Negative Symptoms and Regional Cerebral Blood Flow in Patients with Schizophrenia: A Single Photon Emission Computed Tomography Study

精神分裂症負性症狀與區域腦血流量關聯性研究

王秀美(Carol sheei-Meei Wang) ； 楊延光(Yen-Kuang Yang) ； 陳昭誠(Mitchell Chen) ； 邱南津(Nan-Tsing Chiu) ； 葉宗烈(Tzung-Lieh Yeh) ； 李怡慧(I-Hui Lee)

《The Kaohsiung Journal of Medical Sciences》 19卷9期 (2003/09) Pp. 464-469

摘要

目的：本研究主要探討精神分裂症患者在靜止狀態時，區域腦血流量及負性症狀間之相關，及各負性症狀及其嚴重度與各區域腦血流量間關聯性。方法：本研究共收集16個(9位男性、7位女性)排除其他器質性原因，同時未接受過電療及鋰鹽治療的精神分裂症患者，年齡分布在25-50歲。應用SANS (Scale for the Assessment of Negative Symptoms)評估其負性症狀，並使用腦部單光子發散電腦斷層攝影(single photo emission computed tomography，SPECT)99m Tc-HMPAO (hexamethylpropylene amine oxime)影像評估靜止狀態之各腦區域血流變化。之後，再以半定量分析腦部SPECT影像以代表局部區域之血流量。以無母數統計方法Spearman’s test分析負性症狀及各次分項與腦各區域血流灌注影像間之關係。結果：本研究顯示，負性症狀之總分與雙側額葉區腦血流量呈現負相關，尤其是左側眶額葉區及雙側上額葉區。負性症狀各項分數中，注意力(attention)的分數與左側額葉-顳葉區及右側小腦區域腦血流明顯現呈負相關；興趣缺乏(anhedonia)的分數和右側腦血流量呈現負相關；情感貧乏(affect)的分數與雙側額葉前區及雙側上額葉區的區域腦血流量呈負相關，而思維活動貧乏(alogia)和意志缺乏(avolition)和區域腦血流量間統計上無顯著相關。結論：精神分裂症負性症狀之嚴重度的確與額葉功能有關。左側大腦前面的區域在注意力缺失上扮演重要角色。然而，負性症狀與神經解剖學上的詳細相關性，仍需進一步研究。

關鍵字

負性症狀,精神分裂症,區域腦血流量,負性症狀量表

並列摘要

There have been few functional imaging studies of negative symptoms in schizophrenia during the resting state, particularly in Asian patients with schizophrenia. The aim of this study was to evaluate the relationship between regional cerebral flood flow (rCBF) and negative symptoms, and to discuss the association between severity and subgroups of negative symptoms and rCBF. Sixteen patients with chronic schizophrenia were evaluated for negative symptoms using the Scale for the Assessment of Negative Symptoms (SANS), and brain single photon emission computed tomography (SPECT) imaging to assess rCBF during the resting state. Results were assessed using Spearman’s correlation analysis. Total SANS scores were significantly negatively correlated with bilateral hypofrontality, especially in the left orbital frontal and bilateral superior frontal areas. Subscores for attention were significantly negatively correlated with the left lower frontal-temporal area and the right cerebellum. Subscores for anhedonia had a negative correlation with the right hemisphere. Subscores for affect were negatively correlated with rCBF in the bilateral prefrontal and bilateral superior frontal areas. There were no associations between rCBF and SANS in alogia and avolition. These results support the notion that frontal lobe dysfunction in schizophrenia is associated with negative symptoms. The left anterior hemisphere may play an important role in attention deficit. These relationships between negative symptoms and neuroanatomy require further clarification.

並列關鍵字

negative symptoms, schizophrenia, regional cerebral blood flow, Scale for the Assessment of Negative Symptoms, SANS