阳雨露,孙蕴怡,肖洪奇,郑耀宗,王梅,沈聃琳,李青,汪待发,邱昌建,孟雅婧.精神疾病患者言语流畅性任务下前额叶激活特征的功能性近红外光谱成像研究[J].四川精神卫生杂志,2023,36(3):235-241.Yang Yulu,Sun Yunyi,Xiao Hongqi,Zheng Yaozong,Wang Mei,Shen Danlin,Li Qing,Wang Daifa,Qiu Changjian,Meng Yajing,Study of prefrontal cortex activation characteristics of patients with psychiatric disorders in verbal fluency task using functional near-infrared spectroscopy[J].SICHUAN MENTAL HEALTH,2023,36(3):235-241

精神疾病患者言语流畅性任务下前额叶激活特征的功能性近红外光谱成像研究

Study of prefrontal cortex activation characteristics of patients with psychiatric disorders in verbal fluency task using functional near-infrared spectroscopy

投稿时间：2023-03-01

DOI：10.11886/scjsws20230301004

中文关键词: 精神疾病近红外光成像技术言语流畅性任务

英文关键词:Mental disease Near-infrared spectroscopy Verbal fluency task

基金项目:四川大学华西医院学科卓越发展1·3·5工程临床研究孵化项目（项目名称：基于杏仁核-终纹床核-内侧前额叶连接的焦虑障碍跨诊断影像学研究，项目编号：ZYJC21083）

作者	单位	邮编
阳雨露	四川大学华西医院心理卫生中心	610041
孙蕴怡	四川大学华西医院心理卫生中心	610041
肖洪奇	四川大学华西医院心理卫生中心	610041
郑耀宗	四川大学华西医院心理卫生中心	610041
王梅	四川大学华西医院心理卫生中心	610041
沈聃琳	四川大学华西医院心理卫生中心	610041
李青	四川大学华西医院心理卫生中心	610041
汪待发	北京航空航天大学生物与医学工程学院	100191
邱昌建	四川大学华西医院心理卫生中心	610041
孟雅婧^*	四川大学华西医院心理卫生中心	610041

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中文摘要:

背景功能性近红外光谱成像（fNIRS）是新一代用于精神疾病辅助诊断的影像学工具，其对不同精神疾病患者前额叶激活模式的辨别是否具有特异性，仍需进一步探索。目的应用fNIRS探讨抑郁障碍、焦虑障碍、双相情感障碍和精神分裂症患者言语流畅性任务（VFT）下前额叶激活的特征。方法于2021年9月-12月，在四川大学华西医院门诊和住院部招募符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的39例精神分裂症患者、205例抑郁障碍患者、212例焦虑障碍患者以及77例双相情感障碍患者。使用fNIRS检测患者在VFT下前额叶血流动力学变化，采用症状自评量表（SCL-90）和32项轻躁狂症状清单（HCL-32）评定患者的临床症状。比较不同病种的患者平均氧合血红蛋白（HbO₂）浓度差异及VFT开始后2~7秒HbO₂初始斜率的差异，使用偏相关分析考查平均HbO₂浓度和初始斜率与临床症状之间的相关性。结果均通过FDR校正，P<0.05。结果抑郁障碍患者在通道4（Z=2.828，P=0.028）和通道6（Z=2.912，P=0.022）的平均HbO₂浓度高于精神分裂症患者，焦虑障碍患者在通道4（Z=3.154，P=0.010）、通道5（Z=3.021，P=0.015）、通道6（Z=2.980，P=0.017）的平均HbO₂浓度以及所有通道的平均HbO₂浓度（Z=2.881，P=0.024）均高于精神分裂症患者。抑郁障碍患者与双相情感障碍患者在通道3的初始斜率差异有统计学意义（Z=2.691，P=0.039）。双相情感障碍患者SCL-90敌对因子评分与通道4（r=-0.505，P=0.004）、通道6（r=-0.390，P=0.004）、通道15（r=-0.546，P=0.002）、通道16（r=-0.550，P=0.002）的HbO₂浓度变化以及所有通道的平均HbO₂浓度变化（r=-0.491，P=0.006）均呈负相关。结论精神分裂症患者在额极区和眶额叶的激活较抑郁障碍患者和焦虑障碍患者更低，抑郁障碍患者在右侧额极区、额下回和眶额叶的初始斜率高于双相情感障碍患者。双相情感障碍患者在额极区和眶额叶、布洛卡区的岛盖部、上外额叶皮层的激活越少，越易怒敌对。

英文摘要:

Background Functional near-infrared spectroscopy （fNIRS） is a new generation of imaging tool that can be used to assist the diagnosis of psychiatric disorders. However， whether the patterns of prefrontal cortex activation observed by fNIRS are specific for different psychiatric disorders remains to be explored.Objective To investigate the characteristics of prefrontal cortex activation in patients with depression， anxiety disorder， bipolar disorder and schizophrenia in verbal fluency task （VFT） using fNIRS.Methods From September to December 2021， 39 patients with schizophrenia， 205 patients with depressive disorder， 212 patients with anxiety disorder and 77 patients with bipolar disorder meeting the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited in the outpatient and inpatient department of West China Hospital， Sichuan University. fNIRS was used to monitor the prefrontal cortex hemodynamic changes of patients under VFT， and the clinical symptoms of patients were assessed by Symptom Checklist 90 （SCL-90） and Hypomania Checklist-32 items（HCL-32）. Differences in mean oxyhemoglobin （HbO₂） concentration and the initial slope from 2 to 7 second during VFT were compared among patients with different diseases， and the correlation between mean HbO₂ concentration/initial slope and clinical symptoms was analyzed by partial correlation analysis.Results The concentration of HbO₂ in channel 4 （Z=2.828， P=0.028） and channel 6 （Z=2.912， P=0.022） in patients with depression were significantly higher than those in patients with schizophrenia. Patients with anxiety had significantly higher changes in mean HbO₂ concentration in channel 4 （Z=3.154， P=0.010）， channel 5 （Z=3.021， P=0.015）， channel 6 （Z=2.980， P=0.017） and of all channels （Z=2.881， P=0.024） than those of schizophrenia patients. There was a statistically significant difference in the initial slope of channel 3 between patients with depressive disorder and those with bipolar disorder （Z=2.691， P=0.039）. Among patients with bipolar disorder， the anger-hostility scores of SCL-90 were negatively correlated with the mean HbO₂ concentration changes in channel 4 （r=-0.505， P=0.004）， channel 6 （r=-0.390， P=0.004）， channel 15 （r=-0.546， P=0.002）， channel 16 （r=-0.550， P=0.002） and the mean HbO₂ concentration changes of all channels （r=-0.491， P=0.006）.Conclusion Patients with schizophrenia had lower activation in frontopolar and orbitofrontal region than patients with depression and anxiety disorder， and the initial slope of the right frontopolar， inferior frontal and orbitofrontal region in patients with depression is higher than patients with bipolar disorder. In addition， patients with bipolar disorder had less activation in the frontopolar and orbitofrontal lobe， the insular cover of Broca's area and the upper outer frontal cortex， and were more irritable and hostile. ［Funded by 1·3·5 Project for Disciplines of Excellence-Clinical Research Incubation Project， West China Hospital， Sichuan University （number， ZYJC21083）］

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