychotics.
No significant statistical differences between the baseline and follow-up in -acetylaspartate (NAA:creatine plus phosphocreatine [Cr] and NAA/HO) levels were observed in any region of interest. We found a significant statistical correlation between 5-year difference in frontal NAA/Cr levels and duration of the last antipsychotic treatment in this period (=0.908, =0.012). We found a trend (=0.068) toward lower choline-containing compounds (Cho/Cr ratio) in the temporal lobe over 5 years and a trend (=0.079) in higher glutamate-glutamine- GABA (Glx/HO) levels in the left thalamus. The patients showed social and clinical improvement at follow-up examination, and there were no changes in Wisconsin Card Sorting Test results.
The observed tendency toward decline in choline ratio might have been due to decreased temporal cell density or impaired neuron-membrane or myelin functions. A tendency for higher Glx levels suggest the involvement of thalamus dysfunction in the chronic schizophrenia process. The lack of NAA decrease might have been due to effective antipsychotic treatment. Further longitudinal studies on large patient groups are required to confirm these metabolic changes in schizophrenia.
研究精神分裂症对各种脑代谢物水平变化的纵向影响及其与尚未完全解释清楚的认知缺陷之间的关系。
在最初的30名精神分裂症首发患者首次检查5年后，对其中11名患者进行了复查。使用威斯康星卡片分类测验评估他们的认知功能。在1.5T扫描仪上进行磁共振成像和质子磁共振波谱分析。将8cm的体素置于左额叶、左颞叶和左丘脑。该研究采用自然主义设计，患者接受了各种抗精神病药物治疗。
在任何感兴趣区域，均未观察到基线与随访时N-乙酰天门冬氨酸（NAA：肌酸加磷酸肌酸[Cr]和NAA/水）水平之间存在显著统计学差异。我们发现额叶NAA/Cr水平的5年差异与该时期最后一次抗精神病治疗的持续时间之间存在显著统计学相关性（r = 0.908，p = 0.012）。我们发现5年间颞叶中含胆碱化合物（Cho/Cr比值）有降低趋势（p = 0.068），左丘脑中谷氨酸-谷氨酰胺-GABA（Glx/水）水平有升高趋势（p = 0.079）。在随访检查中，患者的社交和临床状况有所改善，威斯康星卡片分类测验结果无变化。
观察到的胆碱比值下降趋势可能是由于颞叶细胞密度降低或神经元膜或髓鞘功能受损所致。Glx水平升高的趋势表明丘脑功能障碍参与了慢性精神分裂症过程。NAA未降低可能是由于有效的抗精神病治疗。需要对更大的患者群体进行进一步的纵向研究，以证实精神分裂症中的这些代谢变化。
