双相Ⅰ型障碍不同疾病状态认知功能与氧化应激相关分析

Correlation between cognitive function and oxidative stress in different disease states of bipolar disorder type Ⅰ

目的探讨双相Ⅰ型障碍患者不同疾病状态下认知功能与氧化应激生化指标的相关关系。方法纳入双相Ⅰ型障碍的稳定期患者83例、躁狂期患者42例、抑郁期患者21例及正常对照115名,采用中文版重复性神经心理测查系统(repeatable battery for the assessment of neuropsychological status,RBANS)评估认知功能,检测外周血生化指标超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-PX)、过氧化氢酶(catalase,CAT)、丙二醛(malonaldehyde,MDA)、总抗氧化能力(total antioxidant capacity,T-AOC)、一氧化氮(nitric oxide,NO)水平。结果双相稳定期组、躁狂期组、抑郁期组的即刻记忆、言语功能、注意、延时记忆评分及认知总分均低于对照组(P<0.01);躁狂期组、抑郁期组的视觉广度评分低于对照组(P<0.01),注意评分与认知总分均低于稳定期组(P<0.01);抑郁期组患者的延时记忆评分低于稳定期组(P=0.04)。躁狂期组、抑郁期组患者的MDA水平高于稳定期组(P<0.05);躁狂期、抑郁期、对照组NO水平高于稳定期组(P<0.05),CAT水平低于稳定期组(P<0.05)。双相稳定期组的视觉广度(r=-0.50,P=0.04)、注意(r=-0.67,P<0.01)、延时记忆(r=-0.61,P=0.01)与GSH-PX均呈负相关,延时记忆与T-AOC呈负相关(r=-0.54,P=0.03);双相躁狂期组的言语功能与SOD呈负相关(r=-0.46,P=0.01);双相抑郁期组的即刻记忆与NO呈正相关(r=0.61,P=0.02),延时记忆与CAT呈正相关(r=0.67,P=0.01),言语功能(r=-0.76,P<0.01)、认知总分(r=-0.59,P=0.03)与GSH-PX呈负相关。结论双相障碍患者存在不同程度的认知功能下降及氧化应激改变,部分抗氧化酶系统与认知功能具有相关性。

Objective To explore the relationship between cognitive function and oxidative stress biochemical markers in patients with bipolar disorder.Methods One hundred forty-six patients who met the DSM-Ⅳ bipolar disorder diagnostic criteria including 83 patients with stable phase,42 patients with manic episodes and 21 patients with depression and 115 normal controls were recruited.Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function.Biochemical indicators were measured including superoxide dismutase (SOD),glutathione peroxidase (GSH-PX),catalase (CAT),malonaldehyde (MDA),total antioxidant capacity (T-AOC) and nitric oxide (NO).Results The immediate memory,speech function,attention,time-delay memory,and total score of patients in biphasic stable phase,manic phase,and depression were lower than those in the control group (P<0.01).The visual breadth scores of patients in manic and depression were lower than those in the control group (P<0.01),and the attention scores and total scores were lower than those in the stable group (P<0.01).The delayed memory score of patients with depression was lower than that of stable group (P=0.04).The MDA level of patients with manic episode and depression was higher than that of stable group (P<0.01);the level of NO in manic,depression and control group was higher than that in stable group,and CAT level was low in the stable phase group (P<0.05).In the stable phase group,the visual breadth (r=-0.50,P=0.04),attention (r=-0.67,P<0.01),delayed memory (r=-0.61,P=0.01) were correlated with GSH-PX respectively;time-delay memory was negatively correlated with T-AOC (r=-0.54,P=0.03).The speech function of the biphasic mania phase group was negatively correlated with SOD (r=-0.46,P=0.01).The immediate memory of the biphasic depression group was positively correlated with NO (r=0.61,P=0.02);delayed memory was positively correlated with CAT (r=0.67,P=0.01);speech function (r=-0.76,P<0.01) and cognitive total score (r=-0.59,P=0.03) were negatively correlated with GSH-PX.Conclusion Patients with bipolar disorder have varying degrees of cognitive decline and oxidative stress changes,and some antioxidant enzyme systems are associated with cognitive function.