利培酮治疗首发精神分裂症患者血清脑源性神经营养因子的变化及其与临床疗效和认知功能的关系  

Effect of risperidone treatment on serum levels of BDNF and the correlation of between serum BDNF levels and clinical efficiency and cognition improvement in first-episode schizophrenic patients

作　　者：陈大春[1] 李艳丽[1] 修梅红[1] 王宁[1] 杨可冰[1] 聂鹰[1] 卞清涛[1] 张向阳[1] 

机构地区：[1]北京回龙观医院,北京100096

出　　处：《中国神经精神疾病杂志》2010年第9期529-532,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：美国斯坦利基金资助(编号:03T-459;5T-726)

摘　　要：目的探讨利培酮对首发精神分裂症患者血清脑源性神经营养因子(brain derived neurotrophic fac-tors,BDNF)的影响及其与临床疗效、认知功能的关系。方法 90例首发精神分裂症住院患者采用单一利培酮治疗12周,以阳性和阴性症状量表(positive and negative syndrome scale,PANSS)、汉密尔顿抑郁量表(Hamilton depressionscale,HAMD)、重复性神经心理状态测查(repeatable battery for the assessment of neuropsychological status,RBANS)、威斯康辛卡片分类(Wisconsin cards sort test,WCST)评定临床症状及认知功能;同时选择84名正常人作为对照。使用酶联免疫吸附法检测血清BDNF。结果患者组治疗前的血清BDNF低于正常对照组(P<0.01),治疗后BDNF也低于对照组(P<0.05),治疗前后BDNF无显著变化(P>0.05)。以基线BDNF平均值为界分组,低BDNF组12周治疗后BDNF较基线升高(P<0.05);而高BDNF组治疗后BDNF水平较基线下降(P<0.05),其基线BDNF水平与治疗后的HAMD减分值、PANSS减分值、RBANS总分改善值、即刻记忆改善值正相关(r为0.34、0.43、0.39、0.35,P均小于0.05)。低BDNF组12周末的RBANS总分、注意、延时记忆和WCST的完成分类数、正确应答数、错误应答数的成绩均提高(P<0.05),高BDNF组12周末的RBANS总分、即刻记忆、延时记忆成绩均提高(P<0.05),但WCST各项成绩未见明显改善(P>0.05)。结论利培酮对BDNF有双向调节作用;治疗前BDNF水平高低对认知功能、精神症状的改善有影响。Objective To investigate the effects of 12-week risperidone treatment on serum levels of brain derived neurotrophic factors （BDNF） and the correlation between serum BDNF levels and clinical efficiency and cognitive function improvement in the first-episode schizophrenia.Methods Ninety first-episode schizophrenia inpatients,defined by the diagnostic and statistical manual of mental disorders version IV （DSM-IV）,were treated with risperidone only for 12 weeks.The psychiatric symptoms were estimated using the positive and negative syndrome scale （PANSS）,the Hamilton depression scale （HAMD）.The cognitive function were assessed using repeatable battery for the assessment of neuropsychological status （RBANS）,and Wisconsin cards sort test（WCST）.The serum BDNF levels of schizophrenic patients and normal controls （n=84） were detected with Sandwish ELISA.Results The serum BDNF levels were markedly lower in patient group both before and after treatment compared to normal controls（P0.05）.There was no significant difference in serum BDNF levels between baseline and treatment with risperidone for 12 weeks（P0.05）.Patients were further divided into two subgroups based on BDNF level at baseline：low BDNF and high BDNF groups.In low BDNF group,BDNF levels significant increased after treatment for 12 weeks [（6.22±2.40）μg/L vs （10.94±5.71） μg/L,P0.05].In contrast,BDNF levels markedly decreased after treatment for 12 weeks in high BDNF group [（12.50±4.33）μg/L vs （9.23±3.75） μg/L,P0.05].In high BDNF group,the base levels of BDNF were positive correlated with changing of HAMD score,PANSS score,total RBANS score and immediate memory score（P0.05）.In low BDNF group,total RBANS,attention,delay memory score and categories completed,replies correct,replies error of WCST markedly improved after 12 weeks （P0.05）.In high level BDNF group,total RBANS,immediate memory,delay memory score significant increased （P0.05）.Conclusions Risperidone has a biphasic action on BDNF level

关 键 词：精神分裂症 利培酮 脑源性神经营养因子 认知功能 

分 类 号：R749.3[医药卫生—神经病学与精神病学]