【摘要】 目的 探讨不同性质或不同来源的童年期应激是否与精神分裂症不同症状维度之间具有特异性的关联。方法 我们在106名精神分裂症患者和56名健康对照中使用儿童期虐待问卷（CTQ）、童年期社会挫败问卷（CSDQ）、社会支持评定量表（SSRS）及罗森伯格自尊量表（Rosenberg self-esteem scale,SES）对童年期经历的不同来源和性质的创伤或应激进行了全面评定，同时使用阳性和阴性症状量表（PANSS）评定患者的临床症状，从而探讨与精神分裂症阳性症状、阴性症状和一般病理症状关系最密切的童年期应激类型。结果 患者组在所有不同性质、来源童年期应激维度上的评分均高于对照组（P<0.001）；在不同应激维度与症状的特异性关联方面发现与阳性症状显著相关的应激维度包括：CTQ中的性虐待（SA,r=0.266,P<0.01）,CSDQ总分（r=0.240,P<0.05）及其中的社会地位挫败（r=0.247,P<0.05）、家庭关系挫败（r=0.233,P<0.05）；与阴性症状显著相关/负相关的应激维度包括：CTQ总分（r=0.198,P<0.05）及其性虐待（SA,r=0.218,P<0.05）,CSDQ中的社会地位挫败（r=0.193,P<0.05）,SSRS得分（r=-0.279,P<0.01）,SES得分（r=-0.242,P<0.05）；与一般病理症状显著相关/负相关的应激维度包括：CTQ总分（r=0.239,P<0.05）及其躯体忽视（PN,r=0.264,P<0.01）、SA(r=0.211,P<0.05),CSDQ总分（r=0.248,P<0.05）及其中的中的社会交往挫败（r=0.246,P<0.05）,SSRS得分（r=-0.207,P<0.05）,SES得分（r=-0.208,P<0.05）;PANSS总分则与除CTQ中的躯体虐待、情感虐待和情感忽视外的大部分童年期应激维度呈显著负相关。结论 不同性质与来源的童年期应激维度可能通过不同的机制导致不同的精神分裂症症状易感性，即：家庭关系挫败可能特异性导致阳性症状；躯体忽视和社会交往挫败可能特异性导致一般病理症状；社会地位挫败使个体对阳性和阴性症状更易感；SA使个体对精神分裂症症状全面易感。本研究结果有助于精神分裂症的发病机制研究及个体化干预。更多还原

【Abstract】 Objective To investigate whether childhood stress of different nature or from different sources is specifically associated with different dimensions of schizophrenia symptoms. Methods We comprehensively assessed childhood trauma or stress from different sources and natures in 106 schizophrenia patients and 56 healthy controls using the Childhood Trauma Questionnaire(CTQ),Childhood Social Defeat Questionnaire(CSDQ),Social Support Rating Scale(SSRS),and Rosenberg Self-Esteem Scale(SES). Concurrently,we assessed the clinical symptoms of patients using the Positive and Negative Syndrome Scale(PANSS)to explore the types of childhood stress most closely related to positive symptoms,negative symptoms,and general pathological symptoms of schizophrenia. Results The patient group scored higher than the control group on all dimensions of childhood stress of different natures and sources(P<0.001). In terms of the specific correlation between different stress dimensions and symptoms,significant correlations were found between the following stress dimensions and positive symptoms:sexual abuse in CTQ(SA,r=0.266,P<0.01),total score of CSDQ(r=0.240,P<0.05) and its components of social status defeat(r=0.247,P<0.05),and family relationship defeat(r=0.233,P<0.05). Stress dimensions significantly correlated/negatively correlated with negative symptoms included:total score of CTQ(r=0.198,P<0.05)and its sexual abuse(SA,r=0.218,P<0.05),social status defeat in CSDQ(r=0.193,P<0.05),SSRS score(r=-0.279,P<0.01),SES score(r=-0.242,P<0.05). Stress dimensions significantly correlated/negatively correlated with general pathological symptoms included:total score of CTQ(r=0.239,P<0.05)and its physical neglect(PN,r=0.264,P<0.01),SA(r=0.211,P<0.05),total score of CSDQ(r=0.248,P<0.05)and its social interaction defeat(r=0.246,P<0.05),SSRS score(r=-0.207,P<0.05),SES score(r=-0.208,P<0.05). The PANSS total score was significantly negatively correlated with most childhood stress dimensions except for physical abuse,emotional abuse,and emotional neglect in CTQ. Conclusion Childhood stress dimensions of different natures and sources may lead to different susceptibilities to schizophrenia symptoms through different mechanisms,namely:family relationship defeat may specifically lead to positive symptoms;physical neglect and social interaction defeat may specifically lead to general pathological symptoms.Social status defeat makes individuals more susceptible to positive and negative symptoms. SA makes individuals susceptible to comprehensive schizophrenia symptoms. The results of this study contribute to the research on the pathogenesis of schizophrenia and personalized interventions.更多还原