作　　者： ; ; ; ;

机构地区： 暨南大学附属第一医院

出　　处： 《中华精神科杂志》 2018年第5期316-321,共6页

摘　　要： 目的 探讨首诊强迫症与共病抑郁症的强迫症患者工作记忆及脑代谢物水平的差异.方法 采用2-back、视空间位置记忆测试（visual space memory test,VSMT）、数字广度测试（digit span test,DST）和Stroop色-词关联测试（Stroop color and word test,SCWT）评估单纯强迫症（强迫症组,35例）、共病抑郁症的强迫症（共病组,38例）和健康对照者（对照组,41名）的工作记忆,采用氢质子磁共振波谱（^1H magnetic resonance spectroscopy,^1H-MRS）成像技术检测3组额叶、基底节、丘脑N-乙酰天冬氨酸（N-acetylasparte,NAA）、胆碱复合物（choline,Cho）和肌酸（creatine,Cr）的代谢水平,采用SPSS21.0统计分析3组工作记忆和脑生化代谢的差异.结果 强迫症组和共病组2-back正确数低于对照组（P=0.022、0.049）;共病组VSMT[（1 963±1 193） ms与（1 302±587） ms]和SCWT-C[（16.6±4.2）s与（13.9±4.3）s]反应时较对照组长（P=0.004、0.007）,VSMT正确数、数字广度-顺背、数字广度-倒背、DST评分低于对照组,差异均有统计学意义（P=0.003、0.020、0.042、0.006）;共病组左侧前额叶白质NAA/Cr比值低于对照组（2.07±0.40与2.32±0.33,P=0.017）.结论 共病抑郁症的强迫症患者存在言语、视觉空间工作记忆损伤和中央执行功能的抑制缺陷,单纯强迫症患者仅存在言语工作记忆损伤,同时共病抑郁症的强迫症患者左侧前额叶白质神经功能下降. Objective To investigate the differences of working memory and brain biochemical metabolism between untreated obsessive-compulsive disorder （OCD） patients comorbid with and without major depressive disorder （MDD） by proton magnetic resonance spectroscopy （^1H-MRS）.Methods Thirty-five patients with OCD,38 patients with OCD comorbid MDD,and 41 healthy controls were studied in our study.2-back,visual space memory test （VSMT）,digit span test （DST） and Stroop color and word test （SCWT） were performed to evaluate working memory.And the 3 groups were also measured the levels of N-acetylaspartate （NAA）,choline-containing compounds （Cho） and creatine （Cr） in frontal lobe and basal ganglia by using ^1H-MRS,the ratios of NAA/Cr and Cho/Cr were calculated.Results The accurate answer number of 2-back task in both OCD patients comorbid with and without MDD were lower than that in healthy control （P=0.022,0.049）,and the completion time of VSMT （（1 963± 1 193） ms vs.（1 302±587） ms） and SCWT-C （（16.6±4.2） s vs.（13.9±4.3）s）in OCD comorbid with MDD patients were longer than healthy controls （P=0.004,0.007）.Also,OCD patients comorbid with MDD had lower score in VSMT,digit span forward,digit span backward and total DST than that in healthy controls （P=0.003,0.020,0.042,0.006）.The NAA/Cr ratio in the left prefrontal white matter of OCD comorbid with MDD patients was significantly lower than that in healthy controls （2.07± 0.40 vs.2.32 ± 0.33,P=0.017）.Conclusions OCD patients comorbid with MDD have verbal,visuospatial working memory impairments and inhibition dysfunction of central executive system,and OCD without MDD patients only have verbal working memory impairments.In addition,neuronal dysfunction in the left prefrontal white matter was found in OCD comorbid with MDD.

关 键 词： 强迫性障碍 抑郁症 磁共振波谱学 共病 工作记忆

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