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目的 探讨有无幻听的精神分裂症患者静息态fMRI比率低频振荡振幅(fraction amplitude of low-frequency fluctuation,fALFF)的特征及幻听产生的神经影像机制.方法 采用静息态功能磁共振fALFF研究方法,对49例有幻听的患者(幻听组)、23例无幻听的患者(非幻听组)及81名健康对照者(对照组),进行静息态fMRI扫描.计算fALFF的值,3组进行方差分析得出有差异的脑区,并分别进行两组之间的独立样本t检验,最后将幻听评分与差异脑区fALFF值进行相关分析.结果 (1)3组fALFF值存在差异的脑区:双侧小脑后叶、左侧尾状核和豆状核、双侧额中回及前扣带回(AlphaSim校正,P＜0.05,体素个数＞21);(2)有差异脑区fALFF值的组间比较:右侧和左侧小脑后叶:与对照组(-1.10±0.35、-1.26±0.38)相比,幻听组(-0.83±0.40、-0.98±0.50)和非幻听组(-0.55±0.41、-0.62±0.40)fALFF值升高(t=-4.009、-3.603,均P＜0.05);而幻听组与非幻听组相比,幻听组fALFF值降低(t=-2.782、-2.958,均P＜0.05);左侧尾状核:与对照组相比,幻听组和非幻听组fALFF值增高(t=-4.51、-1.81,均P＜0.05);左侧豆状核:与对照组(-0.32±0.40)相比,幻听组(0.05±0.52)fALFF值增高(t=-6.614,P＜0.01)而非幻听组(-0.15±0.38)与对照组比较差异无统计学意义;左侧和右侧额中回:与非幻听组相比,幻听组(t=-4.051、-3.154)和对照组(t=-6.645、-5.535)fALFF值增高(均P＜0.05);左侧和右侧前扣带回:与对照组相比,幻听组(t=3.898、5.004)和非幻听组(t=4.616、5.860)fALFF值降低(均P＜0.05);(3)相关分析:幻听严重程度与左右侧小脑后叶fALFF值呈负相关(r=-0.401、-0.547,均P＜0.01);与左侧豆状核fALFF值呈正相关(r=0.311,P＜0.05)但与左侧尾状核、双侧额中回及前扣带回无明显相关性.结论 精神分裂症患者存在多个脑区的自发功能活动异常.伴有幻听的精神分裂症患者可能存在显著双侧小脑后叶及左侧豆状核的功能活动异常,为进一步揭示幻听产生的病理生理机制提供了神经影像基础.

Objective Using the fraction amplitude of low-frequency fluctuation (fALFF) of reststating fMRI to explore the characteristics of fALFF in schizophrenia with/without auditory hallucination and understand the pathological mechanism of brain function in schizophrenia with auditory hallucinations.Methods 49 schizophrenic patients (APG) with and 23 without auditory hallucination (NPG),81 healthy volunteers (NC) were included in the study.All subjects underwent rest-stating fMRI.Values of fALFF were calculated in the tape limit ranging from 0.01 Hz to 0.08 Hz.A one-way analysis of covariance,with group as fixed factor (whole-brain corrected),was conducted and followed by post hoc pairwise comparisons.Meanwhile,pearson correlation analyses were performed to further assess the relationships between these different regions of fALFF values and the Hoffman scores in patients with auditory hallucinations.Result (1) There were different on fALFF values among 3 groups in bilateral cerebellum posterior lobe,the left caudate,the left lentiform nucleus,bilateral middle frontal gyrus,bilateral anterior cingulate (AlphaSim corrected,P＜0.05,voxel＞21).(2)The fALFF values:Bilateral cerebellum posterior lobe:compared with NC (-1.10±0.35,-1.26±0.38),both APG(-0.83±0.40,-0.98±0.50) and NPG(-0.55±0.41,-0.62±0.40)showed increased fALFF (t=-4.009,-3.603,both P＜0.05),but APG showed decreased fALFF (t=-2.782,-2.958,both P＜0.05) than NPG;The left caudate:compared with NC,both APG and NPG showed increased fALFF (t=-4.51,-1.81,both P＜0.05);The left lentiform nucleus:compared with NC (-0.32±0.40),APG (0.05±0.52) showed increased fALFF(t=-6.614,P＜0.01),but NPG (-0.15±0.38) showed no difference;Bilateral middle frontal gyrus:compared with NPG,both APG (t=-4.051,-3.154)and NC (t=-6.645,-5.535)showed increased fALFF (all P＜0.05);Bilateral anterior cingulate:Compared with NC,both APG (t=3.898,5.004)and NPG (t=4.616,5.860)showed decreased fALFF (all P＜0.05).(3) Pearson correlation analyses showed that Hoffman score showed negatively correlated with bilateral cerebellum posterior lobe (r=-0.401,-0.547;both P＜0.01)and positively correlated with the left lentiform nucleus (r=0.311,P＜0.05),but no relationship with bilateral middle frontal gyrus,bilateral anterior cingulate and the left caudate nucleus.Conclusion This study confirmed schizophrenia patients had abnormal spontaneous activity in multiple regions.Schizophrenia with auditory hallucinations may show abnormal activity in bilateral cerebellum posterior lobe and the left lentiform nucleus,which can help us to reveal the neuroimaging mechanism of auditory hallucinations.