奥氮平联合重复经颅磁刺激对精神分裂症患者认知功能及外周血补体C3、C4水平的影响

Effect of olanzapine combined with repetitive transcranial magnetic stimulation on cognitive function and levels of peripheral blood complements C3 and C4 in patients with schizophrenia

目的探究奥氮平联合重复经颅刺激(r TMS)对精神分裂症患者认知功能及外周血补体C3、C4水平的影响。方法前瞻性选取2020年1~10月上海交通大学医学院附属精神卫生中心收治的100例精神分裂症患者为研究对象,按随机数字表法将其分为对照组和观察组,各50例。对照组予以奥氮平+伪刺激治疗,观察组予以奥氮平+10Hz r TMS治疗。观察两组临床疗效,比较两组治疗前、治疗2个月后阳性和阴性症状量表(PANSS)评分(阴性症状、阳性症状及一般精神病理学症状)、认知功能成套测验(MCCB)评分(连线测验、注意操作测验、迷宫测验)及外周血补体C3、C4水平,并记录不良反应发生情况。结果观察组临床总有效率(76.00%)明显高于对照组(56.00%),差异有统计学意义(P<0.05)。治疗2个月后,观察组阴性症状、阳性症状及一般精神病理学症状评分为(15.78±1.96)、(16.11±1.85)、(30.56±4.84)分,均明显低于对照组[(18.34±2.23)、(19.27±1.94)、(33.79±5.12)分],差异均有统计学意义(P<0.05)。治疗2个月后,观察组连线测验、注意操作测验、迷宫测验评分为(39.28±4.51)、(38.84±3.97)、(29.34±5.29)分,均明显高于对照组[(37.06±4.32)、(36.76±3.74)、(27.06±5.78)分],差异均有统计学意义(P<0.05)。治疗2个月后,观察组外周血补体C3、C4水平为(1.33±0.14)、(0.26±0.04)g/L均明显高于对照组[(1.20±0.16)、(0.23±0.04)g/L],差异均有统计学意义(P<0.05)。两组头晕、静坐不能、震颤等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论奥氮平联合r TMS治疗精神分裂症疗效显著,可有效改善患者的认知功能,缓解其临床症状,提升外周血补体C3、C4水平可能是其机制之一。

Objective To explore the effect of olanzapine combined with repeated transcranial magnetic stimulation(rTMS)on cognitive function and levels of peripheral blood complements C3 and C4 in patients with schizophrenia.Methods A total of 100 patients with schizophrenia admitted to Mental Health Center,Shanghai Jiao Tong University School of Medicine from January to October 2020 were selected as the research subjects,and they were randomly divided into the control group and the observation group with 50 cases in each group.The control group was treated with olanzapine+pseudo-stimulation,whereas the observation group was given olanzapine+10 Hz rTMS.The clinical efficacy of the two groups was observed,and the Positive and Negative Symptom Scale(PANSS)scores(negative symptoms,positive symptoms and general psychopathological symptoms),MATRICS consensus cognitive battery(MCCB)scores(trail making test,attention operation test,maze test)and levels of peripheral blood complements C3 and C4 were compared between the two groups before and after 2 months of treatment,and the occurrence of adverse reactions were recorded.Results The total clinical effective rate of the observation group(76.00%)was significantly higher than that of the control group(56.00%),the difference was statistically significant(P<0.05).After 2 months of treatment,the scores of negative symptoms,positive symptoms and general psychopathological symptoms in the observation group were(15.78±1.96),(16.11±1.85),(30.56±4.84)points,which were significantly lower than those in the control group[(18.34±2.23),(19.27±1.94),(33.79±5.12)points],the differences were statistically significant(P<0.05).After 2 months of treatment,the scores of trail making test,attention operation test and maze test in the observation group were(39.28±4.51),(38.84±3.97),and(29.34±5.29)points,which were significantly higher than those in the control group[(37.06±4.32),(36.76±3.74),(27.06±5.78)points],the differences were statistically significant(P<0.05).After 2 months of treatment,the levels of peripheral blood complements C3 and C4 in the observation group were(1.33±0.14),(0.26±0.04)g/L,which were significantly higher than those in the control group[(1.20±0.16),(0.23±0.04)g/L],the differences were statistically significant(P<0.05).There were no significant differences in the incidence rates of dizziness,akathisia,tremor and other adverse reactions between the two groups(P>0.05).Conclusion Olanzapine combined with rTMS has a significant efficacy in the treatment of schizophrenia.It can effectively improve the cognitive function and relieve the clinical symptoms of patients,and the increases of levels of peripheral blood complements C3 and C4 may be one of its mechanisms.