吸烟对利培酮治疗首发精神分裂症疗效、认知功能的影响

Effects of smoking on the efficiency and cognition of first episode schizophrenia treated with risperidone

目的探讨吸烟对利培酮治疗首发精神分裂症的疗效和认知功能的影响。方法选择符合美国精神障碍诊断与统计手册第4版（DSM-IV）诊断标准的首发精神分裂症住院患者90例，其中吸烟患者27例，非吸烟患者63例，均使用利培酮治疗。详细收集临床资料，使用住院患者烟草使用状态调查表对患者吸烟状况进行详细调查，使用阳性和阴性症状量表（PANSS）评定基线时及治疗12周末的临床症状；威斯康星卡片分类（WCST）、重复性神经心理测查系统（RBANS）对患者在基线时及治疗12周末进行认知功能的检测，分别对吸烟组和非吸烟组的患者治疗前、后临床症状和认知功能变化值进行比较。结果基线时吸烟组患者PANSS总分（91.3±20.9）vs.（80.6±17.2）、阴性症状量表分（20.7±8.6）vs.（17.4±6.3）、一般精神病理症状量表分（43.4±12.3）vs.（38.2±10.8）均高于非吸烟组（均P〈0.05）；非吸烟组的正确应答数高于吸烟组（50.6±18.2）vs.（42.2±14.3），P〈0.05，而错误应答数低于吸烟组（75.5±21.9）vs.（85.3±15.8），P〈0.05。治疗12周末，吸烟组患者阴性症状减分值为（12.2±10.4），非吸烟组（6.1±5.8）两组比较有显著性差异（t=2.7，P〈0.05）；吸烟组患者WCST中完成测查总应答数、错误应答数以及学习到学会的改善值显著高于非吸烟组，差异有统计学意义（t分别为-2.2、-2.1、2.0；P均〈0.05）；RBANS总分及各分量表分的增分值在两组之间差异不显著，无统计学意义（P均〉0.05）。结论吸烟患者临床症状、认知功能受损程度重于非吸烟患者；但是吸烟患者阴性症状、认知功能在治疗后的改善明显好于非吸烟患者。

Objective To explore the effects of smoking on the efficiency and cognitive function of first episode schizophrenia treated with risperidone. Methods 90 first episode schizophrenic inpatients, according to DSM-Ⅳ, were admitted into our study group with risperidone treatment, including 27 smoking patients and 63 non-smoking ones. Smoking status scale was used to investigate the inpatients carefully; Positive And Negative Syndrome Scale （PANSS） was applied to evaluate clinical symptoms; Wisconsin Cards Sort Testing （WCST） and Repeatable Battery for the Assessmental of Neuropsychological Status （RBANS） were used to test cognitive function of patients at pre- and post-treatments for 12 weeks. Then, we compared the various values of symptoms and cognition between smoking and non -smoking patients at pre- and post-treatment. Results Factorial scores of negative symptoms, general psychopathology and total scores of PANSS were significantly higher in smoking group than those in nonsmoking group]-（91.3±20.9）vs. （80.6±17.2）, （20.7±8.6） vs. （17.4±6.3）, （43.4±12.3） vs. （ 38. 2±10.8）, P±0.05 1. Rc （replies correct） and Re （replies error） of WCST were significantly different between smoking and nonsmoking groups]（50.6i18.2） vs. （42.2±14.3）, （75.5±21.9） vs. （85.3! 15. 8）, P 〈 0.05 ]. The reduction of negative symptoms in smoking group is（12.2± 10.4）, and（6.1 ± 5.8） in non-smoking group, there is significant difference between these two groups （t = 2.7,P 0.05）; The improving values of Ra, Re, and L-L% of WCST in smoking group are significant higher than non-smoking group （t = 2.2, - 2.1,2.0;P 〈 0.05） ; however, the increased values of total and sub-scale scores of RBANS show no significant difference between two groups （P 〉 0.05）. Conclusions Psycho-symptoms and cognitive function of smoking patients are impaired more severely than nonsmoking ones. However, after the treatment, the improved of negative symptoms and cognitive function in smoking patients is more significant than non-smoking ones.