精神病临床高危综合征与首发精神分裂症患者的神经认知功能比较研究

Comparative research between cognitive changes in patients at clinical high risk for psychosis and drug-naive first-episode schizophrenia patients

目的 探讨精神病临床高危综合征人群和首发未服药精神分裂症（First-episode Drug-naive Schizophrenia,FES）患者的神经认知功能特征.方法 应用中文版精神病高危综合征定式访谈（SIPS）收集精神病高危综合征人群46例,采用Matrics成套认知功能测试（MCCB）中文版评估认知功能,并与20例FES患者和37例健康对照进行比较分析.结果 除情绪管理分测验外,MCCB的其他8项分测验结果在三组之间差异均有统计学意义,包括连线（F=5.76,P=0.00）、符号编码（F=19.82,P=0.00）、词语学习（F=10.20,P=0.00）、空间广度（F=5.30,P=0.01）、迷宫（Hc=16.97,P=0.00）、空间记忆（Hc=19.07,P=0.00）、语义流畅（F=9.99,P=0.00）以及持续操作（Hc=15.46,P=0.00）.两两比较发现：两组患者的成绩均显著差于健康对照组;精神病临床高危综合征人群与FES患者相比,词语学习测验分较高（LSD-t=2.60,P=0.01）.结论 精神病临床高危综合征的神经认知功能明显受损,其特征与首发精神分裂症相似.词语学习测验,对于区分精神病临床高危综合征和已经发病的精神分裂症患者,可能具有参考价值.

Objective To investigate the neurocognitive features of clinical high risk patients （CHR）, first-- episode drug-- naive schizophrenia patients （FES）. Methods Forty-- six CHR outpatients who met the Chinese version of Structured Interview for Prodromal Syndromes（SIPS） criteria, 20 FES outpatients who met ICD--10 diagnostic criteria for schizophrenia and 37 health controls underwent MC- CB test using the Chinese version of Matrics Consensus Cognitive Battery. Results Excepting Mayer-- Salovey--Caruso Emotional Intelligence Test Managing Emotions subtest, there were significantly differ- ence among three groups in all 8 MCCB subtests, including Trial- making test （F = 5.76, P = 0.00）, BACS Symbol--coding （F = 19.82,P = 0.00）, Hopkins Verbal Learning Test-- Revised （F = 10.20,P = 0.00）, WMS--Third Edition Spatial Span （F = 5.30,P = 0.01）, Neuropsychological Assessment Bat- tery Mazes （Hc = 16.97,P = 0.00）, Brief Visuospatial Memory Test-- Revised （Hc = 19.07,P = 0.00）, Category Fluency Animal Naming （F = 9.99,P = 0.00） and Continuous Performance Test-- Identical Pairs （Hc = 15.46,P = 0.00）. In the post--hoc analysis, both patient group showed worse performance than healthy controls in MCCB test score. In addition, FES patients had significantly lower score than CHR patients in HVLE--R subtest （LSD-- t = 2.60,P = 0.01）. Conelusions CHR patients have already showed similar neurocognitive impairments with first--episode schizophrenia patients. The verbal learning test may be a marker to distinguish CHR oatients and those onset schizoohrenia patients.