Relationship between 1H-MRS-detected neurometabolic markers and psychiatric symptoms in first-episode schizophrenia

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

Abstract

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

CLC Number:

R749.3

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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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.11.006

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

Figures/Tables 6

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

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

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

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

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

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

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

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

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

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

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

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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