伴炎症性抑郁精神分裂症患者的临床特征及其影响因素

Clinical characteristics and related factors in schizophrenic patients with inflammatory depression

目的:探讨伴发炎症性抑郁的精神分裂症患者临床特征及其影响因素。方法:来自3家医院的慢性精神分裂症患者330例中,87例精神分裂症抑郁量表(CDSS)总分≥5,诊断为伴发抑郁症状的精神分裂症;其中25例血浆超敏C反应蛋白(hs-CRP)≥3 mg/L归入炎症性抑郁组,62例血浆hs-CPR<3 mg/L归入非炎症性抑郁组;比较两组人口学(性别、年龄、受教育年限、婚姻状况等)及临床资料[发病年龄、病程、体质量指数(BMI)、因精神分裂症住院次数、自杀状况、躯体疾病(冠心病、心力衰竭、高血压、糖尿病、脑卒中、肿瘤等)、用药情况等]、血液生化指标(血糖、血脂、食欲素A、瘦素)、阳性和阴性症状量表(PANSS)及失眠严重指数(ISI)评分,分析伴发炎症性抑郁的影响因素。结果:与非炎症性抑郁组相比,炎症性抑郁组BMI、血浆食欲素A及瘦素水平明显增高,服用的抗精神病药氯丙嗪等效剂明显量降低(P均<0.05);二分类Logistic回归显示,高瘦素水平(OR=1.375,95%CI:1.022~1.850,P=0.035)、低氯丙嗪等效剂量(OR=0.997,95%CI:0.994~0.999,P=0.013)是炎症性抑郁的影响因素。结论:高瘦素水平及服用低剂量抗精神病药可能是精神分裂症患者伴发炎症性抑郁的危险因素。

Objective:To explore clinical characteristics and related factors of schizophrenic patients with inflammatory depression.Method:We recruited 330 inpatients with chronic schizophrenia from 3 hospitals,and 87 patients whose Calgary Depression Scale for Schizophrenia(CDSS)total score≥5 were eventually diagnosed as schizophrenia with depression.According to high sensitive C-reactive protein(hs-CRP)levels,patients were divided to two subgroups,including schizophrenic patients with inflammatory depression(hs-CRP≥3 mg/L,n=25)and without inflammatory depression(hs-CRP<3 mg/L,n=62).Then,sociodemographic characteristics(such as gender,age,education years and marriage),clinical characteristics including age of onset,duration of illness,body mass index(BMI),numbers of hospitalization,suicide,physical illness(such as coronary disease,heart failure,hypertension,diabetes,stroke and tumour)and medical conditions,biochemical characteristics(blood glucose,lipids,orexin A and leptin),Positive and Negative Syndrome Scale(PANSS)and Insomnia Severity Index(ISI)were respectively compared between two subgroups.Further analyses were performed to examine the related factors.Results:BMI,orexin A and leptin were elevated in schizophrenic patients with inflammatory depression,and antipsychotic dose were decreased(all P<0.05).Logistic regression showed that leptin(OR=1.375,95%CI:1.022-1.850,P=0.035)and antipsychotic dose(OR=0.997,95%CI:0.994-0.999,P=0.013)predicted variables of inflammatory depression.Conclusion:Elevated leptin and decreased antipsychotic dose are risk factors of inflammatory depression.