吸烟对首发精神分裂症患者细胞因子、症状以及认知功能的影响

发布时间：2018-03-04 08:14

  本文选题：吸烟　切入点：精神分裂症　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:1、通过对吸烟的和不吸烟的首发精神分裂症患者0周及8周末进行血清炎症因子IL-1β、IL-6以及TNF-α的测查,探讨吸烟是否对精神分裂症患者治疗过程中血清炎症因子的变化有影响。2、通过比较吸烟组和不吸烟组基线和8周末的精神分裂症患者的的临床症状及认知功能的改变,探讨吸烟对分裂症患者症状、认知功能的影响。3、通过吸烟组和不吸烟组分裂症患者的TESS量表评估,探讨吸烟对于精神分裂症患者出现副反应的影响。4、本论文拓展和延伸了有关精神分裂症的研究内容,希望本研究能够为吸烟的精神分裂症患者的临床治疗提供依据和数据支撑,并为有关精神分裂症的后续研究提供理论视野。方法:依据精神障碍统计与诊断手册第5版(DSM-5)的诊断标准,选取34例具有长期吸烟史的首发精神分裂症患者作为观察组(吸烟组)和35例首发不吸烟的患者为对照组(不吸烟组)。入组当天进行全面的病史采集、全面的精神科检查和体格检查。在基线和第8周末于清晨在两组患者的肘部抽取静脉血液,分别使用ELISA进行血清细胞因子中的IL-1β、IL-6和TNF-α的测定,并采用阳性与阴性症状量表(PANSS)和临床疗效总评量表(CGI)评定每位患者的症状严重程度,TESS评估副作用。参照尼古丁依赖量表的得分情况,来评估吸烟组患者的尼古丁依赖程度,比较吸烟组和不吸烟组患者在认知功能方面的差异。在评估认知功能时,使用了精神分裂症认知功能成套测验中文版(MCCB)和STROOP色词测验等相关的认知测验。采用常用的SPSS软件19.0和Excel对收集到的数据进行整理统计与分析,计数资料用例数(百分比)表示,组间的比较采用χ2检验。若计量资料符合正态分布,即采用均数±标准差来表示,组间的比较使用配对t检验的方法,如果计量资料不符合正态分布,则可以采用中位数来表示,组间比较可以采用秩和检验的方法。结果:1、两组在基础的临床特征方面,包括年龄、性别、教育年限、病程以及利培酮剂量等无明显的差异,一般资料具有比较高的可比性。2、吸烟组和不吸烟组在基线时各炎症因子水平有差异但是差异较小,都处于较高水平。8周后,吸烟组的IL-1β、IL-6水平有一定程度下降但依然较高,而不吸烟组经过治疗后,各炎症因子的水平均有显著的下降(P0.05)。不吸烟组血清细胞因子的变化幅度更大,差别具有明显的统计学意义。两组TNF-α与基线时相比,差异没有达到统计学的意义(P0.05)3、两组患者的PANSS和CGI评分在基线时得分差异无统计学意义,治疗8周后,吸烟组的PANSS阴性症状分有较为明显的下降(P0.05)。4、认知功能方面的测查发现,吸烟组患者在信息处理速度、持续注意和警觉方面的功能得分高于不吸烟组。5、吸烟并没有导致或增加抗精神科药物副反应的发生。相反导致了静坐不能的副反应的减少。结论:1、吸烟可以改变精神分裂症患者体内炎症因子的水平,使IL-1β、IL-6和TNF-a的水平比不吸烟者更高。2、吸烟对精神分裂症患者阴性症状有一定的改善作用。3、吸烟的精神分裂症病人认知功能的一些方面损伤可能较不吸烟的分裂症患者为轻,如信息处理速度、持续注意和警觉方面。4、吸烟的精神分裂症患者出现的“静坐不能”副作用较少。
[Abstract]:Objective: 1, serum inflammatory factor IL-1 beta by smoking and nonsmoking patients with first-episode schizophrenia 0 weeks and 8 weeks, IL-6 and TNF- alpha test, to investigate the changes of serum inflammatory factors of smoking on patients with schizophrenia treatment process have the effect of.2, the ratio of clinical symptoms and cognitive function compared with the smoking group and non-smoking groups at baseline and week 8 schizophrenic patients with the change of smoking on schizophrenia symptoms in patients with.3, cognitive function, the smoking group and non-smoking group split TESS scale to assess patients, to investigate the effects of smoking in patients with schizophrenia have side effects.4, this paper expands and extends the research content of schizophrenia, we hope this research can provide the basis and data support for the clinical treatment of smoking in schizophrenia patients, and follow-up studies of schizophrenia The study provides the theory of vision. Methods: according to diagnostic and Statistical Manual of mental disorders, Fifth Edition (DSM-5) diagnostic criteria, we selected 34 cases with a long-term history of smoking in schizophrenic patients as the observation group (smoking group) and 35 patients with first-episode non-smoking control group (smoking group). The group of the day a comprehensive history taking, comprehensive psychiatric examination and physical examination. At baseline and week eighth in the morning at the elbow venous blood of two groups of patients, respectively, using ELISA serum cytokines in IL-1 beta, the determination of IL-6 and TNF- alpha, and the positive and negative symptoms scale (PANSS) and the clinical curative effect general scale (CGI) assessment of each patient's symptom severity, TESS assessment of side effects. According to the scores of nicotine dependence scale, to assess the degree of nicotine dependence in the smoking group, compared the smoking group and non-smoking group in cognition The difference in functionality. In the assessment of cognitive function, the use of MCCB Chinese Version (MCCB) cognitive test and STROOP color word test and other related statistics and analysis. The commonly used software SPSS 19 and Excel on the collected data, count data case number (percentage) said between the groups, compared with the 2 test. If the measurement data with normal distribution, the mean standard deviation expressed compared using the paired t test between groups, if the measurement data is not consistent with the normal distribution, can be used in bits to represent, comparison between groups can be used to rank sum test methods. Results: 1. Two groups based on the clinical characteristics, including age, gender, years of education, no obvious difference between the duration and dose of risperidone, the general information has high comparability of.2, smoking group and non-smoking group at baseline When the level of inflammatory factors have little difference but the difference is at a relatively high level after.8 weeks, the smoking group IL-1 beta, IL-6 levels decreased to a certain extent but is still high, and no smoking group after treatment, the inflammatory factor levels were significantly decreased (P0.05). Changes of serum cytokines in the non-smoking group the larger, statistically significant difference between two groups. Compared with TNF- a baseline, the difference did not reach statistical significance (P0.05 3), the two groups had no statistical significance in patients with PANSS and CGI scores at baseline differences, after 8 weeks of treatment, the smoking group PANSS negative symptom score are significantly decreased the.4 (P0.05), cognitive function survey found that smoking groups in the information processing speed, sustained attention and vigilance on function score was higher than that of group.5 and no smoking, smoking cause or increase the side effects of anti psychiatric drugs. On the contrary. Lead to reduce side effects of akathisia. Conclusion: 1, smoking can alter the inflammatory factors in patients with schizophrenia in the level of the IL-1 IL-6 beta, and TNF-a levels higher than non-smokers.2, smoking has a certain improvement effect of.3 on the negative symptoms of schizophrenia, some aspects of smoking the spirit of cognitive function in patients with schizophrenia may damage than non-smoking patients with schizophrenia is light, such as information processing speed, sustained attention and vigilance.4, smoking patients with schizophrenia appear "akathisia" fewer side effects.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R749.3
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本文编号：1564846