过度担忧和广泛性焦虑障碍与rCBF关系的SPECT脑显像研究

目的：探查过度担忧者和GAD病人的r CBF变化,更好地了解导致病理性焦虑和GAD的神经病理生理学基础。方法：回顾性分析18例过度担忧者和61例GAD病人SPECT脑显像的结果。GAD患者再按病程分为3个亚组。计算各组患者特定脑区r CBF损伤的百分比及损伤的脑区数。结果：12例（66.7%）过度担忧者可见前额叶、基底节、扣带回、颞叶和枕叶r CBF增加（11例）和/或减少（9例）。58例（95.1%）GAD患者可见r CBF减少,主要累及中和下前额叶、中和下颞叶、前扣带、海马旁回、基底节和丘脑。大多数GAD患者累及的主要脑区等于或大于3个。GAD病人的r CBF损伤和病程之间存在一定的相关性。结论：结果支持GAD患者r CBF的变化是一个与担忧和焦虑等心理和情绪改变密切相关的慢性和渐进的过程。GAD的局部脑功能障碍是病理性焦虑产生的先决条件,并出现在局部脑结构异常之前。

A Functional Neuroimaging Study in Patients with Excessive Worry and GAD Using SPECT

The present study aimed to evaluate the rCBF changes of GAD, and explore neurobiology and neuropathology of GAD. The rCBF was studied using 99mTc-ECD SPECT in 18 patients with excessive worrying （EW） and 61 patients with GAD. Here, 61 GAD patients were divided into 3 subgroups according to course of disease. The percentage of rCBF damage in specified encephalic region was computed as involved cases in contrast with total cases in different groups and subgroups respectively. Four dif- ferent visual classes （0 -III ） were defined for quantity impaired brain regions. The rCBF abnormalities were noted in 12 EW （66.7%） and 58 of GAD pa- tients （95.1% ）. Involved dysfunction regions were equal to or over 3 major brain areas in most GAD. There were relation between extent of rCBF damage and course of disease in GAD. The results suggest that, in GAD, the rCBF change is a chronic and moderately advanced process, and is closely correlated with psychological and emotional alteration such as worry and anxiety, meanwhile, in GAD, the regional brain functional disorder is the precondition for pathological anxiety and the structural abnormality.