首发精神分裂症患者合并高同型半胱氨酸血症的危险因素

Risk Factors of Hyperhomocysteinemia in Patients with First-Episode Schizophrenia

目的探讨首发未用药的精神分裂症患者合并高同型半胱氨酸血症(HHcy)的危险因素。方法选取2018年6月至2020年1月郑州大学第一附属医院收治的188例精神分裂症患者,纳入病例组。病例组患者均为首次发病,未用药。血浆同型半胱氨酸(Hcy)>15μmol·L^(-1)为HHcy。按是否合并HHcy将病例组患者分为HHcy组(90例)与非HHcy组(98例)。同期选取与病例组一般情况匹配的92名健康志愿者,纳入对照组。采用阳性与阴性症状量表(PANSS)评估精神分裂症患者的临床症状。使用酶循环法检测Hcy水平。采用精神分裂症认知功能成套测验(共识版)(MCCB)评估研究对象的认知功能。比较病例组与对照组的Hcy、认知功能。采用Spearman法分析Hcy与认知功能、精神症状的相关性。比较HHcy组与非HHcy组的临床资料。分析精神分裂症患者伴HHcy的影响因素。结果与对照组比较,病例组Hcy水平较高,认知功能得分较低(P<0.05)。病例组Hcy水平与认知功能、精神症状评分均无关(P>0.05)。与非HHcy组比较,HHcy组吸烟患者占比和阳性症状评分较高,病程较短(P<0.05)。吸烟、阳性症状评分是精神分裂症患者伴HHcy的独立危险因素,病程是精神分裂症患者伴HHcy的保护因素(P<0.05)。结论首发未用药的精神分裂症患者的血浆Hcy水平升高。吸烟和阳性症状是精神分裂症患者发生HHcy的独立危险因素。

Objective To investigate the risk factors of hyperhomocysteinemia(HHcy)in patients with first-episode untreated schizophrenia.Methods A total of 188 patients with schizophrenic were admitted to the First Affiliated Hospital of Zhengzhou University from June 2018 to January 2020 and included in case group.All the patients in case group were first onset without medication.The level of homocysteine(Hcy)in plasma over 15μmol·L^(-1) was HHcy.The patients in case group were divided into HHcy group(90 cases)and non-HHcy group(98 cases)according to the presence or absence of HHcy.A total of 92 healthy volunteers matched the general situation of case group were enrolled in control group.Positive and negative syndrome scale(PANSS)was utilized to evaluate the clinical symptoms of patients with schizophrenia.The level of Hcy was measured by the enzyme cycle method.The cognitive functions of the subjects were evaluated using MATRICS consensus cognitive battery(MCCB).The levels of Hcy and cognitive functions were compared between case group and control group.Spearman method was used to analyze the correlation between Hcy and cognitive functions and psychiatric symptoms.The clinical data of HHcy group and non-HHcy group were compared.The influencing factors of HHcy in patients with schizophrenia were analyzed.Results Compared with control group,the level of Hcy in case group was higher and the score of cognitive function was lower(P<0.05).In case group,the level of Hcy was not related to cognitive function or the score of psychiatric symptoms(P>0.05).Compared with non-HHcy group,the proportion of smoking patients and the score of positive symptoms in HHcy group were higher,and the course of the disease was shorter(P<0.05).Smoking and the score of positive symptoms were independent risk factors for schizophrenic patients with HHcy,and the course of disease was a protective factor for schizophrenic patients with HHcy(P<0.05).Conclusion The level of Hcy in plasma is elevated in first episode and drug-free schizophrenic patients.Smoking and positive symptoms are the independent risk factors for HHcy in patients with schizophrenia.