摘要目的:探讨不同灰质结构亚型强迫症患者静息状态下的动态功能连接（dynamic functional connectivity，dFC）模式，并探究不同亚型强迫症患者的异常灰质体积和dFC模式与临床症状的关系。方法:前瞻性收集2013年9月至2020年3月就诊于齐齐哈尔医学院附属第四医院（20例）和齐齐哈尔市精神卫生中心住院和门诊（28例）的共48例强迫症患者的临床资料，其中男 33 例，女 15 例，年龄 18~45（27.1±6.7）岁。同期招募年龄匹配的健康对照者39 名，其中男 31 名，女 8 名，年龄 18~45（28.5±8.6）岁。对符合ICD-10诊断标准的48例强迫症患者（强迫症组）和39名健康对照（对照组）进行磁共振成像扫描。采用基于体素的形态学分析（voxel-based morphometry，VBM），使用半监督机器学习方法，以灰质体积为特征对强迫症组进行亚型分析，选取灰质体积异常的脑区为感兴趣脑区，进行基于全脑体素的dFC分析，探究异常灰质体积和dFC模式与强迫症临床症状之间的相关性。结果:基于灰质体积，强迫症可分为2个亚型，其中亚型1为右中央后回灰质体积增加［809个体素； t=4.31；高斯随机场（Gaussian random field，GRF）校正，体素 P<0.001，团块水平 P<0.05双尾］，亚型2为左颞上回灰质体积降低（1 118个体素； t=-4.37；GRF校正，体素 P<0.001，团块水平 P<0.05双尾）。在亚型1中，右侧中央后回与左内侧额上回之间的dFC显著降低（187个体素； t=-4.42；GRF校正，体素 P<0.001，团块水平 P<0.05双尾）；在亚型2中，左侧颞上回与左侧海马、左侧中央旁小叶之间的dFC显著降低（分别为272、99个体素； t=-4.69、-5.01；GRF校正，体素 P<0.001，团块水平 P<0.05双尾）。亚型1右侧中央后回与左内侧额上回之间的dFC值与病程呈负相关（ r=-0.579； P=0.002，未校正）；亚型2左侧颞上回与左侧海马之间dFC值与病程呈正相关（ r=0.578； P=0.003，未校正）。 结论:静息状态下，基于灰质体积的不同亚型强迫症患者具有不同的dFC异常模式。

abstractsObjective:To analyze the patterns of dynamic functional connectivity(dFC) at rest in different obsessive-compulsive disorder(OCD) subtypes based on gray matter volume, and explore the relationship between abnormal gray matter volume and dFC patterns and clinical symptoms in different OCD subtypes.Methods:Clinical data were prospectively collected from a total of 48 patients with OCD from inpatient and outpatient departments of the Fourth Affiliated Hospital of Qiqihar Medical College(20 cases) and Qiqihar Mental Health Center(28 cases) from September 2013 to March 2020. There were 33 males and 15 females, aged 18 to 42(27.1±6.7) years. During the same period, 39 age-matched healthy controls were also recruited, including 31 males and 8 females, aged 18 to 43(28.5±8.6) years. Structural and resting-state functional magnetic resonance imaging scans were performed on 48 OCD patients(OCD group) who met the ICD-10 diagnostic criteria and 39 healthy controls(control group). Using voxel-based morphometry(VBM) and semi-supervised machine learning methods, the patient group was characterized by gray matter volume to perform subtype analysis, and brain regions with abnormal gray matter volume were selected as regions of interest for whole-brain voxel-wise dFC analysis. Correlations between abnormal gray matter volume and dFC and clinical symptoms in OCD patients were analyzed.Results:Based on gray matter volume, OCD patients were computed into two subtypes, of which subtype 1 increased gray matter volume in the right central posterior gyrus(809 voxels; t=4.31; GRF corrected voxel P<0.001, cluster P<0.05 two-tailed), and subtype 2 showed reduced gray matter volume in the left superior temporal gyrus(1 118 voxels; t=-4.37; GRF corrected voxel P<0.001, cluster P<0.05 two-tailed). In subtype 1, the dFC between the right central posterior gyrus and left medial superior frontal gyrus was significantly reduced(187 voxels; t=-4.42; GRF corrected voxel P<0.001, cluster P<0.05 two-tailed); in subtype 2, dFC between the left superior temporal gyrus and left hippocampus, and left central opercular cortex was significantly reduced(272 voxels、99 voxels; t=-4.69, -5.01; GRF corrected voxel P<0.001, cluster P<0.05 two-tailed). In subtype 1, dFC between the right central posterior gyrus and left medial superior frontal gyrus was negatively correlated with illness duration( r=-0.579; P=0.002, uncorrected). In subtype 2, dFC between the left superior temporal gyrus and left hippocampus was positively correlated with illness duration( r=0.578; P=0.003, uncorrected). Conclusions:In the resting state, patients with different subtypes of OCD may have different patterns of dFC abnormalities based on gray matter volume.