【摘要】 背景:弓形虫感染被认为至少与部分精神分裂症的发生有关,不少临床和实验性研究支持该假说。目的:调查首发精神分裂症患者及其母亲弓形虫抗体阳性率,比较弓形虫抗体阳性与阴性患者在临床表现上的区别。设计:采用成组病例对照观察。单位:武汉大学人民医院精神卫生中心。对象:选择2000-01/2004-12武汉大学人民医院精神科住院600例精神分裂症患者为精神分裂症组,患者家属同意参加此调查。选择同期本院参加健康体检的、无任何躯体疾病和精神障碍的正常人200人为正常对照组。选择本院内外科住院的、精神健康的躯体疾病患者200例为疾病对照组。收集252份精神分裂症患者母亲的血样本。方法:①采用酶联免疫法检测血清样本中弓形虫IgG,IgM抗体的水平。②在患者入院两三天后作30～40min的半结构式晤谈,结合患者家属和管床医师提供的有关资料,记录患者的精神障碍家族史、病程、受教育程度、发病年龄、母亲年龄、居住地区。③精神症状评定采用阳性与阴性症状量表,该量表包括阳性症状量表7项(分别为妄想、概念紊乱、幻觉行为、兴奋、夸大、多疑/被害、敌对性),阴性症状量表7项[分别为情感迟钝、情绪退缩、(情感)交流障碍、被动/淡漠社交退缩、抽象思维困难、交谈缺乏自发性和流畅性、刻板思维]和一般精神病理量表16项(分别为关注身体健康、焦虑、自罪感、紧张、装相和作态、抑郁、动作迟缓、不合作、不寻常思维内容、定向障碍、注意障碍、判断和自知力缺乏、意志障碍、冲动控制障碍、先占观念、主动回避社交),共30项,及3个补充项目(分别为愤怒、延迟满足困难、情感不稳)评定攻击危险性(7项评分:1为无,7为极重度)。④计量资料差异比较采用两样本独立t检验;计数资料差异比较采用χ2检验。主要观察指标:①正常对照组、疾病对照组、精神分裂症组及其母亲弓形虫抗体阳性率比较。②弓形虫抗体阳性组和阴性组患者年龄、教育程度、病程、发病年龄和母亲年龄比较。③弓形虫抗体阳性组患者和阴性组患者精神障碍家族史阳性率、居住地区比例、母亲弓形虫抗体阳性率比较。④弓形虫抗体阳性组和阴性组患者阳性与阴性症状量表评分结果。结果:精神分裂症组600例,正常对照组200人,疾病对照组200例,精神分裂症患者母亲252例,其中抗体阴性组患者母亲206例,阳性组患者母亲46例,均进入结果分析。①正常对照组、疾病对照组、精神分裂症组和精神分裂症患者母亲间IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率差异明显(P<0.01)。②进一步χ2检验表明,正常对照组和疾病对照组IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率差异不明显。③精神分裂症患者母亲IgG抗体阳性率明显高于精神分裂症组和正常对照组+疾病对照组(P<0.05,0.01),精神分裂症组明显高于正常对照组+疾病对照组(P<0.01)。④精神分裂症患者母亲IgM抗体阳性率明显高于精神分裂症组和正常对照组+疾病对照组(P<0.05,0.01),精神分裂症组明显高于正常对照组+疾病对照组(P<0.05)。⑤分裂症患者母亲IgG抗体或IgM抗体阳性率明显高于精神分裂症组(P<0.01)和正常对照组+疾病对照组(P<0.01),精神分裂症组明显高于正常对照组+疾病对照组(P<0.01)。⑥根据患者弓形虫抗体是否阳性分组,IgG抗体或IgM抗体中任一个为阳性则为阳性组(n=99),IgG和IgM抗体均为阴性则为阴性组(n=501)。弓形虫抗体阴性组和阳性组患者年龄、受教育情况、发病时间、病程、母亲年龄相近。⑦弓形虫抗体阴性组患者有精神障碍家族史的比例显著高于弓形虫抗体阳性组患者(P<0.01);弓形虫抗体阳性组患者的母亲IgG抗体阳性率、IgM抗体阳性率、IgG或IgM抗体阳性率均高于阴性组患者(P<0.05～0.01);弓形虫抗体阳性组和阴性组患者阳性与阴性症状量表、阳性症状量表、阴性症状量表、一般精神病理量表总分差异不明显。⑧弓形虫抗体阳性组阳性与阴性症状量表分量表患者兴奋、敌对、装相和作态、意志障碍、冲动控制障碍、愤怒、延迟满足困难得分明显高于弓形虫抗体阴性组(P<0.01);而多疑得分低于弓形虫抗体阴性组(P<0.01)。结论:①弓形虫感染是精神分裂症的重要候选病因。②弓形虫感染与精神分裂症患者年龄、受教育情况、发病时间、病程、母亲年龄关系不大。③未感染弓形虫的精神分裂症患者有精神障碍家族史的更多,感染弓形虫的精神分裂症患者母亲感染弓形虫情况更多见。④弓形虫感染阳性的精神分裂症患者临床表现倾向于兴奋、激越和行为紊乱,对于紊乱性兴奋的精神病患者应注意其是否存在弓形虫感染。更多还原

【Abstract】 BACKGROUND: It is hypothesized that Toxoplasma Gondii (T. gondii) may contribute to the development of partial schizophrenia at least, as is supported by several clinical and laboratory researches.OBJECTIVE: To survey the prevalence of antibodies to T. gondii in patients with first episode of schizophrenia and their mothers and explore the difference in clinical symptoms between seropositive and seronegative schizophrenic patients. DESIGN: A grouped case-control observationSETTING: Department of Psychiatry, Renmin Hospital, Wuhan University.PARTICIPANTS: The schizophrenic group included 600 cases of schizophrenia of first episode, who were hospitalized at the Psychiatry Department, Renmin Hospital, Wuhan University from January 2000 to December 2004. The patient’s relatives agreed to participate in the investigation. The normal controls included 200 healthy people who came to the hospital to receive health examination and did not have any physical or mental disorders. And 200 inpatients with physical diseases and without mental disorders in the same hospital were chosen to form a physical disease control group. Totally 252 serum samples were collected from the mothers of the schizophrenic patients.METHODS: ① The level of IgG and IgM antibody of T.gondii were tested with ELISA. ②The patients received 30-40 minutes of semi-structured interview after they were admitted to the hospital for 2 or 3 days. Data required for scoring were obtained from the medical team of the inpatients and their families. The patients’ information about family history, course of disease, education, age of onset, age of their mothers and living areas were recorded. ③The psychiatric symptoms of the patients with schizophrenia were scored with the Positive and Negative Syndrome Scale (PANSS). It included seven items of the positive subscale (delusions, conceptual disorganization, hallucinatory behavior, excitement, grandiosity, suspiciousness/ persecution, and hostility); seven items of the negative subscale (blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking, lack of spontaneity and flow of conversation, and stereotyped thinking); sixteen items of the general psychopathology subscale (somatic concern, anxiety, guilt, tension, mannerisms and posturing, depression, motor retardation, uncooperativeness, unusual thought content, disorientation, poor attention, lack of judgment and insight, disturbance of volition, poor impulse control, preoccupation, and active social avoidance); and three complementary items (anger, difficulty in delaying gratification, affective lability) to assess the risk of attack. Seven-grade scores were used, with 1 representing none and 7 representing very severe in the severity of symptoms. The evaluation was carried out in the ward on the admitted day of the patients . ④Independent t-test was used for continuous numerical variables, and chi-squared test was used for qualitative data.MAIN OUTCOME MEASURES: ① The rates of seropositivity to antibody to T. gondii in the normal control group, the physical disease control group, the schizophrenic group and the mother group were compared. ②The age, educational years, disease of course, age of onset, age of the mothers in the seropositive and seronegative schizophrenic patients were compared.③The rate of positive family history of mental disorders, proportion of living areas, the rates of seropositivity to T.gondii in the mothers between the seropositive patients with schizophrenia and the seronegative patients with schizophrenia were compared. ④The scores of PANSS of the seropositive and the seronegative schizophrenic patients..RESULTS: The data of the 600 patients with schizophrenia, 200 normal controls, 200 physical disease controls, 252 mothers of the schizophrenic patients (206 mothers of seronegative schizophrenic patients and 46 mothers of seropositive schizophrenic patients) were analyzed. ① The rate of positive IgG, IgM, IgG or IgM antibody among the normal controls, the physical disease controls, the schizophrenia and the mothers of the patients were different statistically (P < 0.01). ②Further chi-squared tests indicated that there was no statistical difference for IgG, IgM, IgG or IgM seropositive rate between the normal control group and the physical disease patient. ③The IgG seropositive rate in the mothers of the schizophrenic patients was higher than that in the schizophrenic group and the merged control group (the normal control group plus the physical disease patient group) (P < 0.05, 0.01); and the same rate in the schizophrenic group was higher than that in the merged control group (P < 0.01). ④The IgM seropositive rate in the mothers of the schizophrenic patients was higher than that in the schizophrenic group and the merged control group (the normal control group plus the physical disease patient) (P < 0.05, 0.01); and the same rate in the schizophrenic group was higher than that in the merged control group (P < 0.05).⑤ The IgG or IgM seropositive rate in the mothers of the schizophrenic patients was higher than that in the schizophrenic group and the merged control group (the normal control group plus the physical disease patient) (both P < 0.01); and the same rate in the schizophrenic group was higher than that in the merged control group (P < 0.01). ⑥The schizophrenic patients were separated into two groups according to whether they had detectable antibody (IgG or IgM) to T. gondii or not. The patients with detectable IgG or IgM antibody to T. gondii were the positive group (n=99), and the opposite was the negative group (n=501). There was no significant difference in age, education, duration of illness, or age of onset of schizophrenia between the two groups, and so was the age of the mothers of the two groups of patients ⑦ The rate of positive family history of mental disorders In the negative group was higher than that in the positive group (P < 0.01). The rates of IgG, IgM, IgG or IgM seropositive rate in the mothers of the positive group were higher than those in the mothers of the negative group (P < 0.01-0.05). The differences in total score, positive scale score, negative scale score, and general psychopathology scale score of PANSS between the seropositive and seronegative groups were not significant. ⑧ The following scores in the seropositive group were statistically higher than those in the seronegative group (P < 0.01): excitation, hostility, mannerisms and posturin, disturbance of volitio), poor impulse control and anger, difficulty in delaying gratification; and the score of suspiciousness in the seronegative group was lower than that of the seropositive group (P < 0.01). CONCLUSION: ① Toxoplasma infection is an important candidate etiological factor for schizophrenia. ② Toxoplasma infection has no significant correlation with schizophrenic patients’ age, education, age of onset, course of disease and their mother’s age. ③ The rate of positive family history of mental disorders in seronegative schizophrenic patients was higher than that in seropositive patients, and Toxoplasma infection was more common in mothers of schizophrenic patients with Toxoplasma infection. ④ Schizophrenic patients with Toxoplasma infection tend to be excited and agitated with disorganized behavior. For schizophrenic patients with disorganized behavior, attention should be paid to whether they have Toxoplasma infection.更多还原