【作者】 王磊；

【导师】 周晓琴；

【作者基本信息】 安徽医科大学 ， 精神病与精神卫生学， 2021， 硕士

【摘要】 目的:探讨慢性精神分裂症伴发高同型半胱氨酸血症患者认知功能障碍的特点。方法:共纳入2019年6月～2020年11月在安徽医科大学附属巢湖医院精神科封闭病房内住院的,疾病符合《疾病和有关健康问题的国际统计分类》第10版(ICD-10)中精神分裂症的诊断标准的患者162例,使用全自动生化分析仪检测所有患者的血浆同型半胱氨酸(Hcy)水平,根据血浆Hcy水平检测结果将所有患者划分为伴发高同型半胱氨酸血症(HHcy)的患者组(即共病组)83例,和不伴发高同型半胱氨酸血症的患者组(即单病组)79例。所使用的量表包括自编调查问卷、阳性和阴性症状量表(PANSS)和重复性成套神经心理状态测验(RBANS)。采用PANSS量表评定患者的临床精神症状,采用RBANS量表评定患者的认知功能,对结果进行统计学分析。结果:1.共病组的PANSS量表阴性症状分和总分高于单病组,差异具有统计学意义(t=-4.166,P<0.001;t=-2.559,P=0.011)。2.共病组的即刻记忆、注意、延时记忆和RBANS量表总分均低于单病组,差异具有统计学意义(t=3.764,P<0.001;t=2.051,P=0.042;t=3.159,P=0.002;t=3.161,P=0.002)。3.经Pearson或Spearman相关分析结果显示,RBANS量表总分与HHcy、年龄、病程、婚姻史、PANSS量表阴性症状分、一般精神病理症状分和总分呈负相关(r=-0.234、-0.297、-0.183、-0.184、-0.305、-0.205、-0.286,P<0.05或P<0.01),与受教育年限呈正相关(r=0.249,P<0.01)。4.经多元线性回归分析结果显示,慢性精神分裂症患者的认知功能受HHcy影响,具体为HHcy与即刻记忆(β=-0.208,P=0.005)、注意(β=-0.190,P=0.021)、延时记忆(β=-0.200,P=0.008)等认知功能因子分及RBANS量表总分(β=-0.156,P=0.031)相关。此外,慢性精神分裂症患者的临床精神症状也会影响其认知功能,具体为PANSS量表总分与即刻记忆(β=-0.220,P=0.003)、延时记忆(β=-0.223,P=0.003)认知功能因子分及RBANS量表总分(β=-0.263,P<0.001)相关,PANSS量表阴性症状分与视觉广度(β=-0.198,P=0.007)、言语功能(β=-0.290,P<0.001)及注意(β=-0.323,P<0.001)等认知功能因子分相关。结论:伴发HHcy的慢性精神分裂症患者,其临床精神症状较不伴发HHcy的患者更严重,尤其是阴性症状。伴发HHcy的慢性精神分裂症患者,其总体认知功能障碍较不伴发HHcy的患者更严重,主要表现在即刻记忆、注意和延时记忆等方面。慢性精神分裂症患者的认知功能受到HHcy和临床精神症状影响,分别与两者具有一定相关性。更多还原

【Abstract】 Objective:To investigate the characteristics of cognitive impairment in patients with chronic schizophrenia complicated with hyperhomocysteinemia.Method:A total of 162 patients who were hospitalized in the closed ward of the Department of Psychiatry,Chaohu Hospital of Anhui Medical University from June2019 to November 2020,and whose disease diagnosis met the diagnostic criteria of schizophrenia in the 10 th edition of the International Classification of Diseases and Related Health Problems(ICD-10)were enrolled.The plasma homocysteine(Hcy)levels of all patients were detected by automatic biochemical analyzer.According to the results of plasma Hcy levels,the patients were divided into two groups: 83 patients with hyperhomocysteinemia(comorbidity group)and 79 patients without hyperhomocysteinemia(single disease group).The scales used included self-designed questionnaire,Positive and Negative Symptom Scale(PANSS)and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).The Positive and Negative Symptom Scale(PANSS)was used to evaluate the clinical symptoms of the patients,and the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)was used to evaluate the cognitive function of the patients.The results were statistically analyzed.Results:1.The total score of PANSS and the negative symptom in the comorbidity group were higher than those in the single disease group,and the difference was statistically significant(t=-2.559,P=0.011;t=-4.166,P<0.001).2.The total score of RBANS and the immediate memory,attention,delayed memory in the comorbidity group were lower than those in the single disease group,and the difference was statistically significant(t=3.161,P=0.002;t=3.764,P<0.001;t=2.051,P=0.042;t=3.159,P=0.002).3.Correlation analysis showed that the total score of RBANS was negatively correlated with HHcy,age,course of disease,marriage history,negative symptom score,general psychopathological symptom score and PANSS total score(r=-0.234、-0.297、-0.183、-0.184、-0.305、-0.205、-0.286,P<0.05 or P<0.01),and positively correlated with years of education(r=0.249,P<0.01).4.Multivariate linear regression analysis showed that HHcy could affect the cognitive function of patients with chronic schizophrenia,such as HHcy was related to immediate memory(β=-0.208,P=0.005),attention(β=-0.190,P=0.021),delayed memory(β=-0.200,P=0.008)and the total score of RBANS(β=-0.156,P=0.031).In addition,patients’ clinical mental symptoms also affect cognitive function,such as the total score of PANSS is related to immediate memory(β=-0.220,P=0.003),delayed memory(β=-0.223,P=0.003)and total score of RBANS(β=-0.263,P<0.001),while the score of negative symptoms is related to visuospatial constructional(β=-0.198,P=0.007),language(β=-0.290,P<0.001)and attention(β=-0.323,P<0.001).Conclusion:The clinical mental symptoms of chronic schizophrenic patients complicated with HHcy were more serious than those without HHcy,especially negative symptoms.The overall cognitive impairment of chronic schizophrenic patients complicated with HHcy was more serious than that of patients without HHcy,mainly in immediate memory,attention and delayed memory.Cognitive impairment of chronic schizophrenic patients was related to HHcy and clinical mental symptoms.更多还原