CAJ | 학술논문

目的：探讨精神分裂症首发未服药患者血清脑源性神经营养因子(BDNF)的特点及其与临床疗效的关系。方法研究组39例患者,符合 DSM-Ⅳ中精神分裂症的诊断标准,首次发病未进行过药物治疗,均给予单一非典型抗精神病药物治疗6周,治疗前、治疗6周末完成阳性和阴性症状量表(PANSS)评估和 BDNF 含量测定。健康对照30例,入组时完成血清 BDNF 含量测定。结果研究组血清 BDNF 含量治疗前、后分别为(6.82±2.15)μg/L、(8.16±2.84)μg/L,治疗后高于治疗前,差异有统计学意义(t=2.349,P =0.021),但均低于对照组的(11.6±3.32)μg/L,差异有统计学意义(t=7.239,P <0.001；t=4.634,P <0.001)。与治疗前比较,治疗后患者的 PANSS 总分、阳性症状评分、阴性症状评分及一般精神病理评分均下降,差异有统计学意义(t =6.164,P <0.001；t =4.520,P <0.001；t =4.132,P <0.001；t=5.142,P <0.001)。治疗前血清 BDNF 含量与 PANSS 总评分减分率、阴性症状评分减分率呈正相关(r=0.348、0.351,P 均<0.05),与阳性症状分减分率、一般精神病理评分减分率及病程无相关性(r =0.204、0.186、-0.058,P 均>0.05)；治疗前后的血清 BDNF 含量变化值与病程呈负相关(r=-0.345,P <0.05),与 PANSS总评分及各因子评分的减分率均无相关性(r=0.036-0.174,P >0.05)。结论精神分裂症首发未服药患者的血清BDNF 含量低于正常人,治疗后血清 BDNF 可提高；治疗前的含量可能作为预测药物疗效的指标之一。
목적：탐토정신분렬증수발미복약환자혈청뇌원성신경영양인자(BDNF)적특점급기여림상료효적관계。방법연구조39례환자,부합 DSM-Ⅳ중정신분렬증적진단표준,수차발병미진행과약물치료,균급여단일비전형항정신병약물치료6주,치료전、치료6주말완성양성화음성증상량표(PANSS)평고화 BDNF 함량측정。건강대조30례,입조시완성혈청 BDNF 함량측정。결과연구조혈청 BDNF 함량치료전、후분별위(6.82±2.15)μg/L、(8.16±2.84)μg/L,치료후고우치료전,차이유통계학의의(t=2.349,P =0.021),단균저우대조조적(11.6±3.32)μg/L,차이유통계학의의(t=7.239,P <0.001；t=4.634,P <0.001)。여치료전비교,치료후환자적 PANSS 총분、양성증상평분、음성증상평분급일반정신병리평분균하강,차이유통계학의의(t =6.164,P <0.001；t =4.520,P <0.001；t =4.132,P <0.001；t=5.142,P <0.001)。치료전혈청 BDNF 함량여 PANSS 총평분감분솔、음성증상평분감분솔정정상관(r=0.348、0.351,P 균<0.05),여양성증상분감분솔、일반정신병리평분감분솔급병정무상관성(r =0.204、0.186、-0.058,P 균>0.05)；치료전후적혈청 BDNF 함량변화치여병정정부상관(r=-0.345,P <0.05),여 PANSS총평분급각인자평분적감분솔균무상관성(r=0.036-0.174,P >0.05)。결론정신분렬증수발미복약환자적혈청BDNF 함량저우정상인,치료후혈청 BDNF 가제고；치료전적함량가능작위예측약물료효적지표지일。
Objective To evaluate the effects of 6-week atypical antipsychotics treatment on serum brain-derived neurotrophic factor (BDNF)level,and the correlation between BDNF level and clinical efficiency in first-episode antipsychotic-na?ve schizophrenia.Methods We recruited 39 hospitalized patients with first-episode antipsychotic-na?ve schizophrenia that met with Diagnostic and Statistical Manual of Mental Disorders—4th Edition (DSM-IV).Both Positive and Negative Syndrome Scale (PANSS)and the level of serum BDNF were measured before and after 6 weeks’treatment with atypical antipsychotics.We also studied 30 healthy controls.Serum BDNF was assayed at baseline.Results Pre-treatment BDNF level was significantly lower in the schizophrenic patients than in the controls [(6.82±2.1 5 )μg/L vs .(1 1.6 ± 3.32 )μg/L,t = 7.239,P < 0.001 ].Although BDNF level increased with treatment (t =2.349,P =0.021)in the schizophrenics,post-treatment BDNF level was still lower than in the normal controls (t =4.634,P <0.001).After 6 weeks’treatment for schizophrenia,the total score of PANSS,the scores of positive and negative symptoms,and the score of general psychopathology scale were all decreased (t =6.1 64,P < 0.001;t = 4.520,P < 0.001;t = 4.132,P < 0.001;t = 5.142,P < 0.001 ).Pre-treatment BDNF levels were directly correlated not only with the rate of decreased PANSS total score (r =0.348, P <0.05),but also with the rate of decreased negative symptoms score (r = 0.35 1,P < 0.05 ).However,pre-treatment BDNF levels were not correlated with improved positive symptoms,general psychopathology (r =0.204, 0.186,P >0.05),or duration of illness (r = - 0.058,P > 0.05 ).Changes in BDNF levels with treatment were correlated with the duration of illness (r =-0.345,P <0.05),but not with psychiatric improvement (r =0.036-0.1 74,P >0.05).Conclusion BDNF level is significantly lower in patients with first-episode antipsychotic-na?ve schizophrenia than in normal controls.It could be improved by using antipsychotics.Higher pre-treatment BDNF level may predict better response to antipsychotics.