血清蛋白因子对精神分裂症首次发病患者的疗效预测

Serum protein factors and the prediction about treatment effect in first-episode schizophrenia

目的:探讨血清蛋白因子浓度的改变对首次发病精神分裂症患者疗效的预测性。方法:采用酶联免疫吸附技术测定82例首发精神分裂症患者(患者组)在利培酮治疗前后血清脑源性神经营养因子(BDNF)、神经生长因子(NGF)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、钙结合蛋白(S100β)和神经胶质纤维酸性蛋白(GFAP)浓度的变化;并与78名正常者(对照组)进行比较;采用阳性与阴性症状量表(PANSS)于治疗前后评估临床症状的变化并分析血清蛋白因子浓度与PANSS评分之间的相关性。结果:治疗前,患者组血清BDNF浓度(t=-13.75)及NGF浓度(t=-13.76)低于对照组(P均<0.01);IL-6(t=11.46)、TNF-α(t=8.09)、S100β(t=8.58)和GFAP(t=2.95)浓度高于对照组,差异有统计学意义(P均<0.01)。治疗3个月后,患者组血清IL-6(t=4.86)、TNF-α(t=5.29)、BDNF(t=2.43)和NGF(t=5.35)浓度较治疗前下降,差异有统计学意义(P<0.05或P<0.01);而S100β(t=1.73,P=0.09)和GFAP(t=0.75,P=0.46)浓度变化无统计学意义。治疗前,有效组血清BDNF浓度明显高于无效组;治疗后,有效组血清GFAP浓度明显高于无效组(P<0.05)。患者组治疗前后IL-6浓度差与PANSS减分率呈正相关(r=0.41,P<0.01)。结论:较高血清BDNF基线浓度和(或)较高GFAP浓度可能与较好的临床疗效有关;利培酮对疾病的炎性状态可能有抑制或调节作用。

Objective：To investigate the possibility of using six protein factors to predict treatment effect of patients.Method：We analyzed the change of serum levels about brain-derived neurotrophic factor（ BDNF）,nerve growth factor（ NGF）,interleukin-6,（ IL-6）,tumor necrosis factor alpha（ TNF-α）,calcium binding protein（ S100β）,glial fibrillary acidic protein（ GFAP） in 82 patients with first episode schizophrenia before and after the risperidone treatment,and compared with 78 healthy controls（ the control group）.The serum concentration of six kinds of protein factors in 82 patients and 78 healthy controls were assayed by enzyme linked immunosorbent assay（ ELISA） respectively.The change of clinical symptoms before and after the treatment was appraised with the positive and negative syndrome scale（ PANSS）.Further,we analyzed serum levels of protein factors and the relationship to the PANSS score.Results：Before the treatment,the serum concentration of IL-6（ t = 11.46）,TNF-α（ t = 8.09）,S100β（ t = 8.58）,GFAP（ t = 2.95） in first-episode schizophrenia patients is significantly higher than the control group,while the levels of both BDNF（ t =-13.75） and NGF（ t =-13.76）are lower than the controls（ P〈0.01）.Treatment for 3 months,there are no significant differences in the levels of serum S100β（ t = 1.73,P = 0.09） and GFAP（ t = 0.75,P = 0.46）,while the serum IL-6（ t = 4.86）,TNF-α（ t = 5.29）,BDNF（ t = 2.43） and NGF（ t = 5.35） levels are remarkably lower than admission in the schizophrenia patients（ P〈0.05 or P〈0.01）.At baseline,BDNF is prominently lower in non-response patients than in both minimal-improved and much-improved patients.After the treatment,GFAP levels are conspicuously lower in non-response patients than in others（ P〈0.05）.In patients group,the reduction of IL-6 after treatment and PANSS deducted rate were positively correlated（ r = 0.41,P〈0.01）.Conclusion：Higher serum BDNF baseline level and（ or） improving the level of serum GFAP might be associated with better response to treatment.Risperidone may play a role to either suppress or adjust the inflammatory state of disease.