早发性精神分裂症谱系障碍的临床特征及疗效分析

Clinical features and therapeutic effects of early onset schizophrenia spectrum disorder

目的 探索早发性精神分裂症谱系障碍（early onset schizophrenia spectrum,EOS）患儿的临床特征及疗效,并比较儿童阶段起病的精神分裂症谱系障碍（child onset schizophrenia,COS）与青少年阶段起病的精神分裂症谱系障碍（adolescent onset schizophrenia,AOS）患儿的差异.方法 对2006-2012年在我院住院患儿的病例资料进行回顾性分析,了解EOS患儿的一般特征、病前情况、临床表现和治疗效果;根据起病年龄分为≤13岁儿童阶段起病组（COS组,n=113）和＞13岁青少年阶段起病组（AOS组,n=192）,卡方检验比较2组特征差异;通过相关分析和Logistic回归分析影响EOS患儿疗效的因素.结果 30.8％（94/305）EOS患儿的家庭成员存在精神异常;最常见的症状依次为幻觉、妄想、思维形式障碍;首次住院治疗显效率为71.3％（216/303）.COS组生长发育存在异常的比率（21.2％,24/113）高于AOS组（11.5％,22/192; x2=5.31,P=0.030）,妄想症状发生率（61.9％,70/113）低于AOS组（74.0％,142/192;x2=4.84,P=0.029）,治疗显效率（64.3％,72/112）低于AOS组（75.4％,144/191,x2=6.63,p=0.034）;Logistic回归分析显示,孤独退缩的临床表现和存在精神发育迟滞或Asperger综合征的发育性基础疾病是EOS治疗效果的风险因素（x2=31.63,P＜0.01）.结论 儿童阶段起病患儿存在更多的发育性异常,疗效较青少年阶段起病更差;孤独退缩和存在神经发育异常基础是疗效不佳的风险因素.

Objective To explore the features of early onset schizophrenia spectrum disorder （EOS）,and also the difference between childhood onset schizophrenia spectrum disorder （COS） and adolescent onset schizophrenia spectrum disorder （AOS）.Methods A retrospective analysis on demographic feature,pre-morbid situation,clinical characteristics and curative effect,was conducted based on the history review of EOS patients in children and adolescent department from 2006 to 2012,the differences between COS subgroup （≤13 ys,n=113） and AOS subgroup （＞13 ys,n=192）,were compared by t-test and Chi-square.Correlation analysis and logistic regression were used to explore the risk factor for curative effect of EOS.Result 30.8％ （94/305） of EOS children had a history of psychosis in their family members; the most common symptoms in EOS included hallucination,delusion,and formal thought disorder in order; the rate of significantly improved in first episode psychosis in in-patient clinic was 71.3％ （216/303）.Abnormal development history was more common in COS （21.2％,24/113） than it in AOS （11.5％,22/192;x2=5.31,P=0.030）,while the symptom of delusion （61.9％ （70/113） vs.（142/192） ; x2=4.84,P=0.029）and the rate of significantly improved（64.3％（72/112） vs.75.4％（144/191）,x2=6.63,P=0.034）were significantly higher in AOS than it in COS.When significantly improved was designated as 1 and without significant improvement was designated as 0,social withdrawal and comorbidity with mental retardation or Asperger syndrome,fit the logistic regression equation very well （x2=31.63,P＜0.01）,were risk factors for curative effect of EOS.Conclusion The curative effect of COS is probably not as good as AOS.Much more abnormal development history is in COS,which may suggest a more significant biological basis in COS.Social withdrawal and comorbidity with neurodevelopmental disorder may be the risk factors in prognosis of EOS.