Lucey J V, Costa D C, Blanes T, Busatto G F, Pilowsky L S, Takei N, Marks I M, Ell P J, Kerwin R W
Institute of Psychiatry, London.
Br J Psychiatry. 1995 Nov;167(5):629-34. doi: 10.1192/bjp.167.5.629.
We tested whether cortical and subcortical regional cerebral blood flow (rCBF) differs between patients with obsessive-compulsive disorder (OCD) and healthy controls. We then explored the relationship between rCBF and OCD mental state.
Thirty out-patients from the Maudsley Hospital with OCD as defined in DSM-III-R were scanned at rest using brain-dedicated, high-resolution, single photon emission tomography. RCBF was measured as uptake of 99mTc-HMPAO in 15 regions of interest and compared with rCBF data in 30 healthy people matched for age, sex and handedness. Symptom ratings were obtained using standard measures on the scanning day. Principal components factor analysis identified two distinct clinical dimensions: obsessive-compulsive (OC) and anxious-avoidant (AA). These were correlated with patients' rCBF measurements, using Spearman's rank correlation coefficient, and multiple regression coefficients calculated.
We found significant reductions in rCBF measurements of OCD patients compared with resting, healthy controls (F = 1.92, P = 0.04) in seven brain regions: the right and left superior frontal cortex, right inferior frontal cortex, left temporal cortex, left parietal cortex, right caudate nucleus and right thalamus. Regional differences were not secondary to generalised reduction in patients' brain perfusion. Reduced blood flow to the right inferior frontal cortex correlated significantly with illness severity (r = 0.37, P = 0.02). There was no relationship with age, age-of-onset, sex, handedness, depression or medication status. OC clinical dimension, concerning obsessions, compulsions and low mood, was significantly negatively correlated with left inferior frontal, medial frontal and right parietal rCBF. AA dimension, concerning anxiety and avoidance, was significantly positively associated with left and right superior frontal, right inferior frontal, medial frontal cortical, and right and left caudate and thalamic rCBF.
rCBF differs significantly between resting OCD patients and healthy controls, and separate clinical dimensions are associated with functionally distinct rCBF patterns.
我们测试了强迫症（OCD）患者与健康对照者之间皮质和皮质下区域脑血流量（rCBF）是否存在差异。然后，我们探讨了rCBF与OCD精神状态之间的关系。
对30名来自莫兹利医院的门诊患者进行扫描，这些患者符合DSM-III-R中对强迫症的定义，在静息状态下使用脑部专用的高分辨率单光子发射断层扫描。在15个感兴趣区域测量99mTc-HMPAO的摄取量来测定rCBF，并与30名年龄、性别和利手相匹配的健康人的rCBF数据进行比较。在扫描当天使用标准测量方法获得症状评分。主成分因子分析确定了两个不同的临床维度：强迫（OC）和焦虑回避（AA）。使用Spearman等级相关系数以及计算出的多元回归系数，将这些维度与患者的rCBF测量值相关联。
我们发现，与静息状态下的健康对照者相比，强迫症患者在七个脑区的rCBF测量值显著降低（F = 1.92，P = 0.04）：左右额上回皮质、右额下回皮质、左颞叶皮质、左顶叶皮质、右尾状核和右丘脑。区域差异并非继发于患者脑灌注的普遍降低。右额下回皮质血流减少与疾病严重程度显著相关（r = 0.37，P = 0.02）。与年龄、发病年龄、性别、利手、抑郁或用药状态无关。涉及强迫观念、强迫行为和情绪低落的OC临床维度与左额下回、额内侧和右顶叶rCBF显著负相关。涉及焦虑和回避的AA维度与左右额上回、右额下回、额内侧皮质以及左右尾状核和丘脑的rCBF显著正相关。
静息状态下的强迫症患者与健康对照者之间rCBF存在显著差异，并且不同的临床维度与功能上不同的rCBF模式相关。
