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目的:应用结构磁共振成像技术、基于表面的形态学分析方法，观察伴有暴力行为的精神分裂症患者皮质的结构改变，探讨其神经病理生理机制。方法:纳入符合ICD-10诊断标准的精神分裂症患者38?例。利用修订版外显攻击行为量表（Modified Overt Aggression Scale, MOAS）评分将患者分为暴力组和无暴力组。使用CAT12软件计算2组皮质厚度与分形维数，组间比较采用双样本n t检验；全脑的皮质厚度、分形维数分别与PANSS评分进行相关分析。n 结果:暴力组（n n=20）较无暴力组（n n=18）左侧舌回（n t=4.11，n P=0.000 11）、岛回（n t=3.48，n P=0.000 66）、中央前回（n t=3.52，n P=0.000 60），右侧的中央前回（n t=3.94，n P=0.000 18）、缘上回（n t=3.72，n P=0.000 34）、中央后回（n t=3.72，n P=0.000 34）及顶叶下回（n t=3.64，n P=0.000 43）的皮质厚度减低（顶点水平n P<0.001，未校正）；暴力组皮质分形维数在左侧中央后回（n t=3.86，n P=0.000 23）增加，右侧楔前叶（n t=3.62，n P=0.000 44）减低（顶点水平n P<0.001，未校正）。相关分析显示，精神分裂症患者左侧中央后回皮质分形维数与PANSS一般病理评分（n r=0.56，n P=0.000 17）、总评分（n r=0.53，n P=0.000 40）均呈正相关；左侧梭状回皮质分形维数与PANSS总评分呈正相关（n r=0.50，n P=0.000 47）；右侧顶叶上回（n r=0.62，n P=0.000 03）、顶叶下回（n r=0.62，n P=0.000 03）、中央后回（n r=0.57，n P=0.000 12）、颞下回（n r=0.56，n P=0.000 17）皮质分形维数与PANSS阴性评分均呈正相关。n 结论:伴有暴力行为与无暴力行为的精神分裂症患者多个脑区的皮质厚度与分形维数存在差异，提示伴有暴力行为的患者存在神经元密度与分布的异常，这有助于观察精神分裂症患者疾病的进展过程。“,”Objective:To explore the neuropathological mechanism of brain dysfunction in schizophrenia with violent behaviors based on the methods of surface-based morphometry, using structural magnetic resonance imaging.Methods:Thirty-eight patients diagnosed with schizophrenia by ICD-10 were included in the study. The Modified Overt Aggression Scale (MOAS) was used to assess patient′s violent behaviors. Patients were divided into two groups based on the total score of MOAS, the violent and non-violent group. The CAT12 software was employed to recognize the cortex thickness and fractal dimension values differences between the two groups. Correlated analysis of cortex thickness/fractal dimension and PANSS scores were carried out.Results:Compared with non-violent group (n n=18), the cortex thickness values of the violent group (n n=20) decreased in the left lingual (n t=4.11, n P=0.000 11), insula (n t=3.48, n P=0.000 66), precentral (n t=3.52, n P=0.000 60) and right precentral (n t=3.94, n P=0.000 18), supramarginal (n t=3.72, n P=0.000 34), postcentral (n t=3.72, n P=0.000 34), inferiorparietal gyrus region (n t=3.64, n P=0.000 43; n P<0.001, uncorrected); the cortex fractal dimension of the violent group increased in the left postcentral (n t=3.86, n P=0.000 23) and decreased in the right precuneus (n t=3.62, n P=0.000 44; n P<0.001, uncorrected). The PANSS psychopathology scores were positively correlated with the cortex fractal dimension value of left postcentral (n r=0.56, n P=0.000 17), and total scores were positively correlated with the cortex fractal dimension value in the left postcentral (n r=0.53, n P=0.000 40) and the left fusiform (n r=0.50, n P=0.000 47); the cortex fractal dimension value of right superiorparietal (n r=0.62, n P=0.000 03), inferiorparietal (n r=0.62, n P=0.000 03), postcentral(n r=0.57, n P=0.000 12), inferiortemporal (n r=0.56, n P=0.000 17) were positively correlated with PANSS negative scores.n Conclusion:The brain structural differences between schizophrenia patients with violent behaviors and those without suggest that schizophrenia patients show abnormal distribution, density and connectivity of neurons across cortical layers.