c-Jun氨基末端激酶与首发精神分裂症患者认知功能及预后的相关性研究

Correlations of serum c-Jun N-terminal kinase expression with cognitive function and prognosis in patients with first-episode schizophrenia

目的探讨首发精神分裂症患者血清c-Jun氨基末端激酶(JNK)表达与认知功能及出院1年预后的相关性。方法对168例首发精神分裂症患者进行临床资料调查、认知功能评估和出院后随访。根据有无认知功能受损,168例患者被分为认知功能受损组65例和认知功能正常组103例。采用Pearson相关分析法分析患者血清JNK表达水平与认知功能[MATRICS共识认知成套测试(MCCB)得分]的相关性。采用Logistic回归分析探讨患者认知功能受损的影响因素,绘制受试者工作特征(ROC)曲线分析血清JNK表达水平等因素对患者认知功能受损的预测效能,采用Cox回归分析法对患者出院后1年的随访预后进行单因素和多因素分析。结果认知功能受损组血清JNK表达水平为(78.12±9.28)%,高于认知功能正常组的(59.38±6.17)%,差异有统计学意义(t=10.420,P<0.001)。首发精神分裂症患者血清JNK表达水平与MCCB得分呈显著负相关(r=-0.492,P<0.001)。血清JNK表达水平是首发精神分裂症患者认知功能受损的独立危险因素(OR=3.080,95%CI:1.864~12.157);血清JNK表达水平预测患者认知功能受损的曲线下面积(AUC)为0.756,最佳截断值为73.49,特异度为0.885,敏感度为0.913。出院后随访1年,高JNK水平患者的无病生存期短于低JNK水平患者,差异有统计学意义(P<0.05)。Cox回归分析显示,年龄、睡眠障碍、抑郁、焦虑、血清JNK表达水平均为首发精神分裂症患者出院后随访预后不良的独立影响因素(P<0.05)。结论首发精神分裂症患者血清JNK表达水平与认知功能、出院1年预后存在相关性,临床医务人员应密切监测患者血清JNK表达水平。

Objective To investigate the correlations of serum c-Jun N-terminal kinase(JNK)expression with cognitive function and 1-year prognosis after discharge in patients with first-episode schizophrenia.Methods A total of 168 patients with first-episode schizophrenia were investigated for clinical data,cognitive function measurement and one-year follow-up after discharge.According to the presence or absence of cognitive impairment,168 patients were divided into cognitive impairment group(65 cases)and normal cognitive function group(103 cases).Pearson correlation analysis was used to analyze correlation of serum JNK expression and cognitive function[MATRICS Consensus Cognitive Battery(MCCB)score]in patients with first-episode schizophrenia.Logistic regression was used to analyze the influencing factors of cognitive dysfunction in first-episode schizophrenics,receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of independent risk factors of cognitive dysfunction in first-episode schizophrenics,and Cox regression analysis was used to analyze the univariate and multivariate prognosis of patients one year after discharge.Results The level of JNK expression in the cognitively impaired group was(78.12±9.28)%,which was significantly higher than(59.38±6.17)%in the cognitively normal group,and the difference was statistically significant(t=10.420,P<0.001).There was a significant negative correlation between MCCB score and JNK expression(r=-0.490,P<0.01).JNK expression was an independent risk factor for cognitive function impairment in patients with first-episode schizophrenia(OR=3.080;95%CI,1.864 to 12.157).The area under the curve(AUC)of serum JNK expression in predicting cognitive impairment was 0.756,the optimal cut-off value was 73.49,the specificity was 0.885,and the sensitivity was 0.913.At 1-year follow-up after discharge,the disease-free survival of patients with high JNK level was shorter than those with low JNK level(P<0.05).Cox regression analysis showed that age,sleep disorder,depression,anxiety and serum JNK expression level were independent influencing factors of poor prognosis in patients with first-episode schizophrenia after discharge(P<0.05).Conclusion Serum JNK level is correlated with cognitive function and prognosis one year after discharge in patients with first-episode schizophrenia.Clinical staff should closely monitor the serum JNK level of patients.