三种不同情况强迫症状的临床特点及全血5-羟色胺浓度的比较研究

Study on clinical characteristic and whole-blood serotonin concentration of obsessive-compulsive symptoms in three different conditions

目的比较强迫症、精神分裂症伴有的强迫症状和精神分裂症经氯氮平治疗导致的强迫症状等3组不同患者在症状学和全血5-羟色胺(5-HT)浓度方面的差异,探讨强迫症状与5-HT异常间的关系。方法对强迫症、伴强迫症状的及氯氮平治疗导致强迫症状的精神分裂症各15例,不伴强迫症状的(19例)以及氯氮平治疗未导致强迫症状的精神分裂症组(15例)使用Yale-Brown强迫量表(YBOCS)、汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)及阳性和阴性症状量表(PANSS)进行临床症状评定;采用高效液相色谱法检测上述5组和正常组(15例)的全血5-HT浓度。结果强迫症和精神分裂症伴有的强迫症状中强迫思维和行为均多见,而氯氮平导致的强迫症状则以强迫行为为主。有无强迫症状的精神分裂症组比较,后者的PANSS阳性量表分低,HAMA评分高(P<0.05)。有强迫症状的3组患者的全血5-HT浓度均低于无强迫症状的3组(正常组,精神分裂症不伴强迫症状组和氯氮平治疗未导致强迫症状组)(P<0.05),并且全血5-HT浓度和这3组的YBOCS分,强迫思维评分及强迫行为评分均无显著相关性。结论强迫症状在强迫症和精神分裂症中存在着症状学差异;5-HT功能低下可能是这三种强迫症状产生的共同生化机制之一。

Objective To explore the differences of symptoms and whole-blood serotonin concentration among patients with obsessive-compulsive disorder （OCD）, schizophrenia with obsessive-compulsive symptoms （OCSs） （S ＋ OCSs） and schizophrenia with OCSs caused by clozapine-treated （ CLZ ＋ OCSs）. Methods The subjects were 35 OCD patients, schizophrenic patients with （15） and without （19） OCSs （S-OCSs）, schizophrenic patients with （15） and without （15） OCSs caused by clozapine-treated （CLZ-OCSs） and 15 healthy controls. All the patients were assessed with Yale-Brown Obsessive-Compulsive Scale （YBOCS）, Hamilton Anxiety Scale （HAMA）, Hamilton Depression Scale （HAMD） and Positive and Negative Symptom Scale （PANSS）. Whole-blood serotonin concentrations of all the patients and healthy controls were detected with high performance liquid chromatography. Results S ＋ OCSs patients showed similar level of obsessions and compulsions compared to the patients with OCD. However, CLZ ＋ OCSs patients suffered from dominant compulsions but fewer obsessions compared with the OCD and S ＋ OCSs patients. Schizophrenic patients with OCSs （ S ＋ OCSs and CLZ ＋ OCSs） had lower P score than those without OCSs （S-OCSs and CLZ-OCSs）, and higher HAMA score than the latter （P 〈 0. 05 ）. OCD, S ＋ OCSs and CLZ ＋ OCSs groups had significantly lower whole-blood serotonin concentration than did the healthy controls, S-OCSs and CLZ-OCSs groups （ P 〈 0. 05 ）. Moreover, no significantly correlation existed between the whole-blood serotonin levels and YBOCS scores, obsessions scores and compulsion scores in the three groups with OCSs, respectively. Conclusions OCSs in OCD, schizophrenia have symptomatic differences. It suggests that alterations in serotonin metabolism may be common biological mechanisms underlie OCSs.