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  本文選題：吸煙　切入點：精神分裂癥　出處：《天津醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1、通過對吸煙的和不吸煙的首發(fā)精神分裂癥患者0周及8周末進(jìn)行血清炎癥因子IL-1β、IL-6以及TNF-α的測查,探討吸煙是否對精神分裂癥患者治療過程中血清炎癥因子的變化有影響。2、通過比較吸煙組和不吸煙組基線和8周末的精神分裂癥患者的的臨床癥狀及認(rèn)知功能的改變,探討吸煙對分裂癥患者癥狀、認(rèn)知功能的影響。3、通過吸煙組和不吸煙組分裂癥患者的TESS量表評估,探討吸煙對于精神分裂癥患者出現(xiàn)副反應(yīng)的影響。4、本論文拓展和延伸了有關(guān)精神分裂癥的研究內(nèi)容,希望本研究能夠為吸煙的精神分裂癥患者的臨床治療提供依據(jù)和數(shù)據(jù)支撐,并為有關(guān)精神分裂癥的后續(xù)研究提供理論視野。方法:依據(jù)精神障礙統(tǒng)計與診斷手冊第5版(DSM-5)的診斷標(biāo)準(zhǔn),選取34例具有長期吸煙史的首發(fā)精神分裂癥患者作為觀察組(吸煙組)和35例首發(fā)不吸煙的患者為對照組(不吸煙組)。入組當(dāng)天進(jìn)行全面的病史采集、全面的精神科檢查和體格檢查。在基線和第8周末于清晨在兩組患者的肘部抽取靜脈血液,分別使用ELISA進(jìn)行血清細(xì)胞因子中的IL-1β、IL-6和TNF-α的測定,并采用陽性與陰性癥狀量表(PANSS)和臨床療效總評量表(CGI)評定每位患者的癥狀嚴(yán)重程度,TESS評估副作用。參照尼古丁依賴量表的得分情況,來評估吸煙組患者的尼古丁依賴程度,比較吸煙組和不吸煙組患者在認(rèn)知功能方面的差異。在評估認(rèn)知功能時,使用了精神分裂癥認(rèn)知功能成套測驗中文版(MCCB)和STROOP色詞測驗等相關(guān)的認(rèn)知測驗。采用常用的SPSS軟件19.0和Excel對收集到的數(shù)據(jù)進(jìn)行整理統(tǒng)計與分析,計數(shù)資料用例數(shù)(百分比)表示,組間的比較采用χ2檢驗。若計量資料符合正態(tài)分布,即采用均數(shù)±標(biāo)準(zhǔn)差來表示,組間的比較使用配對t檢驗的方法,如果計量資料不符合正態(tài)分布,則可以采用中位數(shù)來表示,組間比較可以采用秩和檢驗的方法。結(jié)果:1、兩組在基礎(chǔ)的臨床特征方面,包括年齡、性別、教育年限、病程以及利培酮劑量等無明顯的差異,一般資料具有比較高的可比性。2、吸煙組和不吸煙組在基線時各炎癥因子水平有差異但是差異較小,都處于較高水平。8周后,吸煙組的IL-1β、IL-6水平有一定程度下降但依然較高,而不吸煙組經(jīng)過治療后,各炎癥因子的水平均有顯著的下降(P0.05)。不吸煙組血清細(xì)胞因子的變化幅度更大,差別具有明顯的統(tǒng)計學(xué)意義。兩組TNF-α與基線時相比,差異沒有達(dá)到統(tǒng)計學(xué)的意義(P0.05)3、兩組患者的PANSS和CGI評分在基線時得分差異無統(tǒng)計學(xué)意義,治療8周后,吸煙組的PANSS陰性癥狀分有較為明顯的下降(P0.05)。4、認(rèn)知功能方面的測查發(fā)現(xiàn),吸煙組患者在信息處理速度、持續(xù)注意和警覺方面的功能得分高于不吸煙組。5、吸煙并沒有導(dǎo)致或增加抗精神科藥物副反應(yīng)的發(fā)生。相反導(dǎo)致了靜坐不能的副反應(yīng)的減少。結(jié)論:1、吸煙可以改變精神分裂癥患者體內(nèi)炎癥因子的水平,使IL-1β、IL-6和TNF-a的水平比不吸煙者更高。2、吸煙對精神分裂癥患者陰性癥狀有一定的改善作用。3、吸煙的精神分裂癥病人認(rèn)知功能的一些方面損傷可能較不吸煙的分裂癥患者為輕,如信息處理速度、持續(xù)注意和警覺方面。4、吸煙的精神分裂癥患者出現(xiàn)的“靜坐不能”副作用較少。
[Abstract]:Objective: 1, serum inflammatory factor IL-1 beta by smoking and nonsmoking patients with first-episode schizophrenia 0 weeks and 8 weeks, IL-6 and TNF- alpha test, to investigate the changes of serum inflammatory factors of smoking on patients with schizophrenia treatment process have the effect of.2, the ratio of clinical symptoms and cognitive function compared with the smoking group and non-smoking groups at baseline and week 8 schizophrenic patients with the change of smoking on schizophrenia symptoms in patients with.3, cognitive function, the smoking group and non-smoking group split TESS scale to assess patients, to investigate the effects of smoking in patients with schizophrenia have side effects.4, this paper expands and extends the research content of schizophrenia, we hope this research can provide the basis and data support for the clinical treatment of smoking in schizophrenia patients, and follow-up studies of schizophrenia The study provides the theory of vision. Methods: according to diagnostic and Statistical Manual of mental disorders, Fifth Edition (DSM-5) diagnostic criteria, we selected 34 cases with a long-term history of smoking in schizophrenic patients as the observation group (smoking group) and 35 patients with first-episode non-smoking control group (smoking group). The group of the day a comprehensive history taking, comprehensive psychiatric examination and physical examination. At baseline and week eighth in the morning at the elbow venous blood of two groups of patients, respectively, using ELISA serum cytokines in IL-1 beta, the determination of IL-6 and TNF- alpha, and the positive and negative symptoms scale (PANSS) and the clinical curative effect general scale (CGI) assessment of each patient's symptom severity, TESS assessment of side effects. According to the scores of nicotine dependence scale, to assess the degree of nicotine dependence in the smoking group, compared the smoking group and non-smoking group in cognition The difference in functionality. In the assessment of cognitive function, the use of MCCB Chinese Version (MCCB) cognitive test and STROOP color word test and other related statistics and analysis. The commonly used software SPSS 19 and Excel on the collected data, count data case number (percentage) said between the groups, compared with the 2 test. If the measurement data with normal distribution, the mean standard deviation expressed compared using the paired t test between groups, if the measurement data is not consistent with the normal distribution, can be used in bits to represent, comparison between groups can be used to rank sum test methods. Results: 1. Two groups based on the clinical characteristics, including age, gender, years of education, no obvious difference between the duration and dose of risperidone, the general information has high comparability of.2, smoking group and non-smoking group at baseline When the level of inflammatory factors have little difference but the difference is at a relatively high level after.8 weeks, the smoking group IL-1 beta, IL-6 levels decreased to a certain extent but is still high, and no smoking group after treatment, the inflammatory factor levels were significantly decreased (P0.05). Changes of serum cytokines in the non-smoking group the larger, statistically significant difference between two groups. Compared with TNF- a baseline, the difference did not reach statistical significance (P0.05 3), the two groups had no statistical significance in patients with PANSS and CGI scores at baseline differences, after 8 weeks of treatment, the smoking group PANSS negative symptom score are significantly decreased the.4 (P0.05), cognitive function survey found that smoking groups in the information processing speed, sustained attention and vigilance on function score was higher than that of group.5 and no smoking, smoking cause or increase the side effects of anti psychiatric drugs. On the contrary. Lead to reduce side effects of akathisia. Conclusion: 1, smoking can alter the inflammatory factors in patients with schizophrenia in the level of the IL-1 IL-6 beta, and TNF-a levels higher than non-smokers.2, smoking has a certain improvement effect of.3 on the negative symptoms of schizophrenia, some aspects of smoking the spirit of cognitive function in patients with schizophrenia may damage than non-smoking patients with schizophrenia is light, such as information processing speed, sustained attention and vigilance.4, smoking patients with schizophrenia appear "akathisia" fewer side effects.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R749.3
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本文編號：1564846