首发精神分裂症患者治疗效果与血清炎性因子水平变化关系研究

发布时间：2018-06-28 13:18

  本文选题：精神分裂症 + 奥氮平　； 参考：《新乡医学院》2017年硕士论文

【摘要】：背景精神分裂症是一种复杂的临床综合征,其病因至今仍未被研究者完全阐明。免疫炎症假说是精神分裂症重要的病因学学说之一,这一观点以患者外周多种炎性细胞因子水平升高(即免疫激活现象)为基础。超敏C-反应蛋白(hs-CRP)、转化生长因子-β1(TGF-β1)、白介素1β(IL-1β)、白介素6(IL-6)、白介素17(IL-17)是人体内常见的炎性细胞因子,深入研究上述炎性细胞因子在治疗前后的变化,比较它们在不同疗效患者群体间差异,有助于进一出阐明免疫炎症对精神分裂症转归的影响。目的1.观察治疗前后首发精神分裂症患者外周炎性细胞因子水平的变化,探索患者外周不同细胞因子的变化规律,丰富精神分裂症免疫炎症假说的临床证据。2.比较不同临床疗效的患者群体炎性细胞因子水平的差异,并分析这种差异的临床意义,获取评估精神分裂症临床疗效潜在生物学指标。方法1.选取首发精神分裂症患者82例,入组后单一使用奥氮平治疗4周,分别在治疗前和治疗4周末评定阳性和阴性症状量表(PANSS)评分。根据PANSS减分率(50%为界)将纳入患者分为A、B两组。同时选取年龄和性别与病例组相匹配的30例健康人群作为对照组。2.入组后抽取所有受试者外周静脉血5ml,病例组治疗4周后再次采取外周静脉血5ml,分离、分装血浆,保存于-70℃冰箱备用。使用酶联免疫吸附法(ELISIA)检测所有参与者血清TGF-β1、IL-1β、IL-6、IL-17水平,乳酸增强免疫比浊法检测hs-CRP水平。3.应用统计学软件SPSS19.0进行数据处理,以均数±标准差((?)+s)表示计量资料,以配对样本t检验或独立样本t检验比较相应组别间的差异,记P0.05为有统计学差异。结果1.82例患者治疗前PANSS评分为88.34±11.50,治疗后降为67.15±18.69;其中有42例PANSS减分率50%(A组);40例PANSS减分率≥50%(B组)。2.治疗前患者组5种炎性因子水平均显著高于健康对照,差异有统计学意义(P0.05);治疗4周后hs-CRP水平显著升高,差异有统计学意义(P0.05);与治疗前相比,治疗后TGF-β1水平无显著变化(P0.05),IL-1β、IL-6、IL-17水平显著降低,差异均有统计学意义(P0.05)。3.治疗4周后,A、B 2组患者血清hs-CRP水平均较治疗前显著升高,差异有统计学意义(P0.05),IL-1β、IL-6、IL-17均较治疗前显著下降,差异有统计学意义(P0.05);A组患者治疗后血清IL-1β、IL-6、IL-17水平较B组低,差异有统计学意义(P0.05)。结论1.精神分裂症患者外周存在着免疫异常现象,而抗精神病药奥氮平能够改善这一异常现象。2.精神分裂症患者血清hs-CRP、TGF-β1可能不是评估精神分裂症临床疗效的炎性标记物。3.IL-1β、IL-6、IL-17可作为评估患者临床疗效的潜在生物学指标。
[Abstract]:Background schizophrenia is a complex clinical syndrome, the etiology of which has not been fully elucidated by researchers. The immune inflammation hypothesis is one of the most important etiological theories of schizophrenia, which is based on the elevated levels of multiple inflammatory cytokines (i.e., immune activation) in patients with schizophrenia. High sensitive C-reactive protein (hs-CRP), transforming growth factor- 尾 1 (TGF- 尾 1), interleukin-1 尾 (IL-1 尾), interleukin-6 (IL-6) and interleukin-17 (IL-17) are common inflammatory cytokines in human body. Comparing their differences among different groups of patients is helpful to elucidate the effect of immune inflammation on the outcome of schizophrenia. Objective 1. To observe the changes of peripheral inflammatory cytokines in patients with first-episode schizophrenia before and after treatment, to explore the changes of peripheral cytokines, and to enrich the clinical evidence of immune inflammation hypothesis of schizophrenia. To compare the level of inflammatory cytokines in different clinical efficacy patients, and analyze the clinical significance of the differences, and obtain the potential biological indicators to evaluate the clinical efficacy of schizophrenia. Method 1. 82 patients with first-episode schizophrenia were treated with olanzapine alone for 4 weeks. The positive and negative symptom scale (PANSS) scores were assessed before and after treatment for 4 weeks. Patients were divided into two groups according to PANSS score reduction rate (50%). At the same time, the age and gender matched with the case group of 30 healthy people as the control group. 2. 2. The peripheral venous blood was collected from all the subjects at 5 ml after treatment for 4 weeks. The peripheral venous blood was separated and divided into plasma and stored in the refrigerator at -70 鈩，

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