Altered orbitofrontal sulcogyral pattern in schizophrenia
Altered orbitofrontal sulcogyral pattern in schizophrenia
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DOI：
10.1093/brain/awm007
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发表时间：
2007-03-01
期刊：
影响因子：
14.5
通讯作者：
Shenton, Martha E.
中科院分区：
文献类型：
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作者：
Nakamura, Motoaki;Nestor, Paul G.;Shenton, Martha E.
精神分裂症患者的眼眶前额改变还没有得到很好的描述，可能是由于显著的解剖变异。为了调查这种改变的存在，我们评估了这个‘H’形沟的沟回模式。对50例精神分裂症患者(100个大脑半球)和50例年龄、性别匹配的对照组(100个大脑半球)进行了3D高空间分辨率磁共振成像。根据Chiavaras和Petrides(2000)以前的研究，构成主要眶前回边界的H型沟在每个半球内被分为三种类型(按频率顺序为I、II和III)。采用卡方分析比较脑沟回类型，应用分类回归分析临床/认知关联。对照数据复制了Chiavaras和Petrides报道的眶前沟回模式(P=0.9-0.95)，其中左右半球的分布有显著差异(类型I：右&>左，类型II，III：左&>右，x(2)=6.41，P=0.041)。精神分裂症患者与对照组比较差异有统计学意义(x(2)=11.90，P=0.003)，尤其是右脑(x(2)=13.67，P=0.001)。此外，精神分裂症患者不存在正常对照组的不对称性(x(2)=0.13，P=0.94)。具体地说，与对照组相比，精神分裂症患者中最常见的I型表达减少，最罕见的III型表达增加。此外，与没有III型表达的患者相比，在任何半球都有III型表达的患者表现出较差的社会经济地位、较差的认知功能、更严重的症状和冲动。在结构上，III型患者的颅内内容物体积明显小于非III型患者(t(40)=2.29，P=0.027)。本研究提供了精神分裂症患者眶前沟回分布改变的证据，可能反映了精神分裂症的神经发育异常。这种沟回模式的改变不太可能是由于疾病的副作用，如药物治疗。此外，在患者组中观察到的III型与较小ICC体积之间的结构关联可能表明，III型表达可能是系统性神经发育改变的一部分，因为较小的ICC体积可以反映脑生长驱动的颅骨生长早期减慢。观察到的III型表达与较差的预后之间的对比关系，以及I型表达与较好的结果的对比关系，进一步表明了临床异质性，以及精神分裂症治疗反应性的可能差异。
Orbitofrontal alteration in schizophrenia has not been well characterized, likely due to marked anatomical variability. To investigate the presence of such alterations, we evaluated the sulcogyral pattern of this 'H-shaped' sulcus. Fifty patients with schizophrenia (100 hemispheres) and 50 age- and gender-matched control subjects (100 hemispheres) were evaluated using 3D high-spatial resolution MRI. Based on a previous study by Chiavaras and Petrides (2000), the sulcogyral pattern of the 'H-shaped' sulcus, which forms the boundaries of major orbitofrontal gyri, was classified into three types (Type I, II and III, in order of frequency) within each hemisphere. Chi-square analysis was performed to compare the sulcogyral pattern, and categorical regression was applied to investigate clinical/cognitive associations. The control data replicated the orbitofrontal sulcogyral pattern reported by Chiavaras and Petrides (P = 0.90-0.95), where the distribution was significantly different between the left and right hemisphere (Type I: right > left, Type II, III: left > right, x(2) = 6.41, P = 0.041). For schizophrenics, the distribution differed significantly from controls (x(2) = 11.90, P = 0.003), especially in the right hemisphere (x(2) = 13.67, P = 0.001). Moreover, the asymmetry observed in controls was not present in schizophrenia (x(2) = 0.13, P = 0.94). Specifically, the most frequent Type I expression was decreased and the rarest Type III expression was increased in schizophrenia, relative to controls. Furthermore, patients with Type III expression in any hemisphere evinced poorer socioeconomic status, poorer cognitive function, more severe symptoms and impulsivity, compared to patients without Type III expression. In contrast, patients with Type I in any hemisphere showed better cognitive function and milder symptoms compared to patients without Type I. Structurally, patients with Type III had significantly smaller intra-cranial contents (ICC) volumes than did patients without Type III (t(40) = 2.29, P = 0.027). The present study provides evidence of altered distribution of orbitofrontal sulcogyral pattern in schizophrenia, possibly reflecting a neurodevelopmental aberration in schizophrenia. Such altered sulcogyral pattern is unlikely to be due to secondary effects of the illness such as medication. Moreover, the structural association between Type III and small ICC volume, observed in the patient group, may suggest that Type III expression could be part of a systematic neurodevelopmental alteration, given that the small ICC volume could reflect early reduction of cranial growth driven by brain growth. The observed contrasting association of Type III expression with poorer outcome, and that of Type I expression with better outcome, further suggests clinical heterogeneity, and possible differences in treatment responsiveness in schizophrenia.