阳性和阴性症状为主首发精神分裂症患者血脂水平与认知功能的相关性

The correlation between lipid level and cognitive function in first-episode schizophrenia patients with positive and negative symptoms

目的探讨以阳性和阴性症状为主的首发精神分裂症患者的血脂水平、认知障碍的特点及二者的相关性。方法纳入住院的首发精神分裂症患者70例,采用阳性与阴性症状量表(positive and negative syndrome scale,PANSS)评定患者精神症状,并分为以阳性症状为主组(n=42例)和阴性症状为主组(n=28)。所有患者采用精神分裂症认知功能成套测验中文版(measurement and treatment research to improve cognition in schizophrenia consensus cognitive battery,MCCB)行认知评估,比较两组患者认知功能的差异和特点。记录患者入院时体质量指数(body mass index BMI),血清甘油三酯、总胆固醇、低密度脂蛋白及高密度脂蛋白,并对两组的上述结果进行组间比较。将认知评估结果与各代谢指标在组内进行Pearson相关分析。结果阳性组患者的认知功能在MCCB的连线测验、符号编码、霍普金斯词语学习、迷宫、持续操作得分[分别为(27.13±6.89)分,(32.97±13.69)分,(35.70±7.52)分,(32.63±4.59)分,(33.35±11.10)分]均高于阴性组[分别为(12.90±14.72)分,(19.90±11.98)分,(25.80±5.44)分,(27.50±5.20)分,(19.89±11.29)分],差异具有统计学意义(均P<0.05)。在BMI及脂代谢指标方面,阴性组的总胆固醇、低密度脂蛋白水平[分别为(5.03±1.42),(3.04±1.18)]高于阳性组[分别为(4.18±0.78),(2.45±0.64)],差异具有统计学意义(均P<0.05)。相关分析结果显示在阴性组中患者总胆固醇及低密度脂蛋白与认知功能中连线测验(r=-0.469,-0.751)、符号编码(r=-0.517,-0.538)、持续操作得分(r=-0.495,-0.542)存在负相关(均P<0.05)。结论以阳性和阴性症状为主的首发精神分裂症患者在认知功能上存在相似的损害维度但阴性症状为主的患者损害程度更重。在脂代谢方面二者存在差异,以阴性症状为主的患者的总胆固醇水平偏高且与认知功能存在负相关。

Objective To explore the characteristics of blood lipid level and cognitive impairment in first-episode schizophrenic patients with positive and negative symptoms, and their correlation. Methods Seventy inpatients with first-episode schizophrenia were enrolled in the hospital.Their psychiatric symptoms were assessed by positive and negative syndrome scale (PANSS). They were divided into two groups: positive symptoms group with 42 patients and negative symptoms group with 28 patients.All patients were assessed with the Chinese version of the measurement and treatment research to improve cognition in schizophrenia consensus cognitive battery (MCCB). The differences and characteristics of cognitive function between the two groups were compared.Body mass index (BMI), serum triglyceride, total cholesterol, low density lipoprotein and high density lipoprotein were recorded at admission, and the results were compared between the two groups.The correlation between cognitive assessment scores and metabolic indicators intra groups were analyzed using pearson correlation analysis. Results The scores of trail making test(TMT), brief assessment of cognition in schizophrenia-symbol encoding(BACS), Hopkins verbal learning test, maze and continuous performance test-identical pairs(CPT-IP) in positive group((27.13±6.89),(32.97±13.69),(35.70±7.52),(32.63±4.59),(33.35±11.10)) were higher than those in negative group ((12.90±14.72),(19.90±11.98),(25.80±5.44),(27.50±5.20),(19.89±11.29), all P<0.05). In terms of BMI and lipid metabolism indicators, the total cholesterol and low-density lipoprotein levels in the negative group ((5.03±1.42),(3.04±1.18)) were higher than those in the positive group ((4.18±0.78),(2.45±0.64)), and the difference was statistically significant (P<0.05). In negative group, total cholesterol and low density lipoprotein were negatively correlated with the scores of TMT(r=-0.469,-0.751), BACS(r=-0.517,-0.538) and CPT-IP(r=-0.495,-0.542) in cognitive function(all P<0.05). Conclusion First-episode schizophrenia patients with positive and negative symptoms have similar lesion dimensions in cognitive function, but patients with negative symptoms are more severely impaired.There are differences in lipid metabolism between first-episode schizophrenia patients with positive dominant symptoms and negative dominant symptoms, and the lipid metabolism of first-episode schizophrenia patients with negative dominant symptoms is related to cognitive function.