發(fā)布時間：2018-04-16 03:40

  本文選題：精神分裂癥 + 血漿��； 參考：《中國人民解放軍軍醫(yī)進修學院》2012年碩士論文

【摘要】：精神分裂癥的發(fā)病原因至今未明，多年來發(fā)病機制中研究最多的仍然是神經遞質。Orexin是1998年新發(fā)現(xiàn)的下丘腦神經肽，其作用范圍廣泛，在攝食、睡眠／覺醒、內分泌調節(jié)、物質依賴、中樞犒賞、呼吸、學習與記憶等多方面發(fā)揮作用。隨著研究的深入，國外有證據表明下丘腦的Orexin系統(tǒng)能直接而強烈地興奮去甲腎上腺素、多巴胺、五羥色胺、組胺和膽堿能神經元，Orexin在調節(jié)谷氨酸和其他氨基酸釋放方面也有重要作用。Orexin能調節(jié)皮質多巴胺通路。公開發(fā)表的數(shù)據表明Orexin與精神疾病有必然的聯(lián)系。 目的：研究精神分裂癥患者血漿Orexin-A的水平和藥物治療對其的影響及臨床意義。 第一部分： 方法：選擇61例新入院首發(fā)未用藥的精神分裂癥患者作為研究組，37名與研究組匹配的健康體檢者作為對照組。所有入組對象均晨6：00空腹12小時后采集靜脈血，用放射免疫法測定血漿Orexin-A水平。 結果：首發(fā)未用藥的精神分裂癥患者血漿Orexin-A水平(67.35±59.81)pg/ml,與正常對照組(50.45±71.15)pg/ml比較，沒有統(tǒng)計學差異(P0.05)。 第二部分： 方法：選擇20名首發(fā)精神分裂癥患者持續(xù)應用奧氮平（20mg/天）治療，于治療前和治療12個月末測定血漿Orexin-A水平、體重、BMI、空腹血糖、血清甘油三酯、膽固醇、HDL、LDL水平。用PANSS量表，于治療前和治療第4、8周及治療12個月末評分，并評定療效。 結果：①經奧氮平持續(xù)治療12月后的精神分裂癥患者血漿Orexin-A水平較治療前降低[(68.67±60.31）pg/mlVS (39.83±18.12）pg/ml，P0.05]，體重、BMI、甘油三酯、總膽固醇，空腹血糖、LDL均明顯升高，HDL降低，差異具有統(tǒng)計學意義(P0.05)。②Orexin-A水平降低與LDL的變化正相關（r=0.483，P=0.03）。③體重增加與陽性癥狀分差值顯著負相關(r=0.603，P0.01)，體重增加與Orexin-A水平變化無顯著相關（r=-0.061,P0.05）。④奧氮平治療12個月后，，患者PANSS總分及陽性癥狀分、陰性癥狀分均降低，差異具有顯著性(P0.01），總有效率90%。 結論：首發(fā)未用藥精神分裂癥患者的血漿orexin-A水平與正常人無顯著性差異；奧氮平對首發(fā)精神分裂癥患者Orexin-A及體重、糖脂代謝指標有顯著影響；體重增加與陽性癥狀分差值顯著負相關，推測體重增加與奧氮平對陽性癥狀的治療效果有著緊密的聯(lián)系；體重增加與Orexin-A水平變化無顯著相關，尚不能確定Orexin-A水平降低是體重增加的原因；奧氮平對于首發(fā)精神分裂癥療效確切，可治療精神分裂癥的陽性癥狀及陰性癥狀。
[Abstract]:The pathogenesis of schizophrenia is still unknown. In many years, the neurotransmitter. Orexin, a new hypothalamic neuropeptide discovered in 1998, has a wide range of effects in food intake, sleep / arousal, endocrine regulation.Substance dependence, central reward, respiration, learning and memory play many roles.As the research progresses, there is evidence abroad that the hypothalamic Orexin system can directly and intensely excite norepinephrine, dopamine, serotonin,Histamine and cholinergic neurons Orexin also play an important role in regulating the release of glutamate and other amino acids.Published data suggest an inevitable link between Orexin and mental illness.Objective: to study the level of plasma Orexin-A and its clinical significance in schizophrenic patients.Part I:Methods: a total of 61 patients with schizophrenia were selected as control group.Venous blood samples were collected from all subjects at 6:00 fasting 12 hours in the morning. Plasma Orexin-A levels were measured by radioimmunoassay.Results: the plasma Orexin-A level was 67.35 鹵59.81g / ml in patients with schizophrenia and 50.45 鹵71.15)pg/ml in the control group. There was no significant difference between the two groups (P 0.05).Part II:Methods: 20 first-episode schizophrenia patients were treated with olanzapine 20mg / day. Plasma Orexin-A, body weight, fasting blood glucose, serum triglyceride and cholesterol were measured before and after 12 months of treatment.PANSS scale was used to evaluate the curative effect before treatment, 8 weeks after treatment and 12 months after treatment.Results the plasma Orexin-A levels in patients with schizophrenia after 12 months of continuous treatment with olanzapine were significantly lower than those before treatment [68.67 鹵60.31)pg/mlVS 39.83 鹵18.12 g / ml P 0.05]. BMIs, triglycerides, total cholesterol and fasting blood glucose were significantly increased and decreased.The difference was statistically significant between the decrease of P0.05U. 2Orexin-A level and the change of LDL. There was a significant negative correlation between the weight gain and the difference of positive symptom score. There was no significant correlation between weight gain and Orexin-A level change. After 12 months of treatment, there was no significant correlation between weight gain and Orexin-A level change, after 12 months of treatment with olanzapine, there was no significant correlation between weight gain and Orexin-A level.The total score of PANSS, the score of positive symptom and the score of negative symptom were all decreased, the difference was significant (P 0.01), and the total effective rate was 90%.Conclusion: there was no significant difference in plasma orexin-A levels between first-episode schizophrenia patients and normal controls, and olanzapine had significant effects on Orexin-A, body weight, glucose and lipid metabolism in first-episode schizophrenic patients.There was a significant negative correlation between weight gain and the difference of positive symptoms, which suggested that weight gain was closely related to the efficacy of olanzapine in the treatment of positive symptoms, while weight gain had no significant correlation with the change of Orexin-A level.It is not certain that the decrease of Orexin-A level is the cause of weight gain, and olanzapine is effective for first-episode schizophrenia and can be used to treat the positive and negative symptoms of schizophrenia.
【學位授予單位】：中國人民解放軍軍醫(yī)進修學院
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R749.3

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本文編號：1757173