首发强迫症患者血清TNF-α、IL-2水平和认知功能及其治疗前后的对比研究

发布时间：2018-05-12 23:25

本文选题：强迫症 + 肿瘤坏死因子-α　；参考：《郑州大学》2017年硕士论文

【摘要】：目的探讨首发强迫症患者的血清肿瘤坏死因子-α(TNF-α)和白细胞介素-2(IL-2)水平及认知功能情况,观察经过药物治疗后的强迫症患者血清TNF-α、IL-2水平和认知功能的变化,为强迫症的临床诊治提供理论依据。方法采用病例对照的方法,根据《美国精神障碍诊断与统计手册第4版》(DSM-IV)强迫症的诊断标准,选取符合强迫症诊断的54例患者(强迫症组),给予舍曲林治疗。同期选取54例健康志愿者作为对照组,与入组强迫症患者的年龄、性别和受教育年限相匹配。1.采用耶鲁-布朗强迫症量表(Y-BOCS)和成套神经心理学评估测验(MCCB)中的8个神经心理学测验:(1)连线测试A部分;(2)简易认知评估:符号编码;(3)霍普金斯词语学习测试-修订版;(4)韦氏记忆量表-第三版:空间广度;(4)神经心理评估成套测试:迷宫;(5)简易视觉空间记忆测试-修订版;(6)范畴流畅:动物命名(流畅性);(8)Mayer-Salovey-Caruso情绪智商测试:情绪管理,对研究对象进行强迫症状评定及认知功能评估,应用酶联免疫吸附方法(ELISA)测定血清IL-2和TNF-α水平。2.强迫症组中有21例患者,完成了12周的舍曲林治疗,采用同样方法评估强迫程度、认知功能及血清IL-2、TNF-α水平,进行治疗前、后的对比研究。运用SPSS17.0统计软件对所有数据进行相应的t检验,χ2检验及相关分析等。结果1一般资料比较54例强迫症组和54例健康对照组之间的性别(χ2=0.04,P=0.84)、年龄(t=-0.13,P=0.89)和受教育年限(t=-1.10,P=0.27)无明显差异。2强迫症组与健康对照组血清TNF-α、IL-2水平和认知功能的比较2.1强迫症组血清TNF-α(393.64±49.27pg/ml)和IL-2(428.59±97.33pg/ml)水平均显著高于健康对照组(292.21±60.03pg/ml,304.27±63.27pg/ml),差异具有统计学意义(P0.01)。2.2强迫症组信息处理速度(32.63±9.52)、视觉空间工作记忆(42.06±8.64)、视觉记忆(44.30±10.32)及推理和问题解决的决策能力(34.09±8.03)显著低于健康对照组(47.87±7.30,50.39±7.72,50.15±7.33,47.39±10.44),差异具有统计学意义(P0.01);强迫症组言语记忆(47.11±10.36)和社会认知(44.13±13.05)与健康对照组(47.94±10.08,47.76±17.64)相比,差异无统计学意义(P0.05)。2.3强迫症患者信息处理速度、言语记忆及社会认知与发病年龄呈负相关(r=0.38,0.35,0.38,P0.01);信息处理速度与强迫行为呈负相关(r=0.34,P0.05);血清TNF-α和IL-2水平与各项认知功能、强迫症状及严重程度、年龄、发病年龄和病程均无明显相关性(P0.05)。3药物治疗前、后强迫症患者Y-BOCS量表评分、血清TNF-α、IL-2水平和认知功能的比较3.1药物治疗后患者强迫思维(8.24±3.11分)、强迫行为(6.00±3.38分)及强迫总分(14.24±5.96分)显著低于治疗前(11.14±3.69分,8.90±3.97分,20.05±6.79分),差异具有统计学意义(P0.01)。3.2药物治疗后强迫症患者血清TNF-α(361.48±57.52pg/ml)和IL-2(385.14±89.30pg/ml)水平与治疗前(390.39±41.10pg/ml,433.53±109.60pg/ml)相比,差异无统计学意义(P0.05)。3.3药物治疗后强迫症患者的信息处理速度(39.29±9.63)、言语记忆(55.81±9.94)、视觉记忆(50.62±8.55)及社会认知(52.05±15.03)高于治疗前(32.90±10.01,47.05±10.40,45.48±9.54,43.24±10.24),差异具有统计学意义(P0.05或P0.01);药物治疗后强迫症患者视觉空间工作记忆(43.95±11.95)和推理和问题解决的决策能力(34.81±9.83)与治疗前(42.52±7.31,32.86±9.21)相比,差异无统计学意义(P0.05)。结论1.首发强迫症患者血清TNF-α和IL-2水平升高,认知功能中,信息处理速度、视觉记忆、视觉空间工作记忆及推理和问题解决的决策能力受损。2.通过药物治疗,强迫症患者部分认知功能改善,但血清TNF-α和IL-2水平变化不明显。3.首发强迫症患者发病年龄越小及强迫行为越重对认知功能影响越大。
[Abstract]:Objective to investigate the level of serum tumor necrosis factor - alpha (TNF- - alpha) and interleukin -2 (IL-2) and cognitive function in patients with first onset obsessive-compulsive disorder (OCD), and to observe the changes of serum TNF- a, IL-2 level and cognitive function in patients with obsessive-compulsive disorder after drug treatment, and provide a theoretical basis for the clinical diagnosis and treatment of obsessive-compulsive disorder. According to the diagnostic criteria of the fourth edition of the American psychiatric disorder diagnosis and Statistics Manual (DSM-IV), 54 patients (obsessive-compulsive disorder group) were selected to be treated with obsessive-compulsive disorder (obsessive-compulsive disorder group). 54 healthy volunteers were selected as the control group at the same time. The age, sex and the number of years of education were matched with the age of the obsessive-compulsive disorder, and the Yale - cloth was adopted by.1.. 8 neuropsychological tests in the Y-BOCS and MCCB: (1) connection test A; (2) simple cognitive assessment: symbol coding; (3) Hopki vocabulary learning test revision; (4) Wechsler Memory Scale third: space breadth; (4) neuropsychological assessment complete test: maze; (5) simple Visual spatial memory test - revision; (6) fluency in category: Animal naming (fluency); (8) Mayer-Salovey-Caruso Emotional IQ test: emotional management, compulsive symptom assessment and cognitive function assessment on subjects, and determination of 21 patients in serum IL-2 and TNF- alpha obsessive-compulsive disorder group by enzyme linked immunosorbent assay (ELISA). 12 weeks of sertraline treatment, the same method was used to evaluate the degree of compulsion, cognitive function and the level of serum IL-2, TNF- alpha, before and after the treatment. The corresponding t test, x 2 test and correlation analysis were used by SPSS17.0 statistics software. Results 1 general data were compared in 54 obsessive-compulsive groups and 54 healthy control groups. Sex (x 2=0.04, P=0.84), age (t=-0.13, P=0.89) and education years (t=-1.10, P=0.27), there was no significant difference between.2 obsessive-compulsive disorder group and healthy control group, serum TNF- a, IL-2 level and cognitive function. The level of TNF- a (393.64 + 49.27pg/ml) and IL-2 (428.59 +) in the 2.1 obsessive-compulsive group were significantly higher than those of the healthy control group (292.21 +. 60.03pg/ml, 304.27 + 63.27pg/ml), the difference was statistically significant (P0.01) the speed of information processing in.2.2 obsessive compulsive disorder group (32.63 + 9.52), visual spatial working memory (42.06 + 8.64), visual memory (44.30 + 10.32) and reasoning and problem solving (34.09 + 8.03) significantly lower than that of the healthy control group (47.87 + 7.30,50.39 + 7.72,50.15 + 7.33,47.39 The difference was statistically significant (P0.01); the speech memory (47.11 + 10.36) and social cognition (44.13 + 13.05) of the obsessive-compulsive disorder group were compared with the healthy control group (47.94 + 10.08,47.76 + 17.64), and there was no significant difference (P0.05) with the speed of information processing in.2.3 obsessive-compulsive disorder (P0.05), and the verbal memory and social cognition were negatively correlated with the age of the onset (r=0.38,0.35, 0.38, P0.01); the speed of information processing was negatively correlated with the compulsion behavior (r=0.34, P0.05); serum TNF- alpha and IL-2 levels had no significant correlation with various cognitive functions, compulsive symptoms and severity, age, age and course of disease (P0.05) before.3 drug treatment, Y-BOCS scale for post severe sufferers, serum TNF- alpha, IL-2 level, and cognitive function The forced thinking (8.24 + 3.11), forced behavior (6 + 3.38) and forced total score (14.24 + 5.96 points) were significantly lower than those before the 3.1 drug treatment (11.14 + 3.69, 8.90 + 3.97, 20.05 + 6.79), and the difference was statistically significant (P0.01).3.2 after the treatment of obsessive-compulsive disorder patients TNF- alpha (361.48 + 57.52pg/ml) and IL-2 89.30pg/ml) compared with before treatment (390.39 + 41.10pg/ml, 433.53 + 109.60pg/ml), the difference was not statistically significant (P0.05), the rate of information processing (39.29 + 9.63), speech memory (55.81 + 9.94), visual memory (50.62 + 8.55) and social cognition (52.05 + 15.03) were higher than that before treatment (32.90 + 10.01,47.05 + 10.40,4). 5.48 + 9.54,43.24 + 10.24), the difference was statistically significant (P0.05 or P0.01); there was no significant difference in visual spatial working memory (43.95 + 11.95) and reasoning and problem solving (34.81 + 9.83) of patients with obsessive-compulsive disorder after drug therapy (34.81 + 9.83) and before treatment (42.52 + 7.31,32.86 + 9.21). Conclusion 1. patients with first onset obsessive-compulsive disorder TNF- alpha and IL-2 levels increased, cognitive function, information processing speed, visual memory, visual spatial working memory, and reasoning and problem-solving decision-making ability impaired.2. through drug therapy, partial cognitive function improved in patients with obsessive-compulsive disorder, but the changes in serum TNF- alpha and IL-2 levels were not obvious in patients with.3. first onset obsessive-compulsive disorder, the younger the onset age and compulsion The more serious the behavior is, the greater the effect of the cognitive function.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.7

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