Yu Jianping, Xu Qianwen, Ma Lisha, Huang Yueqi, Zhu Wenjing, Liang Yan, Wang Yunzhan, Tang Wenxin, Zhu Cheng, Jiang Xiaoying
Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
School of Psychology, Nanjing Normal University, Nanjing, China.
Front Psychiatry. 2024 Jul 8;15:1401623. doi: 10.3389/fpsyt.2024.1401623. eCollection 2024.
Obsessive-compulsive disorder (OCD) is a chronic psychiatric illness with complex clinical manifestations. Cognitive dysfunction may underlie OC symptoms. The frontoparietal network (FPN) is a key region involved in cognitive control. However, the findings of impaired FPN regions have been inconsistent. We employed meta-analysis to identify the fMRI-specific abnormalities of the FPN in OCD.
PubMed, Web of Science, Scopus, and EBSCOhost were searched to screen resting-state functional magnetic resonance imaging (rs-fMRI) studies exploring dysfunction in the FPN of OCD patients using three indicators: the amplitude of low-frequency fluctuation/fractional amplitude of low-frequency fluctuation (ALFF/fALFF), regional homogeneity (ReHo) and functional connectivity (FC). We compared all patients with OCD and control group in a primary analysis, and divided the studies by medication in secondary meta-analyses with the activation likelihood estimation (ALE) algorithm.
A total of 31 eligible studies with 1359 OCD patients (756 men) and 1360 healthy controls (733 men) were included in the primary meta-analysis. We concluded specific changes in brain regions of FPN, mainly in the left dorsolateral prefrontal cortex (DLPFC, BA9), left inferior frontal gyrus (IFG, BA47), left superior temporal gyrus (STG, BA38), right posterior cingulate cortex (PCC, BA29), right inferior parietal lobule (IPL, BA40) and bilateral caudate. Additionally, altered connectivity within- and between-FPN were observed in the bilateral DLPFC, right cingulate gyrus and right thalamus. The secondary analyses showed improved convergence relative to the primary analysis.
OCD patients showed dysfunction FPN, including impaired local important nodal brain regions and hypoconnectivity within the FPN (mainly in the bilateral DLPFC), during the resting state. Moreover, FPN appears to interact with the salience network (SN) and default mode network (DMN) through pivotal brain regions. Consistent with the hypothesis of fronto-striatal circuit dysfunction, especially in the dorsal cognitive circuit, these findings provide strong evidence for integrating two pathophysiological models of OCD.
强迫症（OCD）是一种临床表现复杂的慢性精神疾病。认知功能障碍可能是强迫症状的潜在原因。额顶叶网络（FPN）是参与认知控制的关键区域。然而，关于FPN区域受损的研究结果并不一致。我们采用荟萃分析来确定强迫症中FPN的功能磁共振成像（fMRI）特异性异常。
检索PubMed、Web of Science、Scopus和EBSCOhost，以筛选静息态功能磁共振成像（rs-fMRI）研究，这些研究使用低频振幅/低频波动分数振幅（ALFF/fALFF）、局部一致性（ReHo）和功能连接（FC）这三个指标来探索强迫症患者FPN的功能障碍。在初步分析中，我们将所有强迫症患者与对照组进行比较，并在二次荟萃分析中使用激活可能性估计（ALE）算法按药物治疗情况对研究进行划分。
初步荟萃分析共纳入31项符合条件的研究，其中包括1359例强迫症患者（756例男性）和1360例健康对照（733例男性）。我们得出FPN脑区的特定变化，主要位于左侧背外侧前额叶皮质（DLPFC，BA9）、左侧额下回（IFG，BA47）、左侧颞上回（STG，BA38）、右侧后扣带回皮质（PCC，BA29）、右侧顶下小叶（IPL，BA40）和双侧尾状核。此外，在双侧DLPFC、右侧扣带回和右侧丘脑观察到FPN内部及之间连接的改变。二次分析显示相对于初步分析收敛性有所提高。
强迫症患者在静息状态下表现出FPN功能障碍，包括局部重要节点脑区受损以及FPN内部（主要在双侧DLPFC）连接减弱。此外，FPN似乎通过关键脑区与突显网络（SN）和默认模式网络（DMN）相互作用。与额纹状体回路功能障碍的假设一致，特别是在背侧认知回路中，这些发现为整合强迫症的两种病理生理模型提供了有力证据。
