精神分裂症神经内分泌激发试验研究

Paroxetine induced neuroendocrine changes and psychopathology of schizophrenia

目的： 通过神经内分泌激发实验， 探讨慢性精神分裂症中枢５－ＨＴ功能状态。 方法：对７８例精神分裂症、１８ 例正常对照进行帕罗西汀激发实验研究， 以皮质醇和催乳素作为激发实验的应答指标。同时， 对病人进行阳性和阴性症状评定量表 （ＰＡＮＳＳ） 测查。 结果： 治疗前精神分裂症组催乳素基础值明显低于对照组， 帕罗西汀激发实验后催乳素释放增高， 曲线下面积 （ＡＵＣ） 与对照组无显著差异。病人治疗前皮质醇基础值明显高于对照组，帕罗西汀激发试验后各点水平均显著高于对照组， ＡＵＣ显著高于对照组。同时， 皮质醇ＡＵＣ与ＰＡＮＳＳ总分明显正相关。 结论： 精神分裂症可能存在５－ＨＴ能功能亢进或受体敏感性增强；而且精神分裂症中枢５－ＨＴ功能异常可能与精神症状存在显著的相关性， 尤其是阴性症状可能与５－ＨＴ功能亢进有关。

Objective:To study the central sertoninergic function and its relationship with the psychopathology of schizophrenia. Method:A paroxetine induced cortisol and prolactin response test was conducted in 78 inpatients with diagnosis of schizophrenia and 18 normal control subjects.The positive and negative symptoms were measured with the PANSS and SANS. Results:A significantly decreased paroxetine induced cortisol response and a trend to towards significant decrease in prolactin response were noted in the schizophrenic group. There was also a significant increase in the baseline plasma cortisol level and a marked decrease in the baseline prolactin level in the patient group compared with control.Correlation analysis revealed a significant positive relationship between the area under curve (AUC) of cortisol and PANSS total score. Conclusion:The current study suggests a disturbance of neuroendocrine function,mediated by central serotonergic dysfunction, in schizophrenic patients. The significant association between neuroendocrine disturbance and severity of psychopathology further suggests that the schizophrenic symptoms,especially the negative ones,may be related to serotonergic hyperactivity.