精神分裂症患者血浆orexin-A水平及药物治疗的影响

发布时间：2018-04-16 03:40

本文选题：精神分裂症 + 血浆　；参考：《中国人民解放军军医进修学院》2012年硕士论文

【摘要】：精神分裂症的发病原因至今未明，多年来发病机制中研究最多的仍然是神经递质。Orexin是1998年新发现的下丘脑神经肽，其作用范围广泛，在摄食、睡眠／觉醒、内分泌调节、物质依赖、中枢犒赏、呼吸、学习与记忆等多方面发挥作用。随着研究的深入，国外有证据表明下丘脑的Orexin系统能直接而强烈地兴奋去甲肾上腺素、多巴胺、五羟色胺、组胺和胆碱能神经元，Orexin在调节谷氨酸和其他氨基酸释放方面也有重要作用。Orexin能调节皮质多巴胺通路。公开发表的数据表明Orexin与精神疾病有必然的联系。目的：研究精神分裂症患者血浆Orexin-A的水平和药物治疗对其的影响及临床意义。第一部分：方法：选择61例新入院首发未用药的精神分裂症患者作为研究组，37名与研究组匹配的健康体检者作为对照组。所有入组对象均晨6：00空腹12小时后采集静脉血，用放射免疫法测定血浆Orexin-A水平。结果：首发未用药的精神分裂症患者血浆Orexin-A水平(67.35±59.81)pg/ml,与正常对照组(50.45±71.15)pg/ml比较，没有统计学差异(P0.05)。第二部分：方法：选择20名首发精神分裂症患者持续应用奥氮平（20mg/天）治疗，于治疗前和治疗12个月末测定血浆Orexin-A水平、体重、BMI、空腹血糖、血清甘油三酯、胆固醇、HDL、LDL水平。用PANSS量表，于治疗前和治疗第4、8周及治疗12个月末评分，并评定疗效。结果：①经奥氮平持续治疗12月后的精神分裂症患者血浆Orexin-A水平较治疗前降低[(68.67±60.31）pg/mlVS (39.83±18.12）pg/ml，P0.05]，体重、BMI、甘油三酯、总胆固醇，空腹血糖、LDL均明显升高，HDL降低，差异具有统计学意义(P0.05)。②Orexin-A水平降低与LDL的变化正相关（r=0.483，P=0.03）。③体重增加与阳性症状分差值显著负相关(r=0.603，P0.01)，体重增加与Orexin-A水平变化无显著相关（r=-0.061,P0.05）。④奥氮平治疗12个月后，，患者PANSS总分及阳性症状分、阴性症状分均降低，差异具有显著性(P0.01），总有效率90%。结论：首发未用药精神分裂症患者的血浆orexin-A水平与正常人无显著性差异；奥氮平对首发精神分裂症患者Orexin-A及体重、糖脂代谢指标有显著影响；体重增加与阳性症状分差值显著负相关，推测体重增加与奥氮平对阳性症状的治疗效果有着紧密的联系；体重增加与Orexin-A水平变化无显著相关，尚不能确定Orexin-A水平降低是体重增加的原因；奥氮平对于首发精神分裂症疗效确切，可治疗精神分裂症的阳性症状及阴性症状。
[Abstract]:The pathogenesis of schizophrenia is still unknown. In many years, the neurotransmitter. Orexin, a new hypothalamic neuropeptide discovered in 1998, has a wide range of effects in food intake, sleep / arousal, endocrine regulation.Substance dependence, central reward, respiration, learning and memory play many roles.As the research progresses, there is evidence abroad that the hypothalamic Orexin system can directly and intensely excite norepinephrine, dopamine, serotonin,Histamine and cholinergic neurons Orexin also play an important role in regulating the release of glutamate and other amino acids.Published data suggest an inevitable link between Orexin and mental illness.Objective: to study the level of plasma Orexin-A and its clinical significance in schizophrenic patients.Part I:Methods: a total of 61 patients with schizophrenia were selected as control group.Venous blood samples were collected from all subjects at 6:00 fasting 12 hours in the morning. Plasma Orexin-A levels were measured by radioimmunoassay.Results: the plasma Orexin-A level was 67.35 卤59.81g / ml in patients with schizophrenia and 50.45 卤71.15)pg/ml in the control group. There was no significant difference between the two groups (P 0.05).Part II:Methods: 20 first-episode schizophrenia patients were treated with olanzapine 20mg / day. Plasma Orexin-A, body weight, fasting blood glucose, serum triglyceride and cholesterol were measured before and after 12 months of treatment.PANSS scale was used to evaluate the curative effect before treatment, 8 weeks after treatment and 12 months after treatment.Results the plasma Orexin-A levels in patients with schizophrenia after 12 months of continuous treatment with olanzapine were significantly lower than those before treatment [68.67 卤60.31)pg/mlVS 39.83 卤18.12 g / ml P 0.05]. BMIs, triglycerides, total cholesterol and fasting blood glucose were significantly increased and decreased.The difference was statistically significant between the decrease of P0.05U. 2Orexin-A level and the change of LDL. There was a significant negative correlation between the weight gain and the difference of positive symptom score. There was no significant correlation between weight gain and Orexin-A level change. After 12 months of treatment, there was no significant correlation between weight gain and Orexin-A level change, after 12 months of treatment with olanzapine, there was no significant correlation between weight gain and Orexin-A level.The total score of PANSS, the score of positive symptom and the score of negative symptom were all decreased, the difference was significant (P 0.01), and the total effective rate was 90%.Conclusion: there was no significant difference in plasma orexin-A levels between first-episode schizophrenia patients and normal controls, and olanzapine had significant effects on Orexin-A, body weight, glucose and lipid metabolism in first-episode schizophrenic patients.There was a significant negative correlation between weight gain and the difference of positive symptoms, which suggested that weight gain was closely related to the efficacy of olanzapine in the treatment of positive symptoms, while weight gain had no significant correlation with the change of Orexin-A level.It is not certain that the decrease of Orexin-A level is the cause of weight gain, and olanzapine is effective for first-episode schizophrenia and can be used to treat the positive and negative symptoms of schizophrenia.
【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.3

【参考文献】