吸烟对精神分裂症男性患者精神病理症状的影响

Effects of cigarette smoking on psychopathologic symptoms in male patients with schizophrenia

目的分析吸烟对精神分裂症临床精神病理症状的影响，探索精神分裂症患者高比例吸烟的原因。方法收集慢性精神分裂症吸烟患者（332例）和非吸烟患者（95例）共427例，首次发病（以下简称首发）精神分裂症吸烟患者（22例）和非吸烟患者（41例）共63例，均为男性；使用阳性和阴性症状量表（PANSS）评定其临床精神病理症状。结果（1）在慢性精神分裂症患者中，吸烟组PANSS阴性症状分量表中的情感交流障碍得分[（3．9±1．5）分]、被动或淡漠得分[（3．6±1．6）分]及其总分[（24．0±8．2）分]低于非吸烟组[分别为（4．4±1．7）分、（4．0±1．7）分和（26．3±9．5）分；P〈0．05]；PANSS阴性症状分量表7个条目得分及其总分、一般精神病理分量表总分和PANSS总分与患者每天的吸烟量呈负相关（P〈0．05～0．01）；阴性症状分量表中的情感交流障碍[比值比（OR）=0．832，95％可信区间（95％CI）=0．691—0．980，P=0．029]和一般精神病理分量表中的紧张（OR=0．534，95％CI=0．363～0．786，P=0．001）进入Logistic模型。（2）在首发精神分裂症患者中，吸烟组在阴性症状分量表中的情绪退缩得分[（2．7±1．3）分]、被动或淡漠得分[（2．7±1．5）分]低于非吸烟组[分别为（3．5±1．3）分和（3．5±1．4）分；P〈0．05]；一般精神病理分量表中的动作迟缓与患者每天的吸烟量呈负相关，自知力缺乏与吸烟量呈正相关（均P〈0．05）；PANSS一般精神病理分量表中的动作迟缓（OR=0．589，95％CI=0．350～0．989，P=0．045）进入Logistic模型。结论吸烟对阴性症状的正性作用可能是精神分裂症患者高比例吸烟的原因之一。

Objective To compare the differences of psychopathologic symptoms between smokers and non-smokers in chronic and first-episode, drug-naive schizophrenics, then it was attempted to explain the reasons why there is higher rate of smoking behavior in schizophrenia. Methods In all, 427 male chronic schizophrenic patients （332 smokers and 95 non-smokers） and 63 male first-episode drug-naive patients with schizophrenia （22 smokers and 41 non-smokers） were collected. All patients were assessed with the Positive and Negative Syndrome Scale （PANSS）. Results In chronic patients, the item scores of poor rapport and passive/apathetic social withdrawal of PANSS negative subscale were significantly lower in smokers than non-smokers （3.9± 1.5 vs. 4.4± 1.7 ; 3.6 ± 1.6 vs. 4. 0± 1.7, respectively, P 〈 0. 05 ）, and so was the total scores of PANSS negative subscale （24. 0 ± 8.2 vs. 26. 3 ± 9. 5 ）. In first-episode, drug-naive patients, the item scores of emotional withdrawal and passive/apathetic social withdrawal of PANSS negative subscale were significant lower in smokers than non-smokers （2. 7± 1.3 vs. 3.5 ± 1.3 ;2. 7± 1.3 vs. 3.5 ±1.4, respectively, P 〈 0. 05 ）. Conclusion It is suggested there are positive effects of cigarette smoking on the psychopathological symptoms of patients with schizophrenia, which might be one of the mechanisms for higher rates of smoking behavior in schizophrenia.