精神分裂症患者血浆高香草酸浓度与临床症状、性别和药物治疗的关系

Relationship of antipsychotic drug treatment,symptomatology and sex with plasma homovanillic acid in schizophrenia

目的 通过分析精神分裂症患者中枢多巴胺代谢产物 血浆高香草酸浓度 (pHVA)与临床指征的关系 ,进一步探讨多巴胺神经递质及其药物治疗在精神分裂症的作用。方法 在 46例长期药物治疗、5 8例未治疗精神分裂症患者中 ,采用高液相色谱连接电化学分析仪测定pHVA ;测前评定阳性症状量表 (SAPS)和阴性症状量表 (SANS)。结果 (1)与 6 2例健康对照组比 ,治疗组pH VA显著减低 ;未治疗组显著增高 ,以阴性症状组为著。 (2 )未治疗组患者pHVA与SAPS或SANS总分无显著相关 ,但与SANS因子分—兴致、社交缺乏显著正相关 (r=0 32 ,P <0 0 5 ) ;男性患者pH VA与SANS总分显著正相关 (r =0 42 ,P <0 0 5 ) ,而与SAPS因子分 阳性思维形式障碍 (r =-0 5 4,P <0 0 1)和妄想 (r=- 0 5 0 ,P <0 0 1)显著负相关。治疗组pHVA与SANS因子分 思维贫乏(r=0 38,P <0 0 5 )呈正相关。结论 一些主要伴有阴性症状的精神分裂症患者 (男性 )中枢多巴胺转化增强 ,提示多巴胺能神经元活性的改变可能与该病神经发育异常导致的神经病理改变有关 ,且存在性别差异 ;抗精神病药物治疗能减低中枢多巴胺转化 ,从而改善精神症状。

Objective To study the role of dopamine neurotransmission in schizophrenia and its drug treatment by assessing the relationship of plasma homovanillic acid (pHVA),a major central dopamine metabolite to various clinical parameters in schizophrenic patients.Methods pHVA was measured by high-performance liquid chromatography with electrochemical detection in a large cohort of both medicated and unmedicated DSM-IV schizophrenic patients.Prior to the measurement of pHVA,the patients were rated on the Schedule for the Assessment of Positive and Negative Symptoms (PANSS).Results (1)pHVA in 46 patients receiving antipsychotic drugs (7 4±0 4 ng/ml) was significantly decreased,and in 58 drug-free patients (10 1±0 5 ng/ml) significantly increased,compared with a matched control group (8 8±0 4 ng/ml, n =62) (ANOVA F=8 57,df=2, P <0 0001).Within the drug-free group,pHVA was higher in the patients with a more negative symptom profile.(2)No significant correlation of pHVA with overall SAPS or SANS scores was apparent in the drug-free patients although,within the SANS subscales,a significant relationships to anhedonia-asociality (r=0 32, P <0 05)was apparent.The male drug-free patients showed a positive correlation of pHVA with negative symptons (r=0 42, P <0 05),and significant negative correlation with the thought disorder (r=-0 54, P <0 01) and delusions (r=-0 50, P <0 01)subscales of SAPS while females showed no significant relationship with any PANSS subscales.Although there was no significant relationship of total SANS to pHVA within the drug-treated group,a significant correlation with the alogia subscale (r=0 38, P <0 05)was also found that was particularly strong in female patients.Conclusion The results suggest that an increased dopaminergic turnover is apparent in (male) schizophrenic patients with predominantly negative symptoms,providing some support for reports that this change in neuronal activity may be related to the neuropathological abnormalities seen in the disease,which may themselves differ between males and females.Such neuronal deficits of developmental origin may thus result in an elevation/disinhibition of central dopamine metabolism in schizophrenia.