中文摘要：

目的探查未经药物治疗的强迫症患者脑灰质结构存在异常的区域,并探讨脑灰质体积改变与临床症状之间的关系。方法用基于体素的形态学方法（voxel-based morphometry,VBM）,对比分析21例未经药物治疗的强迫症患者和21例年龄、性别及受教育程度相匹配的正常对照者脑灰质体积存在差异的脑区,并采用耶鲁-布郎量表（Y-BOCS）、汉密尔顿抑郁量表（HAMD）及汉密尔顿焦虑量表（HAMA）评估临床症状。结果强迫症患者与正常对照者相比脑灰质结构存在明显萎缩的区域主要位于双侧眶额叶、前扣带回、右侧丘脑以及右侧小脑（P〈0.05,FDR校正）,患者左侧眶额叶的灰质体积与耶鲁布朗量表评分之间存在负相关（r=-0.63,P〈0.01）。结论 ＂皮质-纹状体-丘脑-皮质＂环路的结构异常在强迫症的发病机制中起着重要作用,同时表明环路外小脑等结构的异常也可能参与了强迫症的病理生理学进程。

英文摘要：

Objective To detect gray matter structural changes in drug-naive patients with obsessive compulsive disorder （OCD）, and investigate the correlations between abnormal gray matter volume and clinical symptoms. Methods Twenty-one OCD patients and 21 normal controls （matched with age, sex and education level） underwent magnetic resonance imaging （MRI）. The imaging data were analyzed with a voxel- based morphometry method. The Yale-Brown obsessive-compulsive scale （Y-BOCS） , Hamilton depression rating scale （HAMD） and Hamilton anxiety rating scale （HAMA） were used to assess clinical symptoms. Results Compared with the normal controls, the OCD patients showed regional gray matter atrophy mainly in the bilateral orbitofrontal cortex, anterior cingulate cortex, right thalamus and right cerebellum （ P 〈 0. 05, FDR corrected）. The gray matter volume in the left orbitofrontal cortex of the OCD patients showed a negative correlation with the total scores of Y-BOCS （ r = - 0. 63, P 〈 0. 01 ）. Conclusion The structural abnormality of the cortical-striatal-thalamic-cortical loop plays a vital role in the pathogenesis of OCD. In addition, the abnormality of cerebellum and other structures may also be involved in the pathophysiology of OCD.