计算机化认知矫正治疗对精神分裂症患者认知功能的影响

Effects of computerized cognitive correction therapy on cognitive function of schizophrenia

目的·探讨计算机化认知矫正治疗(computerized cognitive correction therapy,CCRT)辅助疗法对慢性精神分裂症患者认知功能的疗效及对血浆脑源性神经生长因子(brain derived neurotrophic factor,BDNF)和酪氨酸激酶受体B(tyrosine kinase receptors B,TrK-B)表达水平的影响。方法·纳入上海市黄浦区精神卫生中心慢性精神分裂症患者162例,按随机数字表随机分为CCRT组和对照组,每组各81例。对照组以常规抗精神病药物治疗,CCRT组以CCRT联合常规抗精神病药物治疗,治疗时间持续12周。2组在入组时及治疗12周后予神经心理状态评定量表评估认知功能,亲和素-生物素复合酶联免疫吸附试验检测血浆BDNF和TrK-B表达水平。基线期认知功能和血浆BDNF及TrK-B蛋白表达水平2组间比较采用配对样本t检验,2组治疗后与基线期、治疗后2组间认知功能和血浆BDNF及TrK-B蛋白表达水平数据比较使用重复测量方差分析。治疗前后认知功能的改善与蛋白表达改变的相关性用一般线性模型。结果·CCRT组和对照组实际各完成77例。基线期,2组认知功能各维度,BDNF和TrK-B表达水平差异比较无统计学意义;治疗12周后,2组认知功能各维度(P=0.000),BDNF(P=0.007)和TrK-B(P=0.015)表达水平差异有统计学意义;组内比较发现:CCRT组治疗12周与基线期认知功能各维度(P=0.000),BDNF(P=0.002)和TrK-B(P=0.000)表达水平比较差异有统计学意义,对照组治疗12周后认知功能各维度,BDNF和其TrK-B表达水平较基线期比较差异无统计学意义。BDNF蛋白表达水平的改变与词汇学习(r^(2)=1.598,P=0.019)、故事复述(r^(2)=1.495,P=0.038)、数字广度(r^(2)=1.855,P=0.004)、故事回忆(r^(2)=1.459,P=0.047)和注意功能(r^(2)=1.673,P=0.012)改善有显著相关性,TrK-B蛋白表达水平的改变与图画命名的改善有显著相关性(r^(2)=1.582,P=0.034)。结论·CCRT辅助治疗对慢性精神分裂症患者认知功能各维度有显著疗效,且部分认知功能的改善与血浆BDNF和TrK-B表达水平的改变显著相关。

Objective·To explore the effects of computerized cognitive correction therapy(CCRT)on the cognitive function of patients with chronic schizophrenia and the effects on plasma brain-derived nerve growth factor(BDNF)and tyrosine kinase receptors B(TrK-B).Methods·162 patients with chronic schizophrenia from Shanghai Mental Health Center of Huangpu District were randomly divided into CCRT group and control group according to the random number table method.81 patients in the control group were treated with the conventional antipsychotic drugs,and 81 patients in the CCRT group were given CCRT combined with the conventional antipsychotic treatment.The period of treatments is 12 weeks.The cognitive function by Repeatable Battery for the Assessment of Neuropsychological Status(RBANS),detection of plasma BDNF and TrK-B expression levels by avidinbiotincomplex-Enzyme Linked Immune Sorbent Assay(ABC-ELISA)were assessed at the baseline and at the end of the 12th week.Paired sample t-test was applied to compare the cognitive function,plasma BDNF and TrK-B protein expression levels in the baseline between the two groups,and the repeated measurements variance analysis was used to compare the cognitive function and plasma BDNF and TrK-B protein expression levels between the two groups after treatment and change within the group.The correlation between the improvement of cognitive function and the change of protein expression levels used a general linear model.Results·The CCRT group and the control group actually completed 77 cases each.At the baseline,there was no statistically significant difference among cognitive function,BDNF and TrK-B between the two groups;after 12 weeks of treatment,cognitive function(P=0.000),BDNF(P=0.007)and TrK-B(P=0.015)expression level was statistically different between the CCRT and the control group;for CCRT group,cognitive function(P=0.000),BDNF(P=0.002)and TrK-B(P=0.000)expression level was significantly different after 12 weeks of treatment compared with the baseline,but not in the control group.The change of BDNF protein expression level is significantly correlated with the improvement of vocabulary learning(r^(2)=1.598,P=0.019),story retelling(r^(2)=1.495,P=0.038),digital breadth(r^(2)=1.855,P=0.004),story recall(r^(2)=1.459,P=0.047)and attention function(r^(2)=1.673,P=0.012).The change of TrK-B protein expression level is significantly correlated with the improvement of picture naming(r^(2)=1.582,P=0.034).Conclusion·The use of CCRT in the adjuvant treatment of antipsychotic treatment for schizophrenia patients has a significant effect on cognitive function.The improvement of some cognitive functions are significantly related to the changes in the plasma BDNF and its TrK-B expression levels.