首发未用药精神分裂症患者攻击行为与血清C反应蛋白的相关性

Correlation between serum C-reactive protein level and aggressive behavior in first episode drug naive schizophrenia patients

目的探讨首发未用药精神分裂症患者血清C反应蛋白(CRP)水平及临床症状对攻击行为的影响。方法选取2020年1月至2022年11月在山东省精神卫生中心门诊就诊或者住院治疗的164例首发未用药精神分裂症患者为研究对象。采用修改版外显攻击行为量表(MOAS)评估患者的攻击行为,根据MOAS结果将患者分为攻击组(86例)和非攻击组(78例)。采用阳性与阴性症状量表(PANSS)评定患者的临床症状。采用二项Logistic分层回归分析首发未用药精神分裂症患者有攻击行为的影响因素。结果攻击组患者的血清CRP水平[2.97(2.46,3.47)mg/L比1.73(1.36,2.10)mg/L]、PANSS总分[(89.27±9.82)分比(83.47±8.04)分]、阳性症状因子评分[33.90(33.01,34.79)分比30.13(29.28,30.98)分]、兴奋激越因子评分[14.12(13.43,14.80)分比7.01(6.41,7.61)分]、MOAS总分[12.85(11.90,13.80)分比2.28(1.36,3.20)分]、言语攻击维度评分[1.28(1.15,1.41)分比0.38(0.27,0.50)分]、财产攻击维度评分[1.47(1.32,1.61)分比0.28(0.15,0.41)分]及体力攻击维度评分[2.01(1.85,2.17)分比0.14(0.01,0.27)分]均高于非攻击组,差异均有统计学意义(均P<0.01)。攻击组的阴性症状因子评分[24.63(23.64,25.62)分比28.15(26.90,29.40)分]和认知缺损因子评分[10.76(10.24,11.27)分比11.60(10.98,12.23)分]低于非攻击组,差异有统计学意义(均P<0.05)。二项Logistic分层回归分析结果显示,病程长是首发未用药精神分裂症患者有攻击行为的独立保护因素(均P<0.01),PANSS中的兴奋激越因子评分高、血清CRP水平高是首发未用药精神分裂症患者有攻击行为的独立危险因素(均P<0.05)。结论血清CRP水平高、兴奋激越因子评分高是首发未用药精神分裂症患者实施攻击行为的危险因素,有攻击行为患者的病程短于非攻击行为患者,可能与攻击行为更能引起人们的重视相关。

Objective To investigate the effects of serum C-reactive protein(CRP)level and clinical symptoms on aggressive behavior in untreated first-episode schizophrenia patients.Methods A total of 164 untreated patients with first-episode schizophrenia in the department of outpatient and inpatient of Shandong Mental Health Center from January 2020 to November 2022 were selected as research subjects.The modified Overt Aggression Scale(MOAS)were applied to assess patients aggressive behavior.According to the results of MOAS,the patients were divided into the aggressive group(86 cases)and the non-aggressive group(78 cases).The Positive and Negative Symptom Scale(PANSS)was used to evaluate the clinical symptoms of the patients.Binomial Logistic hierarchical regression analysis was used to analyze the influencing factors of aggressive behavior in untreated first-episode schizophrenia patients.Results The serum CPR level[2.97(2.46,3.47)mg/L vs 1.73(1.36,2.10)mg/L],total scores of PANSS[(89.27±9.82)vs(83.47±8.04)],positive factor scores[33.90(33.01,34.79)vs 30.13(29.28,30.98)],excitement factor scores[14.12(13.43,14.80)vs 7.01(6.41,7.61)],total scores of MOA[12.85(11.90,13.80)vs 2.28(1.36,3.20)],verbal aggression scores[1.28(1.15,1.41)vs 0.38(0.27,0.50)],aggression against property scores[1.47(1.32,1.61)vs 0.28(0.15,0.41)]and physical aggression scores[2.01(1.85,2.17)vs 0.14(0.01,0.27)]of the aggressive group were all higher than those of the non-aggressive group,and the differences were statistically significant(P<0.01).The negative factor scores[24.63(23.64,25.62)vs 28.15(26.90,29.40)]and cognitive factor scores[10.76(10.24,11.27)vs 11.60(10.98,12.23)]of the aggressive group were lower than those of the non-aggressive group(P<0.05).The results of binomial Logistic hierarchical regression analysis showed that long duration of disease was the independent protective factor of aggressive behavior in untreated first-episode schizophrenia patients(P<0.05).High score of excitement factor of PANSS and high serum CRP level were independent risk factors of aggressive behavior in untreated first-episode schizophrenia patients(P<0.05).Conclusions High score of excitement factor of PANSS and high serum CRP level are independent risk factors of aggressive behavior in untreated firstepisode schizophrenia patients.Patients with aggressive behavior have a shorter course of disease than patients without aggressive behavior,which may be due to the fact that aggressive behavior attracts more attention.