首发精神分裂症患者质子磁共振波谱神经代谢特征与精神症状的关系

doi:10.3969/j.issn.1004-583X.2025.11.006

摘要/Abstract

摘要：

目的探究首发精神分裂症(FES)患者质子磁共振波谱(1H-MRS)神经代谢特征与精神症状的关系,为FES精准诊疗提供参考。方法选取2023年4月-2025年3月驻马店市第二人民医院收治的FES患者128例,依据入组时有无服药分为用药组(n=97)和未用药组(n=31)。1H-MRS检测神经代谢特征[N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸(Cr)、谷氨酸(Glu)],阳性与阴性症状量表(PANSS)评估患者精神症状,Pearson相关分析1H-MRS神经代谢特征与精神症状的相关性。结果与用药组比,未用药组双侧前扣带回皮层NAA/Cr显著低(P<0.05),丘脑双侧Cho/Cr显著增高(P<0.05);前额叶皮层双侧NAA/Cr显著降低、Glu/Cr显著增高(P<0.05),未用药组PANSS量表中阳性症状评分、阴性症状评分、一般精神病理评分均较高(P<0.05)。Pearson相关分析,左侧前扣带回皮层NAA/Cr与各项评分均呈明显负相关,右侧仅与阳性症状呈明显负相关,左侧前扣带回皮层Cho/Cr与阳性症状呈明显正相关,左侧前扣带回皮层Glu/Cr与阴性症状呈明显负相关(P<0.05);双侧丘脑NAA/Cr与阴性症状呈明显负相关,双侧丘脑Cho/Cr与阳性症状呈明显正相关,双侧丘脑Glu/Cr与阳性症状、一般精神病理评分呈明显正相关(P<0.05);双侧前额叶皮层NAA/Cr与阴性症状评分呈明显负相关,双侧前额叶皮层Glu/Cr与阴性症状呈明显负相关(P<0.05),Cho/Cr无显著关联(P>0.05)。结论 FES患者前扣带回皮层、丘脑、前额叶皮层NAA/Cr、Cho/Cr、Glu/Cr与精神症状相关,有望为FES精准诊疗提供新思路。

关键词: 精神分裂症, 1H-MRS, 神经代谢特征, 精神症状, 关系

Abstract:

Objective To investigate the relationship between proton magnetic resonance spectroscopy (1HMRS)-derived neurometabolic markers and psychiatric symptoms in patients with firstepisode schizophrenia (FES), with the aim of informing more accurate diagnosis and targeted treatment. Methods We prospectively enrolled 128 consecutive FES patients admitted to Zhumadian Second People's Hospital from April 2023 to March 2025. Patients were classified at enrollment as medicated (n=97) or unmedicated (n=31). 1HMRS was used to measure regional metabolite ratios—Nacetylaspartate/creatine (NAA/Cr), choline/creatine (Cho/Cr), and glutamate/creatine (Glu/Cr)-in the anterior cingulate cortex, thalamus, and prefrontal cortex. Psychiatric symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Pearson correlation analysis examined relationships between metabolite ratios and PANSS subscores. Results Compared with the medicated group, the unmedicated group exhibited significantly lower NAA/Cr in the bilateral anterior cingulate and prefrontal cortices, higher Cho/Cr in the bilateral thalami, and higher Glu/Cr in the bilateral prefrontal cortex (all P<0.05). The unmedicated group also had significantly higher PANSS positive, negative, and general psychopathology scores (P<0.05). Correlation analyses revealed region and metabolitespecific associations with symptom domains: Left anterior cingulate: NAA/Cr was negatively correlated with positive, negative, and general psychopathology scores; Cho/Cr was positively correlated with positive symptoms; Glu/Cr was negatively correlated with negative symptoms (all P<0.05). Right anterior cingulate: NAA/Cr was negatively correlated with positive symptom scores only (P<0.05). Thalamus: Bilateral NAA/Cr was negatively correlated with negative symptom scores, while bilateral Cho/Cr correlated positively with positive symptoms. Bilateral Glu/Cr correlated positively with both positive symptoms and general psychopathology (all P<0.05). Prefrontal cortex: Bilateral NAA/Cr and Glu/Cr were negatively correlated with negative symptom scores (P<0.05). No significant correlations were observed between Cho/Cr and negative symptom scores (P>0.05). Conclusion In FES, NAA/Cr, Cho/Cr, and Glu/Cr ratios in the anterior cingulate cortex, thalamus, and prefrontal cortex correlate with psychiatric symptoms and may provide novel biomarkers for precise diagnosis and treatment.

Key words: schizophrenia, 1H-MRS, neurometabolic characteristics, psychiatric symptom, relationship

中图分类号:

R749.3

王娜, 陶俊伟, 何磊, 林亚洲. 首发精神分裂症患者质子磁共振波谱神经代谢特征与精神症状的关系[J]. 临床荟萃, 2025, 40(11): 1006-1011.

Wang Na, Tao Junwei, He Lei, Lin Yazhou. Relationship between 1H-MRS-detected neurometabolic markers and psychiatric symptoms in first-episode schizophrenia[J]. Clinical Focus, 2025, 40(11): 1006-1011.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.11.006

https://www.lchc.cn/CN/Y2025/V40/I11/1006

图/表 6

表1 两组基线资料比较

Tab.1 Comparison of baseline data between the two groups

组别	例数	性别(男/女) (例)	年龄 (岁)	身体质量指数(kg/m²)	病程 (月)
用药组	97	58/29	31.05±5.16	21.07±1.26	15.16±1.71
未用药组	31	21/10	30.99±4.98	20.98±1.30	14.85±1.66
χ²/ $t$ 值		0.012	0.057	0.344	0.885
$P$ 值		0.914	0.955	0.732	0.378

表1 两组基线资料比较

Tab.1 Comparison of baseline data between the two groups

组别	例数	性别(男/女) (例)	年龄 (岁)	身体质量指数(kg/m²)	病程 (月)
用药组	97	58/29	31.05±5.16	21.07±1.26	15.16±1.71
未用药组	31	21/10	30.99±4.98	20.98±1.30	14.85±1.66
χ²/ $t$ 值		0.012	0.057	0.344	0.885
$P$ 值		0.914	0.955	0.732	0.378

表2 两组前扣带回皮层1H-MRS神经代谢特征比较

Tab.2 Comparison of 1H-MRS neurometabolic characteristics in the anterior cingulate cortex between the two groups

组别	例数	NAA/Cr		Cho/Cr		Glu/Cr
组别	例数	左侧	右侧	左侧	右侧	左侧	右侧
未用药组	31	1.38±0.14	1.44±0.15	1.23±0.17	1.19±0.16	1.63±0.16	1.70±0.20
用药组	97	1.45±0.15	1.51±0.16	1.20±0.18	1.18±0.17	1.60±0.17	1.67±0.22
$t$ 值		2.297	2.152	0.818	0.289	0.867	0.675
$P$ 值		0.023	0.033	0.415	0.773	0.388	0.501

表2 两组前扣带回皮层1H-MRS神经代谢特征比较

Tab.2 Comparison of 1H-MRS neurometabolic characteristics in the anterior cingulate cortex between the two groups

组别	例数	NAA/Cr		Cho/Cr		Glu/Cr
组别	例数	左侧	右侧	左侧	右侧	左侧	右侧
未用药组	31	1.38±0.14	1.44±0.15	1.23±0.17	1.19±0.16	1.63±0.16	1.70±0.20
用药组	97	1.45±0.15	1.51±0.16	1.20±0.18	1.18±0.17	1.60±0.17	1.67±0.22
$t$ 值		2.297	2.152	0.818	0.289	0.867	0.675
$P$ 值		0.023	0.033	0.415	0.773	0.388	0.501

表3 两组丘脑1H-MRS神经代谢特征比较

Tab.3 Comparison of neurometabolic characteristics of 1H-MRS in the thalamus between the two groups

组别	例数	NAA/Cr		Cho/Cr		Glu/Cr
组别	例数	左侧	右侧	左侧	右侧	左侧	右侧
未用药组	31	1.38±0.17	1.39±0.14	1.20±0.13	1.18±0.14	1.58±0.16	1.68±0.22
用药组	97	1.40±0.14	1.41±0.16	1.10±0.10	1.08±0.11	1.60±0.18	1.67±0.21
$t$ 值		0.656	0.624	4.492	4.113	0.553	0.228
$P$ 值		0.513	0.534	<0.01	<0.01	0.582	0.820

表3 两组丘脑1H-MRS神经代谢特征比较

Tab.3 Comparison of neurometabolic characteristics of 1H-MRS in the thalamus between the two groups

组别	例数	NAA/Cr		Cho/Cr		Glu/Cr
组别	例数	左侧	右侧	左侧	右侧	左侧	右侧
未用药组	31	1.38±0.17	1.39±0.14	1.20±0.13	1.18±0.14	1.58±0.16	1.68±0.22
用药组	97	1.40±0.14	1.41±0.16	1.10±0.10	1.08±0.11	1.60±0.18	1.67±0.21
$t$ 值		0.656	0.624	4.492	4.113	0.553	0.228
$P$ 值		0.513	0.534	<0.01	<0.01	0.582	0.820

表4 两组前额叶皮层1H-MRS神经代谢特征比较

Tab.4 Comparison of 1H-MRS neurometabolic characteristics in the prefrontal cortex between the two groups

组别	例数	NAA/Cr		Cho/Cr		Glu/Cr
组别	例数	左侧	右侧	左侧	右侧	左侧	右侧
未用药组	31	1.31±0.14	1.34±0.13	1.12±0.11	1.13±0.13	1.79±0.18	1.83±0.20
用药组	97	1.45±0.15	1.51±0.16	1.15±0.12	1.14±0.14	1.62±0.17	1.66±0.18
$t$ 值		4.595	5.372	1.235	0.352	4.778	4.455
$P$ 值		<0.01	<0.01	0.219	0.725	<0.01	<0.01

表4 两组前额叶皮层1H-MRS神经代谢特征比较

Tab.4 Comparison of 1H-MRS neurometabolic characteristics in the prefrontal cortex between the two groups

组别	例数	NAA/Cr		Cho/Cr		Glu/Cr
组别	例数	左侧	右侧	左侧	右侧	左侧	右侧
未用药组	31	1.31±0.14	1.34±0.13	1.12±0.11	1.13±0.13	1.79±0.18	1.83±0.20
用药组	97	1.45±0.15	1.51±0.16	1.15±0.12	1.14±0.14	1.62±0.17	1.66±0.18
$t$ 值		4.595	5.372	1.235	0.352	4.778	4.455
$P$ 值		<0.01	<0.01	0.219	0.725	<0.01	<0.01

表5 两组精神症状比较

Tab.5 Comparison of mental symptoms between the two groups

组别	例数	阳性症状评分 (分)	阴性症状评分 (分)	一般精神病理评分(分)
未用药组	31	35.65±4.85	28.07±2.94	48.76±6.81
用药组	97	12.34±1.74	19.92±1.71	26.01±2.75
$t$ 值		40.178	19.081	26.899
$P$ 值		<0.01	<0.01	<0.01

表5 两组精神症状比较

Tab.5 Comparison of mental symptoms between the two groups

组别	例数	阳性症状评分 (分)	阴性症状评分 (分)	一般精神病理评分(分)
未用药组	31	35.65±4.85	28.07±2.94	48.76±6.81
用药组	97	12.34±1.74	19.92±1.71	26.01±2.75
$t$ 值		40.178	19.081	26.899
$P$ 值		<0.01	<0.01	<0.01

表6 FES患者1H-MRS神经代谢特征与PANSS评分相关性分析

Tab.6 Correlation analysis of 1H-MRS neurometabolic characteristics and PANSS score in FES patients

脑区	指标	阳性症状评分		阴性症状评分		一般精神病理评分
脑区	指标	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值
前扣带回皮层	左侧NAA/Cr	-0.412	0.001	-0.482	<0.01	-0.380	0.003
	右侧NAA/Cr	-0.395	0.002	-0.210	0.072	-0.192	0.091
	左侧Cho/Cr	0.502	<0.01	0.125	0.199	0.204	0.054
	右侧Cho/Cr	0.136	0.179	0.092	0.341	0.118	0.225
	左侧Glu/Cr	-0.101	0.314	-0.292	0.023	-0.165	0.105
	右侧Glu/Cr	-0.117	0.238	-0.178	0.085	-0.110	0.260
丘脑	左侧NAA/Cr	-0.180	0.098	-0.320	0.008	-0.215	0.061
	右侧NAA/Cr	-0.210	0.055	-0.352	0.003	-0.185	0.058
	左侧Cho/Cr	0.331	0.006	0.158	0.135	0.242	0.032
	右侧Cho/Cr	0.298	0.014	0.112	0.268	0.195	0.069
	左侧Glu/Cr	0.362	0.002	0.105	0.302	0.275	0.024
	右侧Glu/Cr	0.385	<0.01	0.091	0.360	0.312	0.009
前额叶皮层	左侧NAA/Cr	-0.225	0.051	-0.521	<0.01	-0.103	0.071
	右侧NAA/Cr	-0.198	0.077	-0.462	<0.01	-0.168	0.094
	左侧Cho/Cr	0.115	0.252	0.085	0.398	0.132	0.190
	右侧Cho/Cr	0.092	0.350	0.072	0.460	0.105	0.295
	左侧Glu/Cr	0.138	0.180	-0.337	0.005	-0.220	0.057
	右侧Glu/Cr	0.121	0.230	-0.298	0.016	-0.195	0.071

表6 FES患者1H-MRS神经代谢特征与PANSS评分相关性分析

Tab.6 Correlation analysis of 1H-MRS neurometabolic characteristics and PANSS score in FES patients

脑区	指标	阳性症状评分		阴性症状评分		一般精神病理评分
脑区	指标	$r$ 值	$P$ 值	$r$ 值	$P$ 值	$r$ 值	$P$ 值
前扣带回皮层	左侧NAA/Cr	-0.412	0.001	-0.482	<0.01	-0.380	0.003
	右侧NAA/Cr	-0.395	0.002	-0.210	0.072	-0.192	0.091
	左侧Cho/Cr	0.502	<0.01	0.125	0.199	0.204	0.054
	右侧Cho/Cr	0.136	0.179	0.092	0.341	0.118	0.225
	左侧Glu/Cr	-0.101	0.314	-0.292	0.023	-0.165	0.105
	右侧Glu/Cr	-0.117	0.238	-0.178	0.085	-0.110	0.260
丘脑	左侧NAA/Cr	-0.180	0.098	-0.320	0.008	-0.215	0.061
	右侧NAA/Cr	-0.210	0.055	-0.352	0.003	-0.185	0.058
	左侧Cho/Cr	0.331	0.006	0.158	0.135	0.242	0.032
	右侧Cho/Cr	0.298	0.014	0.112	0.268	0.195	0.069
	左侧Glu/Cr	0.362	0.002	0.105	0.302	0.275	0.024
	右侧Glu/Cr	0.385	<0.01	0.091	0.360	0.312	0.009
前额叶皮层	左侧NAA/Cr	-0.225	0.051	-0.521	<0.01	-0.103	0.071
	右侧NAA/Cr	-0.198	0.077	-0.462	<0.01	-0.168	0.094
	左侧Cho/Cr	0.115	0.252	0.085	0.398	0.132	0.190
	右侧Cho/Cr	0.092	0.350	0.072	0.460	0.105	0.295
	左侧Glu/Cr	0.138	0.180	-0.337	0.005	-0.220	0.057
	右侧Glu/Cr	0.121	0.230	-0.298	0.016	-0.195	0.071

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