| 王少霞,张翔,卢士豪,李雨涵,宋方庆,方建群.无法忍受不确定性与强迫症状严重程度的关联：小脑ALFF提取值的中介作用[J].四川精神卫生杂志,2026,(3):227-233.Wang Shaoxia,Zhang Xiang,Lu Shihao,Li Yuhan,Song Fangqing,Fang Jianqun,Asociation between intolerance of uncertainty and severity of obsessive-compulsive symptom： the mediating role of cerebellar ALFF value[J].SICHUAN MENTAL HEALTH,2026,(3):227-233 |
| 无法忍受不确定性与强迫症状严重程度的关联：小脑ALFF提取值的中介作用 |
| Asociation between intolerance of uncertainty and severity of obsessive-compulsive symptom： the mediating role of cerebellar ALFF value |
| 投稿时间：2026-01-23 |
| DOI：10.11886/scjsws20260123002 |
| 中文关键词: 强迫症 低频振幅 小脑 无法忍受不确定性 中介效应 |
| 英文关键词:Obsessive-compulsive disorder Amplitude of low-frequency fluctuation Cerebellum Intolerance of uncertainty Mediation effect |
| 基金项目:2023年宁夏回族自治区基础条件与创新平台建设项目（项目名称：宁夏回族自治区第四批临床医学研究中心，项目编号：2022YXGCJS001） |
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| 中文摘要: |
| 背景 强迫症（OCD）致残负担高，无法忍受不确定性（IU）与强迫症状严重程度相关，但其神经机制尚未阐明。小脑可能参与不确定性加工且OCD患者的小脑存在结构和功能异常，但目前尚缺乏对其自发活动在IU与强迫症状关联中的直接证据。目的 探讨OCD患者小脑自发神经活动在IU与强迫症状之间的作用路径，为理解OCD的神经机制提供新的视角。方法 选取2022年11月—2024年11月在宁夏医科大学总医院心理卫生中心门诊就诊的、符合《国际疾病分类（第10版）》（ICD-10）OCD诊断标准的51例OCD患者（OCD组）。同期社区招募与OCD组性别和年龄相匹配的43名志愿者为对照组。采集两组受试者的静息态功能磁共振成像数据，采用低频振幅（ALFF）分析方法比较两组全脑自发神经活动的差异；使用耶鲁-布朗强迫量表（Y-BOCS）和简版无法忍受不确定性量表（IUS-12）进行评定。采用Pearson相关分析检验OCD患者小脑ALFF提取值与各量表评分之间的相关性；以IU为自变量，强迫症状为因变量，组间差异脑区ALFF提取值为中介变量，使用SPSS 24.0插件Process 4.0的模型4检验差异脑区ALFF提取值在IU与强迫症状之间的作用路径，采用Bootstrap法进行中介效应检验。结果 共47名OCD患者和40名对照者完成本研究。OCD组右侧小脑Crus Ⅱ区的ALFF提取值低于对照组（t=-5.254，FWE校正后P<0.01）。相关分析结果显示，OCD组右侧小脑Crus Ⅱ区ALFF提取值与Y-BOCS总评分（r=-0.851）、强迫行为分量表评分（r=-0.647）、IUS-12总评分（r=-0.617）及预期性IU分量表评分（r=-0.717）均呈负相关（P均<0.01）；预期性IU分量表评分与Y-BOCS总评分（r=0.811）及强迫行为分量表评分（r=0.535）均呈正相关（P均<0.01）。中介效应分析显示，右侧小脑Crus Ⅱ区ALFF提取值在预期性IU对强迫行为的影响中起部分中介作用，中介效应值为0.064（95% CI：0.004~0.136），占总效应的24.57%。结论 OCD患者右侧小脑Crus Ⅱ区自发神经活动降低，并与IU及强迫症状相关。该脑区在IU影响强迫行为中起部分中介作用。 |
| 英文摘要: |
| Background Obsessive-compulsive disorder （OCD） carries a considerable disability burden. Intolerance of uncertainty （IU） is associated with the severity of obsessive-compulsive symptoms， yet its neural underpinnings remain unclear. The cerebellum has been implicated in uncertainty processing and demonstrates structural and functional abnormalities in OCD， but direct evidence linking its spontaneous activity to the relationship between IU and obsessive-compulsive symptoms is still lacking.Objective To explore the pathway through which spontaneous cerebellar neural activity mediates the relationship between IU and obsessive-compulsive symptoms in OCD patients， with the aim of providing a new perspective for understanding the neural mechanisms of OCD.Methods A total of 51 patients with OCD who visited the Mental Health Center outpatient clinic of the General Hospital of Ningxia Medical University from November 2022 to November 2024 and met the diagnostic criteria for OCD according to the International Classification of Diseases， tenth edition （ICD-10）. During the same period， 43 community-based volunteers matched for gender and age were enrolled as the control group. Resting-state functional magnetic resonance imaging data were collected from two groups. Amplitude of low-frequency fluctuation （ALFF） analysis was used to compare whole-brain spontaneous neural activity between two groups. Clinical assessments were conducted using the Yale-Brown Obsessive Compulsive Scale （Y-BOCS） and the Intolerance of Uncertainty Scale-12 （IUS-12）. Pearson correlation analysis was used to examine correlations between cerebellar ALFF values and scale scores in OCD patients. Using IU as the independent variable， obsessive-compulsive symptoms as the dependent variable， and ALFF values from between-group difference brain regions as the mediator， Process 4.0 for SPSS 24.0 （model 4） was used to examine the mediating role of these ALFF values between IU and obsessive-compulsive symptoms. The Bootstrap method was used to test the mediation effect.Results A total of 47 OCD patients and 40 controls completed this study. Compared with the control group， the OCD group showed decreased ALFF values in the right cerebellar Crus Ⅱ （t=-5.254， FWE-corrected P<0.01）. Correlation analysis revealed that ALFF value in the right cerebellar Crus Ⅱ was negatively correlated with Y-BOCS total score （r=-0.851）， compulsive behavior subscale score （r=-0.647）， IUS-12 total scores （r=-0.617）， and prospective IU subscale scores （r=-0.717） in OCD group （P<0.01）. Prospective IU subscale scores were positively correlated with Y-BOCS total scores （r=0.811） and compulsive behavior subscale score （r=0.535） （P<0.01）. Mediation analysis showed that ALFF value in the right cerebellar Crus Ⅱ region partially mediated the effect of prospective IU on obsessive-compulsive behavior， with a mediation effect of 0.064 （95% CI： 0.004–0.136）， accounting for 24.57% of the total effect.Conclusion Patients with OCD showed reduced spontaneous neural activity in the right cerebellar Crus Ⅱ region， which was significantly associated with IU and obsessive-compulsive symptoms. This region partially mediated the effect of IU on compulsive behaviors. ［Funded by Basic Conditions and Innovation Platform Construction Project of Ningxia Hui Autonomous Region in 2023 （number， 2022YXGCJS001）］ |
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