Gur R E, Mozley P D, Resnick S M, Mozley L H, Shtasel D L, Gallacher F, Arnold S E, Karp J S, Alavi A, Reivich M
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA.
Arch Gen Psychiatry. 1995 Aug;52(8):657-67. doi: 10.1001/archpsyc.1995.03950200047013.
Functional neuroimaging can elucidate brain dysfunction in schizophrenia. The frontal, temporolimbic, and diencephalic regions have been implicated. There is a lack of prospective samples of first-episode and previously treated patients followed up longitudinally.
Patients and controls (42 per group) were studied. Positron emission tomography with flurodeoxyglucose, cross-registered with magnetic resonance imaging, measured metabolism. Scales assessed clinical features, premorbid adjustment, and outcome.
There were no differences between groups in whole-brain metabolism or regional ratios or in anterior-posterior gradients, but left midtemporal metabolism was relatively higher in patients. This was pronounced in the negative and Schneiderian and absent in the paranoid subtypes. Higher metabolism and lower relative left hemispheric values were associated with better premorbid adjustment and outcome. A higher subcortical-cortical gradient was noted in first-episode patients.
There are no resting metabolic abnormalities in any brain region, but abnormal gradients are evident. These vary in subtypes, and laterality is associated with functioning. The results support the hypothesis of temporolimbic disturbance in schizophrenia that is all ready present at the onset of illness.
功能神经影像学能够阐明精神分裂症患者的脑功能障碍。额叶、颞叶边缘系统及间脑区域均被认为与此有关。目前缺乏对首发患者和既往接受过治疗的患者进行纵向随访的前瞻性样本。
对患者和对照组（每组42例）进行研究。采用氟脱氧葡萄糖正电子发射断层扫描，并与磁共振成像进行交叉配准，以测量代谢情况。使用量表评估临床特征、病前适应情况及预后。
两组在全脑代谢、区域代谢率或前后梯度方面均无差异，但患者的左侧颞叶中部代谢相对较高。这在阴性及施奈德型中较为明显，而在偏执型中则不存在。较高的代谢水平及较低的左侧半球相对值与较好的病前适应情况及预后相关。首发患者的皮质下-皮质梯度较高。
在任何脑区均未发现静息代谢异常，但异常梯度明显。这些在不同亚型中有所不同，且偏侧性与功能有关。研究结果支持精神分裂症患者颞叶边缘系统紊乱在疾病发作时即已存在的假说。
