急性发作精神分裂症患者血清前炎性因子与临床特征的关系

Relationship between clinical traits and pro-inflammatory factors in acute episode patients with schizophrenia

目的分析血清前炎性因子水平与急性发作精神分裂症患者临床特征间的关系，探索前炎性因子在疾病发生机制中可能的作用。方法共纳入急性发作的精神分裂症患者105例（患者组），健康对照50名（对照组）。采用酶联免疫（ELISA）法检测所有研究对象血清IL-1B、IL-6和TNF—的浓度；使用阳性和阴性症状量表（PANSS）评定患者的精神病理症状。在比较患者组与对照组血清前炎性因子浓度差异的同时，分析其与患者临床特征的关系。结果（1）患者组与对照组相比，血清IL-1β[12.3（2．8，15．0）ng／L比7．9（1．3，9．9）ng／L]、TNF—α[151．6（58．9，186．8）ng／L比108．9（37．0，132．3）ng／L]的差异有统计学意义（P〈0．05）；（2）按照性别、发作次数、病程、家族史、精神病理症状对患者组进行分层，首发患者血清IL－1β、TNF－α[水平高于复发患者；病程小于5年患者血清TNF－α水平高于病程超过5年的患者；家族史阳性患者IL－6水平高于阴性患者；以阳性症状为主患者的TNF—α水平高于以阴性症状为主的患者，差异均有统计学意义（P〈0．05）；（3）患者组血清IL－1β与IL－6（r=0．49，P〈0．01）、TNF－α（r=0．30，P〈0．01）呈正相关；对照组血清IL－1β水平与IL－6（r=0．55，P〈0．01）、TNF—α（r=0．34，P=0．02）呈正相关。结论急性发作的精神分裂症患者存在免疫激活，免疫激活程度与疾病的临床特征有关；免疫异常可能在疾病发生过程中起关键作用。

Objective To explore the role of pro-inflammatory factors in the pathogenesis of schizo- phrenia by analyzing the relationship between clinical traits and pro-inflammatory factors in acute episode patients with schizophrenia. Methods A total of 105 acute-episode schizophrenic patients （patient group） and 50 healthy controls （control group） were enrolled in this study. We detected the serum concentrations of IL-1β , IL-6 and TNF- α of all subjects with enzyme-linked immune-sorbent assay （ELISA）. The Positive and Negative Symptom Scale （PANSS） was used to assess the psychiatric symptoms of patients. The serum levels of pro-inflammatory factors between two groups were compared. And the relationship between pro-inflammatory factors and clinical trait was evaluated. Results （1） Compared with control group, the serum concentrations of IL- β and TNF- α were significant lower in patient group [ 12.3（2.8, 15.0）ng/L vs 7.9（1.3, 9.9）ng/L, 151.6（58.9,186.8）ng/L vs 108.9（37.0,132.3）ng/L, P 〈 0.05 1. （2） After stratification, we analyzed the effects of sex, attack times, duration of illness, family history, and psychiatric symptoms on IL-β , TNF- α and IL-6. Compared with relapsed patients, first-episode schizophrenic patients had significant higher levels of IL-1 β and TNF- α. Patients with duration of illness more than 5 years expe- rienced significant higher concentrations of IL-6 and TNF- α, as compared to those with less than 5 years＇ duration. Serum level of IL-6 in patients with positive family history and that of TNF- α in patients with significant positive symptoms were higher than their counterparts separately （P 〈 0.05）. （3） In patient group, serum level of IL- β showed significant positive correlation with that of IL-6 （r=0.49, P 〈 0.01）and TNF-α （r=-0.30, P 〈 0.01）. And in control group, serum level of IL- β also showed significant positive correlation with that of IL-6 （r=-0.55, P 〈 0.01） and TNF-α （r=0.34, P=0.02）. Conclusions Immune activation is experienced in acute-episode schizophrenic patients. The degree of immune activation is associated with patients＇ clinical traits. Immune abnormality might be involved in the pathogenesis of schizophrenia.