精神分裂症患者攻击行为与甲状腺激素和皮质醇的相关性

The relationship between aggression and thyroid hormone and cortisol in schizophrenic patients

目的探讨血清甲状腺激素和皮质醇与精神分裂症患者攻击行为的相关性。方法依据既往暴力史和修订版外显攻击行为量表（modified overt aggression scale，MOAS）加权总分将108例急性发作期精神分裂症患者分为攻击组（n=69）和非攻击组（n=39）。比较两组患者入组前及治疗后第2、4周阳性与阴性症状量表（Positive and negative syndrome scale，PANSS）总评分、血清甲状腺激素水平与皮质醇浓度，并对入组前MOAS加权总分及各因子分与甲状腺激素、皮质醇、PANSS总评分及分量表评分之间作相关分析。结果攻击组患者人组前PANSS总评分、阳性症状评分、一般精神病理评分[（94．19±12．71）分、（23．77±4．94）分、（52．61±6．45）分]均高于非攻击组[（83．26±11．21）分、（21．36±7．10）分、（45．49±6．84）分]，均差异有统计学意义（P〈0．05）。治疗后第2、4周两组PANSS总评分比较差异无统计学意义（P〉0．05）。攻击组患者入组前血清游离甲状腺激素（free thyroxine，FT4）水平[（14．41±3．58）pmol／L]高于非攻击组[（12．95±2．66）pmol／L]，差异有统计学意义（P〈0．05）；促甲状腺激素（thyrotropic—stimulating hormone，TSH）、血清游离三碘甲状腺原氨酸（free tniodothyro—nine，FT3）、总三碘甲状腺原氨酸（total triiodothyronine，TT3）和总甲状腺素（total thyroxine，1、T4）水平的比较差异无统计学意义（P〉0．05）。治疗后第2、4周两组患者TSH、FT3、FT4、TT3、TF4水平的比较差异无统计学意义（P〉0．05）。两组患者在人组前，治疗后第2、4周皮质醇浓度比较差异无统计学意义（P〉0．05）。MOAS加权总分与PANSS总评分、阴性症状评分、一般精神病理评分与FT4水平均存在正相关（r值分别为0．471、0．204、0．531、0．239；P〈0．05）。言语攻击与PANSS总评分、刚性症状评分、一般精神病理评分均存在正相关（r值分别为0．213、0．215、0．292；P〈0．05）。自身攻击与PANSS总评分、一般精神病理评分均存在正相关（r值分别为0．278、0．382；P〈0．05）。体力攻击与PANSS总评分、阴性症状评分、一般精神病理评分与FT4水平均存在正相关（r值分别为0．361、0．193、0．338、0．276；P〈0．05）。结论PANSS总评分、阳性症状评分、一般精神病理评分、FT4水平及其变化值能够反映精神分裂症患者攻击行为的严重程度，可以作为精神分裂症患者攻击行为的预测因子。皮质醇浓度与攻击行为不相关，不能作为精神分裂症患者攻击行为的预测因子。

Objective To explore the relationship between aggressive behavior with thyroid hormone or cortisol and in schizophrenic patients. Methods According to the past violence history and modified overt aggression scale（ MOAS）weighted total scores, 108 schizophrenic patients were divided into aggressive group （n=69） and non-aggressive group（ n= 39）. Positive and Negative Syndrome Scale （PANSS） total scores, serum thyroid hormone levels and cortisol concentration were compared between the two groups before and after 2,4 weeks treatment. And correlations of PANSS and sub-scales scores,thyroid hormone levels and cortisol concentration with MOAS weighted total scores and subscales scores were analyzed before these patients receiving treatment. Results Before treatment, total scores of PANSS, positive symptoms and general psychopathology scores in aggressive group（ （ 94.19±12.71 ） , （23.77±4.94） , （ 52.61 ±6.45 ） ） were higher than that in non-aggressive group （（83.26±11.21）, （21.36±7.10）, （45.49±6.84）） and these differences were significant（P〈0.05）. But the difference of PANSS total scores after 2,4 weeks treatment between the two groups was not significant （P〉 0.05 ）. Free thyroxine （ FT4 ） level of aggressive group （ （ 14.41 ±3.58 ） pmol/L） was higher than that of non-aggressive group （ （12.95±2.66） pmo]/L） before treatment and the difference was significant （P〈0.05）. Meanwhile ,there was no significant differences between the two groups in thyrotropic-stimulating hormone （ TSH ）, free triiodothyronine （ FT3 ） , total triiodothyronine （ TT3 ） and total thyroxine （TT4） levels （all P〉0.05 ）. After 2 or 4 weeks treatment, the differences between the two groups in TSH ,FT3 ,FT4, TT3, TT4 levels were not significant （P〉0.05）. The differences between the two groups of cortisol concentration were not significant before and after 2,4 weeks treatment（P〉0.05）. MOAS weighted to- tal scores were positively correlated with PANSS total scores, negative symptoms scores, general psychopathology scores and level of FT4, and their r values were 0.471,0.204,0.531,0.239（ all P〈0.05 ）. Verbal aggression was positively correlated with PANSS total scores, positive symptoms scores and general psychopathology scores, and their r values were 0.213,0.215,0.292 （P〈 0.05 ）. Auto-aggression was positively correlated with PANSS total scores and general psychopathology scores, and their r values were 0.278,0.382（P〈0.05）. Psychical aggression was positively correlated with PANSS total scores, negative symptoms scores, general psy- chopathology scores and level of FT4, and their r values were 0.361,0.193,0.338,0.276 （P〈 0.05 ）. Conclusion The total scores of PANSS, positive symptoms, general psychopathology scores,level of FT4 and their variances can reflect severity of aggression and predict aggressive behavior in schizophrenic patients. Concentration of eortisol is not associated with aggressive behavior and can not be used as a predictor of aggressive behavior in schizophrenic patients.