本文選題：精神分裂癥 + 奧氮平�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景精神分裂癥是一種復(fù)雜的臨床綜合征,其病因至今仍未被研究者完全闡明。免疫炎癥假說(shuō)是精神分裂癥重要的病因?qū)W學(xué)說(shuō)之一,這一觀點(diǎn)以患者外周多種炎性細(xì)胞因子水平升高(即免疫激活現(xiàn)象)為基礎(chǔ)。超敏C-反應(yīng)蛋白(hs-CRP)、轉(zhuǎn)化生長(zhǎng)因子-β1(TGF-β1)、白介素1β(IL-1β)、白介素6(IL-6)、白介素17(IL-17)是人體內(nèi)常見(jiàn)的炎性細(xì)胞因子,深入研究上述炎性細(xì)胞因子在治療前后的變化,比較它們?cè)诓煌熜Щ颊呷后w間差異,有助于進(jìn)一出闡明免疫炎癥對(duì)精神分裂癥轉(zhuǎn)歸的影響。目的1.觀察治療前后首發(fā)精神分裂癥患者外周炎性細(xì)胞因子水平的變化,探索患者外周不同細(xì)胞因子的變化規(guī)律,豐富精神分裂癥免疫炎癥假說(shuō)的臨床證據(jù)。2.比較不同臨床療效的患者群體炎性細(xì)胞因子水平的差異,并分析這種差異的臨床意義,獲取評(píng)估精神分裂癥臨床療效潛在生物學(xué)指標(biāo)。方法1.選取首發(fā)精神分裂癥患者82例,入組后單一使用奧氮平治療4周,分別在治療前和治療4周末評(píng)定陽(yáng)性和陰性癥狀量表(PANSS)評(píng)分。根據(jù)PANSS減分率(50%為界)將納入患者分為A、B兩組。同時(shí)選取年齡和性別與病例組相匹配的30例健康人群作為對(duì)照組。2.入組后抽取所有受試者外周靜脈血5ml,病例組治療4周后再次采取外周靜脈血5ml,分離、分裝血漿,保存于-70℃冰箱備用。使用酶聯(lián)免疫吸附法(ELISIA)檢測(cè)所有參與者血清TGF-β1、IL-1β、IL-6、IL-17水平,乳酸增強(qiáng)免疫比濁法檢測(cè)hs-CRP水平。3.應(yīng)用統(tǒng)計(jì)學(xué)軟件SPSS19.0進(jìn)行數(shù)據(jù)處理,以均數(shù)±標(biāo)準(zhǔn)差((?)+s)表示計(jì)量資料,以配對(duì)樣本t檢驗(yàn)或獨(dú)立樣本t檢驗(yàn)比較相應(yīng)組別間的差異,記P0.05為有統(tǒng)計(jì)學(xué)差異。結(jié)果1.82例患者治療前PANSS評(píng)分為88.34±11.50,治療后降為67.15±18.69;其中有42例PANSS減分率50%(A組);40例PANSS減分率≥50%(B組)。2.治療前患者組5種炎性因子水平均顯著高于健康對(duì)照,差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療4周后hs-CRP水平顯著升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與治療前相比,治療后TGF-β1水平無(wú)顯著變化(P0.05),IL-1β、IL-6、IL-17水平顯著降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。3.治療4周后,A、B 2組患者血清hs-CRP水平均較治療前顯著升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),IL-1β、IL-6、IL-17均較治療前顯著下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05);A組患者治療后血清IL-1β、IL-6、IL-17水平較B組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.精神分裂癥患者外周存在著免疫異�，F(xiàn)象,而抗精神病藥奧氮平能夠改善這一異�，F(xiàn)象。2.精神分裂癥患者血清hs-CRP、TGF-β1可能不是評(píng)估精神分裂癥臨床療效的炎性標(biāo)記物。3.IL-1β、IL-6、IL-17可作為評(píng)估患者臨床療效的潛在生物學(xué)指標(biāo)。
[Abstract]:Background schizophrenia is a complex clinical syndrome, the etiology of which has not been fully elucidated by researchers. The immune inflammation hypothesis is one of the most important etiological theories of schizophrenia, which is based on the elevated levels of multiple inflammatory cytokines (i.e., immune activation) in patients with schizophrenia. High sensitive C-reactive protein (hs-CRP), transforming growth factor- 尾 1 (TGF- 尾 1), interleukin-1 尾 (IL-1 尾), interleukin-6 (IL-6) and interleukin-17 (IL-17) are common inflammatory cytokines in human body. Comparing their differences among different groups of patients is helpful to elucidate the effect of immune inflammation on the outcome of schizophrenia. Objective 1. To observe the changes of peripheral inflammatory cytokines in patients with first-episode schizophrenia before and after treatment, to explore the changes of peripheral cytokines, and to enrich the clinical evidence of immune inflammation hypothesis of schizophrenia. To compare the level of inflammatory cytokines in different clinical efficacy patients, and analyze the clinical significance of the differences, and obtain the potential biological indicators to evaluate the clinical efficacy of schizophrenia. Method 1. 82 patients with first-episode schizophrenia were treated with olanzapine alone for 4 weeks. The positive and negative symptom scale (PANSS) scores were assessed before and after treatment for 4 weeks. Patients were divided into two groups according to PANSS score reduction rate (50%). At the same time, the age and gender matched with the case group of 30 healthy people as the control group. 2. 2. The peripheral venous blood was collected from all the subjects at 5 ml after treatment for 4 weeks. The peripheral venous blood was separated and divided into plasma and stored in the refrigerator at -70 鈩，

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