首发精神分裂症患者血清高同型半胱氨酸水平与认知功能损害的相关性

Correlation between high homocysteine levels and cognitive dysfunction in first-episode schizophrenia

目的探讨首发精神分裂症患者血清同型半胱氨酸(Hcy)水平与认知功能的相关性。方法选取155例首发精神分裂症患者(患者组)和同期正常健康对照者(对照组)82例,患者组于入组时及入组后第12周末测定叶酸、维生素B12和Hcy浓度(根据患者组血清Hcy值>15μmol/l定为高Hcy组),采用阳性和阴性综合征量表(PANSS)评定精神症状,认知功能采用威斯康星卡片分类测验(WCST)和连续作业测验(CPT)评定执行功能和注意力,对照组仅在入组时进行上述的各项测定。结果入组时及入组后第12周末患者组血清Hcy高于对照组(P<0.05)。入组时及入组后第12周末患者组WCST与CPT的各因子分值均差于对照组(P<0.05)。高Hcy患者组的WCST及CPT的各因子分的差值均差于正常Hcy患者组(P<0.05)。相关性比较显示,患者组血清Hcy水平与PANSS阴性分、WCST的分类数、正确应答数及CPT的正确反应数呈负相关(P<0.05),与WCST的错误应答数、持续错误数和CPT的遗漏错误数呈正相关(P<0.05)。结论首发精神分裂症患者存在血清Hcy水平升高和认知功能的损害,且高Hcy与执行功能和注意力存在有一定的相关性。

Objective To explore the correlation between serum homocysteine（ Hcy） level and cognitive function in patients with first-episode schizophrenia. Methods A total of 155 patients with first-episode schizophrenia（ study group） and 82 healthy controls（ control group） were recruited. Patients in study group were measured to detect serum level of folic acid,vitamin B12,homocysteine（ serum level of Hcy 15 μmol / l was defined as high Hcy group）,and were assessed with Positive and Negative Syndrome Scale（ PANSS）,Wisconsin Card Sorting Test（ WCST） and Continuous Performance Test（ CPT） at baseline and after 12 weeks. These assessments were conducted only at baseline in control group. Results Serum level of Hcy at baseline and at the endpoint in study group were significantly higher than those in control group（ P〈0. 05）. All factor scores in WCST and CPT at baseline and at the endpoint in study group were significantly lower than those in control group（ P〈0. 05）. The decrease of scores of WCST and CPT in patients with high Hcy level were significantly lower than those in patients with low Hcy level（ P〈0. 05）. Correlation analysis showed that serum level of Hcy in study group was negatively correlated with factor score of negative symptoms in PANSS,number of classification and correct response in WCST,number of correct response in CPT（ P〈0. 05）,and was positively correlated with error response,continuous errors in WCST and missing errors in CPT（ P〈0. 05）. Conclusion There are serum high Hcy level and cognitive impairment in patients with first-episode schizophrenia,and high Hcy level is correlated with executive function and attention to a certain extent.