缺陷型及非缺陷型首发精神分裂症患者关联性负变的对照研究

Contingent Negative Variation in First Episode Deficit and Non-Deficit Schizophrenia:A Comparative Study

目的探讨缺陷型与非缺陷型首发精神分裂症患者关联性负变(CNV)的特征及与临床症状的相关性。方法采用Nihon Kohden脑诱发电位仪,运用预警-命令联合刺激序列检测60例非缺陷型首发精神分裂症患者(非缺陷组)、50例缺陷型首发精神分裂症患者(缺陷组)及60名正常对照(对照组)的CNV,并比较3组间差异;采用阳性和阴性症状量表(PANSS)评估患者组精神症状,大体功能评定量表(GAF)评定总体功能;控制性别、年龄、受教育年限,分析CNV同临床特征的相关性。结果同对照组比较,缺陷与非缺陷组的波幅B均降低(F=27.38,P=0.00),反应时间均延长(F=50.30,P=0.00),缺陷组的PINV时程缩短,而非缺陷组的PINV时程延长(F=15.32,P=0.00);同对照组比较,仅缺陷组的A点潜伏期延迟(F=61.01,P=0.00),差异均有统计学意义。3组的A-S2’面积(F=2.34,P=0.10)和PINV面积(F=1.07,P=0.35)比较,差异均无统计学意义。缺陷组的波幅B和PINV时程与其PANSS阴性量表分呈负相关(r=–0.94,–0.89,P<0.05),而非缺陷组的波幅B与其PANSS阳性量表分呈负相关(r=–0.87,P<0.05),PINV时程与其PANSS阳性量表分呈正相关(r=0.88,P<0.05);缺陷组的A点潜伏期与其GAF呈负相关(r=–0.48,P<0.05)。结论缺陷型及非缺陷精神分裂症的CNV均存在异常,前者可能受损更重;缺陷型CNV的A点潜伏期可能可以预测其社会功能。

Objective To detect the contingent negative variation （CNV） in first episode deficit and non-deficit schizophrenia and the relationship between CNV and clinical symptoms. Methods Nihon Kohden evoked brain po- tentials machine were used to measure CNV in 60 patients with non-deficit schizophrenia （NDS）, including 50 patients with deficit schizophrenia （DS） and 60 unrelated healthy controls （HC）. Click-flashing paradigm was used to record the CNV and the differences among three groups were compared. The clinical status of patients with schizophrenia was determined using the Positive and Negative Syndrome Scale （PANSS）. The overall functioning status was assessed using the Global Assessment of Functioning Scale （GAF）. Partial correlations were computed to explore associations among the CNV in DS and the clinical data, controlling the sex, age, and education level. Results Compared to HC, both DS and NDS groups showed significantly reduced amplitude of B （F=27.38, P=0.00）, significantly delayed reaction time （F=50.30, P=0.00）. Compared to HC, the course of PINV in the DS group significantly shortened, while it was significantly delayed in the NDS group （F=15.32, P=0.00）. Only in DS, when compared with that in HC, the latency of point A in CNV was delayed （F=61.01, P=0.00）. There was no significant difference among three groups in both area of A-S2＇ （F=2.34, P=0.10） and area of PINV （F=1.07, P=0.35）. Amplitude of B and the course of PINV in the DS group correlated negatively with PANSS subscale of negative symptoms （r= -0.94, -0.89, respectively, P〈0.05）, whereas in the NDS group amplitude of B correlated negatively with PANSS subscale of positive symptoms （r= -0.87, P〈0.05）, but the course of PINV correlated positively with PANSS subscale of positive symptoms （r=0.88, P〈0.05）. Latency of point A in CNV, which was delayed in the DS group, correlated negatively with GAF （r= -0.48, P〈0.05）. Conclusion Generalized abnormalities of CNV existed in DS and NDS, while DS may cause more impairments in CNV than in NDS. The latency of point A in CNV may predict the social function outcomes of DS.