磁共振波谱联合弥散张量成像 对酒精性幻觉症的研究价值

目的 探究酒精对幻觉症患者神经元、神经纤维的损害。方法 利用磁共振波谱技术与弥散张 量成像技术相结合，观察酒精所致幻觉患者（幻觉组）19 例与健康对照组10 例。通过阳性与阴性症状量表 （PANSS）测评患者精神症状，了解酒精所致幻觉患者神经元、神经纤维损害程度、部位以及神经元、神经纤 维损害与不同精神症状的关联性。结果 幻觉组双侧枕叶、左颞叶及右海马氮- 乙酰天门冬氨酸/ 肌酸（NAA/ Cr）值降低（P <0.05）；双侧颞叶、枕叶、扣带回、胼胝体、左海马、右额叶及右伏隔核的各项异性分数 （FA）值降低（P <0.05）；NAA/Cr 在左额叶、双颞叶、双枕叶及双侧胼胝体与PANSS 多个因子分呈负相 关（P <0.05）；双侧海马、双侧伏隔核的NAA/Cr 与PANSS 反应缺乏因子分呈负相关（r =-0.328、-0.667、 -0.447 及-0.427，P =0.027、0.000、0.015 及0.018）；左扣带回FA 值与PANSS 总分呈负相关（r =-0.272， P =0.038）；区域性的FA 值与PANSS 的一般病理分、抑郁因子分及思维障碍因子分呈负相关（r =-0.372、 -0.264 及-0.301，P =0.021、0.040 及0.029）。结论 枕叶、颞叶等脑区神经元受损是导致幻视与幻听的主要 原因，且酒精所致幻觉的患者还存在颞叶、枕叶、扣带回及胼胝体等区域广泛的神经纤维损害。枕叶、颞叶 神经元损害越重，幻觉等阳性症状越重。神经元损害是出现抑郁、反应缺乏等阴性症状原因，而广泛的神经 纤维损害是导致阳性症状、思维障碍的重要原因。

Research of magnetic resonance spectrum combined with diffusion tensor imaging on alcoholic hallucinosis

Objective To detect lesions of neurons and nerve fibers of hallucinatory disease due to alcohol. Method A total of 19 patients with alcoholic hallucinosis and 10 healthy individuals were detected by Magnetic Resonance Spectrum (MRS) and Diffusion tensor imaging (DTI), and evaluated by positive and negative symptoms scale (PANSS). Results Levels of NAA/Cr inbilateral occipital lobe, left temporal lobe and right hippocampus of the 19 patients with alcoholic hallucinosis decreased significantly (P < 0.05); FA value in bilateral temporal lobe, occipital lobe, cingulate gyrus, corpus callosum, left hippocampus, right frontal lobe and right nucleus accumbens decreased significantly (P < 0.05); NAA/Cr negatively correlated with PANSS depression factor score in left frontal lobe, bilateral temporal lobe, bilateral occipital lobe and bilateral corpus callosum; NAA/Cr in bilateral hippocampus, right cingulate and bilateral nucleus accumbens had negative correlation with response deficiency factor of PANSS; FA value negatively correlated with PANSS scores in left cingulate; and the regional FA value had negative correlation with general pathology, depressive factor and thought disorder factor of PANSS. Conclusion The lesions of neurons in occipital lobe and temporal lobe and the diffused lesions of nerve fibers lesion are the main reasons of alcoholic hallucinosis. The damage degree of neurons has positive correlation with the level ofhallucinosis; the negative symptoms are related to the lesion of neurons, while the positive symptoms are related to the lesion of nerve fibers.