本文選題：強(qiáng)迫癥 + 腫瘤壞死因子-α　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的探討首發(fā)強(qiáng)迫癥患者的血清腫瘤壞死因子-α(TNF-α)和白細(xì)胞介素-2(IL-2)水平及認(rèn)知功能情況,觀察經(jīng)過(guò)藥物治療后的強(qiáng)迫癥患者血清TNF-α、IL-2水平和認(rèn)知功能的變化,為強(qiáng)迫癥的臨床診治提供理論依據(jù)。方法采用病例對(duì)照的方法,根據(jù)《美國(guó)精神障礙診斷與統(tǒng)計(jì)手冊(cè)第4版》(DSM-IV)強(qiáng)迫癥的診斷標(biāo)準(zhǔn),選取符合強(qiáng)迫癥診斷的54例患者(強(qiáng)迫癥組),給予舍曲林治療。同期選取54例健康志愿者作為對(duì)照組,與入組強(qiáng)迫癥患者的年齡、性別和受教育年限相匹配。1.采用耶魯-布朗強(qiáng)迫癥量表(Y-BOCS)和成套神經(jīng)心理學(xué)評(píng)估測(cè)驗(yàn)(MCCB)中的8個(gè)神經(jīng)心理學(xué)測(cè)驗(yàn):(1)連線測(cè)試A部分;(2)簡(jiǎn)易認(rèn)知評(píng)估:符號(hào)編碼;(3)霍普金斯詞語(yǔ)學(xué)習(xí)測(cè)試-修訂版;(4)韋氏記憶量表-第三版:空間廣度;(4)神經(jīng)心理評(píng)估成套測(cè)試:迷宮;(5)簡(jiǎn)易視覺空間記憶測(cè)試-修訂版;(6)范疇流暢:動(dòng)物命名(流暢性);(8)Mayer-Salovey-Caruso情緒智商測(cè)試:情緒管理,對(duì)研究對(duì)象進(jìn)行強(qiáng)迫癥狀評(píng)定及認(rèn)知功能評(píng)估,應(yīng)用酶聯(lián)免疫吸附方法(ELISA)測(cè)定血清IL-2和TNF-α水平。2.強(qiáng)迫癥組中有21例患者,完成了12周的舍曲林治療,采用同樣方法評(píng)估強(qiáng)迫程度、認(rèn)知功能及血清IL-2、TNF-α水平,進(jìn)行治療前、后的對(duì)比研究。運(yùn)用SPSS17.0統(tǒng)計(jì)軟件對(duì)所有數(shù)據(jù)進(jìn)行相應(yīng)的t檢驗(yàn),χ2檢驗(yàn)及相關(guān)分析等。結(jié)果1一般資料比較54例強(qiáng)迫癥組和54例健康對(duì)照組之間的性別(χ2=0.04,P=0.84)、年齡(t=-0.13,P=0.89)和受教育年限(t=-1.10,P=0.27)無(wú)明顯差異。2強(qiáng)迫癥組與健康對(duì)照組血清TNF-α、IL-2水平和認(rèn)知功能的比較2.1強(qiáng)迫癥組血清TNF-α(393.64±49.27pg/ml)和IL-2(428.59±97.33pg/ml)水平均顯著高于健康對(duì)照組(292.21±60.03pg/ml,304.27±63.27pg/ml),差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。2.2強(qiáng)迫癥組信息處理速度(32.63±9.52)、視覺空間工作記憶(42.06±8.64)、視覺記憶(44.30±10.32)及推理和問(wèn)題解決的決策能力(34.09±8.03)顯著低于健康對(duì)照組(47.87±7.30,50.39±7.72,50.15±7.33,47.39±10.44),差異具有統(tǒng)計(jì)學(xué)意義(P0.01);強(qiáng)迫癥組言語(yǔ)記憶(47.11±10.36)和社會(huì)認(rèn)知(44.13±13.05)與健康對(duì)照組(47.94±10.08,47.76±17.64)相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.3強(qiáng)迫癥患者信息處理速度、言語(yǔ)記憶及社會(huì)認(rèn)知與發(fā)病年齡呈負(fù)相關(guān)(r=0.38,0.35,0.38,P0.01);信息處理速度與強(qiáng)迫行為呈負(fù)相關(guān)(r=0.34,P0.05);血清TNF-α和IL-2水平與各項(xiàng)認(rèn)知功能、強(qiáng)迫癥狀及嚴(yán)重程度、年齡、發(fā)病年齡和病程均無(wú)明顯相關(guān)性(P0.05)。3藥物治療前、后強(qiáng)迫癥患者Y-BOCS量表評(píng)分、血清TNF-α、IL-2水平和認(rèn)知功能的比較3.1藥物治療后患者強(qiáng)迫思維(8.24±3.11分)、強(qiáng)迫行為(6.00±3.38分)及強(qiáng)迫總分(14.24±5.96分)顯著低于治療前(11.14±3.69分,8.90±3.97分,20.05±6.79分),差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。3.2藥物治療后強(qiáng)迫癥患者血清TNF-α(361.48±57.52pg/ml)和IL-2(385.14±89.30pg/ml)水平與治療前(390.39±41.10pg/ml,433.53±109.60pg/ml)相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.3藥物治療后強(qiáng)迫癥患者的信息處理速度(39.29±9.63)、言語(yǔ)記憶(55.81±9.94)、視覺記憶(50.62±8.55)及社會(huì)認(rèn)知(52.05±15.03)高于治療前(32.90±10.01,47.05±10.40,45.48±9.54,43.24±10.24),差異具有統(tǒng)計(jì)學(xué)意義(P0.05或P0.01);藥物治療后強(qiáng)迫癥患者視覺空間工作記憶(43.95±11.95)和推理和問(wèn)題解決的決策能力(34.81±9.83)與治療前(42.52±7.31,32.86±9.21)相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.首發(fā)強(qiáng)迫癥患者血清TNF-α和IL-2水平升高,認(rèn)知功能中,信息處理速度、視覺記憶、視覺空間工作記憶及推理和問(wèn)題解決的決策能力受損。2.通過(guò)藥物治療,強(qiáng)迫癥患者部分認(rèn)知功能改善,但血清TNF-α和IL-2水平變化不明顯。3.首發(fā)強(qiáng)迫癥患者發(fā)病年齡越小及強(qiáng)迫行為越重對(duì)認(rèn)知功能影響越大。
[Abstract]:Objective to investigate the level of serum tumor necrosis factor - alpha (TNF- - alpha) and interleukin -2 (IL-2) and cognitive function in patients with first onset obsessive-compulsive disorder (OCD), and to observe the changes of serum TNF- a, IL-2 level and cognitive function in patients with obsessive-compulsive disorder after drug treatment, and provide a theoretical basis for the clinical diagnosis and treatment of obsessive-compulsive disorder. According to the diagnostic criteria of the fourth edition of the American psychiatric disorder diagnosis and Statistics Manual (DSM-IV), 54 patients (obsessive-compulsive disorder group) were selected to be treated with obsessive-compulsive disorder (obsessive-compulsive disorder group). 54 healthy volunteers were selected as the control group at the same time. The age, sex and the number of years of education were matched with the age of the obsessive-compulsive disorder, and the Yale - cloth was adopted by.1.. 8 neuropsychological tests in the Y-BOCS and MCCB: (1) connection test A; (2) simple cognitive assessment: symbol coding; (3) Hopki vocabulary learning test revision; (4) Wechsler Memory Scale third: space breadth; (4) neuropsychological assessment complete test: maze; (5) simple Visual spatial memory test - revision; (6) fluency in category: Animal naming (fluency); (8) Mayer-Salovey-Caruso Emotional IQ test: emotional management, compulsive symptom assessment and cognitive function assessment on subjects, and determination of 21 patients in serum IL-2 and TNF- alpha obsessive-compulsive disorder group by enzyme linked immunosorbent assay (ELISA). 12 weeks of sertraline treatment, the same method was used to evaluate the degree of compulsion, cognitive function and the level of serum IL-2, TNF- alpha, before and after the treatment. The corresponding t test, x 2 test and correlation analysis were used by SPSS17.0 statistics software. Results 1 general data were compared in 54 obsessive-compulsive groups and 54 healthy control groups. Sex (x 2=0.04, P=0.84), age (t=-0.13, P=0.89) and education years (t=-1.10, P=0.27), there was no significant difference between.2 obsessive-compulsive disorder group and healthy control group, serum TNF- a, IL-2 level and cognitive function. The level of TNF- a (393.64 + 49.27pg/ml) and IL-2 (428.59 +) in the 2.1 obsessive-compulsive group were significantly higher than those of the healthy control group (292.21 +. 60.03pg/ml, 304.27 + 63.27pg/ml), the difference was statistically significant (P0.01) the speed of information processing in.2.2 obsessive compulsive disorder group (32.63 + 9.52), visual spatial working memory (42.06 + 8.64), visual memory (44.30 + 10.32) and reasoning and problem solving (34.09 + 8.03) significantly lower than that of the healthy control group (47.87 + 7.30,50.39 + 7.72,50.15 + 7.33,47.39 The difference was statistically significant (P0.01); the speech memory (47.11 + 10.36) and social cognition (44.13 + 13.05) of the obsessive-compulsive disorder group were compared with the healthy control group (47.94 + 10.08,47.76 + 17.64), and there was no significant difference (P0.05) with the speed of information processing in.2.3 obsessive-compulsive disorder (P0.05), and the verbal memory and social cognition were negatively correlated with the age of the onset (r=0.38,0.35, 0.38, P0.01); the speed of information processing was negatively correlated with the compulsion behavior (r=0.34, P0.05); serum TNF- alpha and IL-2 levels had no significant correlation with various cognitive functions, compulsive symptoms and severity, age, age and course of disease (P0.05) before.3 drug treatment, Y-BOCS scale for post severe sufferers, serum TNF- alpha, IL-2 level, and cognitive function The forced thinking (8.24 + 3.11), forced behavior (6 + 3.38) and forced total score (14.24 + 5.96 points) were significantly lower than those before the 3.1 drug treatment (11.14 + 3.69, 8.90 + 3.97, 20.05 + 6.79), and the difference was statistically significant (P0.01).3.2 after the treatment of obsessive-compulsive disorder patients TNF- alpha (361.48 + 57.52pg/ml) and IL-2 89.30pg/ml) compared with before treatment (390.39 + 41.10pg/ml, 433.53 + 109.60pg/ml), the difference was not statistically significant (P0.05), the rate of information processing (39.29 + 9.63), speech memory (55.81 + 9.94), visual memory (50.62 + 8.55) and social cognition (52.05 + 15.03) were higher than that before treatment (32.90 + 10.01,47.05 + 10.40,4). 5.48 + 9.54,43.24 + 10.24), the difference was statistically significant (P0.05 or P0.01); there was no significant difference in visual spatial working memory (43.95 + 11.95) and reasoning and problem solving (34.81 + 9.83) of patients with obsessive-compulsive disorder after drug therapy (34.81 + 9.83) and before treatment (42.52 + 7.31,32.86 + 9.21). Conclusion 1. patients with first onset obsessive-compulsive disorder TNF- alpha and IL-2 levels increased, cognitive function, information processing speed, visual memory, visual spatial working memory, and reasoning and problem-solving decision-making ability impaired.2. through drug therapy, partial cognitive function improved in patients with obsessive-compulsive disorder, but the changes in serum TNF- alpha and IL-2 levels were not obvious in patients with.3. first onset obsessive-compulsive disorder, the younger the onset age and compulsion The more serious the behavior is, the greater the effect of the cognitive function.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.7

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