阿立哌唑联合MECT对精神分裂症患者甲状腺功能及血清神经营养因子水平的影响

Effect of aripiprazole combined with MECT on thyroid function and serum neurotrophic factor in patients with schizophrenia

目的探讨阿立哌唑联合无抽搐电休克(MECT)对精神分裂症患者甲状腺功能及血清神经营养因子水平的影响。方法前瞻性选取2017年6月至2020年6月上海交通大学医学院附属精神卫生中心收治的精神分裂症患者120例。按照随机数表法将患者分为两组:对照组和观察组,各60例。对照组给予阿立哌唑治疗,观察组给予阿立哌唑联合MECT治疗。观察比较两组患者治疗前、治疗9周后甲状腺激素指标[游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、总三碘甲状腺原氨酸(T_(3))、总甲状腺素(T_(4))]水平,神经营养因子[脑源性神经营养因子(BDNF)、血清神经生长因子(NGF)、神经营养因子3(NT-3)]浓度及韦氏成人智力量表(WAIS)评分、阳性与阴性症状量表(PANSS)评分情况,并比较两组患者治疗后不良反应发生率。结果治疗前,两组患者甲状腺激素、神经营养因子、WAIS评分、PANSS评分比较,差异均无统计学意义(P>0.05);治疗9周后,观察组甲状腺激素FT_(3)、FT_(4)、T_(3)、T_(4)水平分别为(3.81±0.79)、(8.72±1.56)、(1.11±0.23)、(8.42±1.64)nmo I/L,均明显高于对照组的(3.12±0.53)、(7.45±0.78)、(0.84±0.14)、(7.31±1.05)nmo I/L,差异均有统计学意义(P<0.05)。治疗9周后,观察组血清营养因子BDNF、NGF、NT-3水平分别为(5100.43±40.29)、(42.84±8.21)、(170.92±20.83)pg/m L,均明显高于对照组的(4200.83±30.64)、(36.61±6.72)、(145.28±14.75)pg/m L,差异均有统计学意义(P<0.05)。治疗9周后,观察组WAIS评分为(84.85±7.13)分,明显高于对照组的(71.16±5.73)分,PANSS评分为(44.28±3.84)分,明显低于对照组的(52.64±5.15)分,差异均有统计学意义(P<0.05)。观察组治疗后不良反应发生率为15.00%,明显低于对照组的28.33%,差异有统计学意义(P<0.05)。结论通过阿立哌唑联合MECT治疗精神分裂症患者临床疗效显著,可改善患者认知功能,降低对甲状腺功能的影响,值得临床推广应用。

Objective To investigate the effect of aripiprazole combined with MECT on thyroid function and serum neurotrophic factor in patients with schizophrenia.Methods A total of 120 patients with schizophrenia admitted to the Mental Health Center of Shanghai Jiaotong University School of Medicine from June 2017 to June 2020 were prospectively selected.According to the random number table method,the patients were divided into two groups:the control group and the observation group,60 cases in each group.The control group was treated with aripiprazole,and the observation group was treated with aripiprazole combined with MECT.The levels of thyroid hormone indicators[free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),total triiodothyronine(T_(3)),and total thyroxine(T_(4))],concentration of neurotrophic factors[brain-derived neurotrophic factor(BDNF),serum nerve growth factor(NGF),neurotrophic factor 3(NT-3)],and Webster's adult intelligence scale(WAIS)score,positive and negative symptom scale(PANSS)scores wer observed and compared before and nine weeks after treatment between the two groups of patients.And the incidence of adverse reactions between the two groups after treatment were compared.Results Before treatment,there was no significant difference in thyroid hormone,neurotrophic factor,WAIS score,and PANSS score between the two groups(P>0.05).The levels of thyroid hormones FT_(3),FT_(4),T_(3) and T_(4) in the observation group nine weeks after treatment were(3.81±0.79),(8.72±1.56),(1.11±0.23),(8.42±1.64)nmoI/L,which were significantly higher than those in the control group(3.12±0.53),(7.45±0.78),(0.84±0.14),(7.31±1.05)nmoI/L,the differences were statistically significant(P<0.05).The levels of serum nutritional factors BDNF,NGF and NT-3 in the observation group nine weeks after treatment were(5100.43±40.29),(42.84±8.21),and(170.92±20.83)pg/mL,which were significantly higher than those in the control group(4200.83±30.64),(36.61±6.72),(145.28±14.75)pg/mL,the differences were statistically significant(P<0.05).The WAIS score of the observation group nine weeks after treatment was(84.85±7.13)points,which was significantly higher than that in the control group(71.16±5.73)points,and the PANSS score was(44.28±3.84)points,which was significantly lower than that in the control group(52.64±5.15)points,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group after treatment was 15.00%,which was significantly lower than 28.33%in the control group,and the difference was statistically significant(P<0.05).Conclusion Aripiprazole combined with MECT has a significant clinical effect in the treatment of patients with schizophrenia,which can improve the cognitive function of patients and reduce the impact on thyroid function.It is worthy of clinical application.