首发未用药精神分裂症患者血清性激素与精神症状及认知功能的关系

Correlations between hormone levels and psychiatric symptoms as well as cognitive function in drugfree first-episode schizophrenics

目的观察首发未用药精神分裂症患者血清性激素水平及其与阴性症状、阳性症状及认知功能的关系，探讨其在首发精神分裂症患者发病过程中可能发挥的作用。方法收集2015年1—11月就诊于郑州大学第一附属医院精神科的首发未用药精神分裂症患者81例（男39例，女42例）和70名健康对照组（男30名，女40名）。采用放射免疫法测定促卵泡生成素（FSH）、促黄体生成素（LH）、泌乳素（PRL）、雌二醇（E2）、孕酮（PROG）及睾酮（TESTO）的水平，采用精神分裂症认知功能成套测验（MCCB）评估患者认知功能，采用阳性与阴性症状量表（PANSS）评估患者精神症状的严重程度。结果（1）男性患者组血清PRL水平[（24±9）ng／ml]高于健康对照组[（10±3）ng／ml]（P〈0．05），E2[（29±10）ng／ml]、TESTO[（3．2±1．7）ng／ml]水平均低于健康对照组[（35±11）ng／ml]、[（4．4±1．6）ng／ml]（均P〈0．05）；女性患者组血清PRL[（29±16）ng／ml]、TESTO[（0．5±0．4）ng／ml]水平均高于健康对照组PRL[（13±5）ng／ml]、[（0．3±0．1）ng／ml]（均P〈0．05），血清E2水平女性患者组[（51±40）ng／ml]低于健康对照组[（63±66）ng／ml]（P=0．05）。（2）男性患者PRL、E2、TESTO与阴性症状分均负相关（r=-0．478，-0．443，-0．576，均P〈0．05），PRL与阳性症状分负相关（r=-0．542，P〈0．05）；女性患者组PRL与阴性症状分负相关（r=-0．343，P〈0．05），E2与阳性症状分、一般病理分、PANSS总分均负相关（r=-0．351，-0．487，-0．405，均P〈0．05），TESTO与阳性症状分正相关（r：0．445，P〈0．05）；男性患者PRL与认知功能七大领域中的工作记忆（WMSⅢ）P分及推理及问题解决（NAB）P分均负相关（r=-0．384，-0．374，均P〈0．05），E2与信息处理速度（SOP）P分、视觉记忆（BVMT）P分、NABP分均正相关（r=0．379、0．336、0．407，均P〈0．05），TESTO与SOPP分、BVMTP分、NABP分均正相关（r=0．564、0．513、0．552，均P〈0．05）；女性患者组PRL与认知功能七大领域中的WMSP分、NABP分、社会认知（MSCEIT）P分均负相关（r=-0．303，-0．358，-0．368，均P〈0．05），E2与SOPP分、词语学习（HVLT）P分、MSCEITP分均正相关（r=0．376、0．453、0．355，均P〈0．05）。结论下丘脑-垂体-性腺轴（HPG）功能失调可能参与精神分裂症的病理生理过程，早期血清PRL水平升高可能是应激状态下机体的反应，血清PRL、E2、TESTO水平可能是评估早期临床症状严重程度的指标。内源性TESTO、E2可能是认知功能的保护因素，TESTO、E2水平降低是男性精神分裂症患者认知功能损害的危险因素。

Objective To explore hormone such as follicle-stimulating hormone （ FSH）, luteinizing （ LH）, prolactin （ PRL）, estradiol （ E2）, progesterone （PROG） and testosterone （TESTO） levels in first-episode drug-free schizophrenics, and the relationship between clinical symptoms and sex hormones, in order to further study the pathogenesis of schizophrenia. Methods Eighty-one first-episode drug-free schizophrenics including thirty-nine male and forty-two female from First Affiliated Hospital of Zhengzhou University and seventy healthy subjects （thirty male and forty female ） were enrolled. Serum levels of hormone were measured using electrical chemil immunoassay, and Positive and Negative Syndrome Scale （PANSS） was used to evaluate the mental symptoms and Matrics Consensus Cognitive Battery （MCCB） was used to evaluate cognitive function. Results （ 1 ） The serum levels of PRL in male patients group （ （24 ±9） ng/ml） was higher than that of control group （ （ 10 ± 3 ） ng/ml） （P 〈 0. 05 ）, the serum levels of E2, TESTO of male patients group （ （29 ± 10） ng/ml）, （ （3.2±1.7） ng/ml） was lower than that of control group （ （35 ± 11 ） ng/ml）, （ （4. 4 ± 1.6） ng/ml） （ P 〈 0. 05 ） ; The serum levels of PRL, TESTO of female patients group （ （29 ± 16） ng/ml）, （ （0. 5±0.4） ng/ml） were dramatically higher than that of control group （ （ 13± 5 ） ng/ml）, （ （0. 3 ± 0. 1 ） ng/ml） （ P 〈 0. 05 ）, the serum levels of E2 of female patients group （ （51 ±40） ng/ml） was lower than that of control group （ （63 ±66） ng/ml） （P = 0. 05）. （2） The serum levels of PRL, E2, TESTO in male patients group were negatively associated with negative symptoms （ r = - 0. 478, - 0. 443, - 0. 576, P 〈 0. 05）, PRL were negatively related to positive symptoms （r = - 0. 542, P 〈 0. 05 ） ; In female patients group, the serum levels of PRL were negatively associated with negative symptoms （ r = - 0. 343, P 〈 0. 05 ）, the serum levels of E2 was negatively related to positive symptoms, general psychopathology grade, total PANSS grade （ r = - 0. 351, - 0. 487, - 0. 405, P 〈 0. 05 ）, TESTO had a positive correlation with positive symptoms （ r = 0. 445, P 〈 0. 05 ）. （3） In male patients group, PRL had an negative correlation with working memory P point, reasoning and problem solving P points （ r = - 0. 384, - 0. 374, P 〈 0. 05）, the serum levels of E2 was positively related to Information processing rate P points, Visual memory P points, Reasoning and problem solving P points （ r = 0. 379, 0. 336, 0. 407, P 〈 0. 05 ）, TESTO had a positive correlation with Information processing rate P points, Visual memory P points, Reasoning and problem solving P points （r = 0. 564, 0. 513, 0. 552, P 〈 0. 05 ）. In female patients group, PRL had an negative correlation with working memory P point, Reasoning and problem solving P points and social cognition P points （ r = - 0. 303, - 0. 358, - 0. 368, P 〈 0.05 ）, the serum levels of E2 was positively related to working memory, Reasoning and problem solving P points, social cognition P points （r = 0. 376, 0. 453, 0. 355, P 〈 0. 05）. Conclusions Our study shows that first- episode drug-free schizophrenics have hormone secretion abnormal, which suggests that hypothalamus- hypophysis-gonad axis may probably involve in physiopathologic mechanism of first-episode medicine-free schizophrenics. Slightly elevated serum PRL level may be the reaction of stress response in first-episode medicine-free schizophrenics. Endogenous testosterone and estradiol may protect cognitive function against recession, and declining of testosterone and estradiol in blood is the hazards of cognitive dysfunction in first- episode drug-free male schizophrenics. PRL, E2, TESTO may be one of the measurements of the severity of clinical symptoms.