| 其他摘要 | BackgroundSchizophrenia is a serious chronic mental disease. Its occurrence is related to pro-inflammatory risk genes, environmental stress factors and changes of immune system. A large number of epidemiological and clinical studies have proved that inflammation and immunity play a role in schizophrenia, and various infection factors are the risk factors of schizophrenia. In addition, schizophrenia is also a heterogeneous mental disease with a wide range of clinical and biological manifestations. However, due to the lack of objective tests or biomarkers, its accurate diagnosis and the choice of effective treatment is still challenging. In terms of clinical characteristics, schizophrenia may be more prone to insulin resistance, lipid abnormalities and weight gain. The risk of metabolic abnormalities is higher than that of the general population. Inflammation is also an important pathophysiological factor of metabolic disorders such as type 2 diabetes. Therefore, it is speculated that the high risk of metabolic abnormalities in patients with schizophrenia may also be related to their inflammation. In this study, biomarkers related to immune inflammation were selected to study in patients with schizophrenia. High sensitivity C-reactive protein (hs-CRP) is an acute inflammatory protein. Neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) are newly found inflammatory markers positively correlated with hs-CRP. Homocysteine (Hcy) can affect vascular endothelial cells through various ways to induce oxidative stress and inflammatory response and participate in the occurrence and development of schizophrenia. Antinuclear antibody (ANA) is an immune biomarker and an autoantibody against a series of nuclear components. In conclusion, this study hypothesized that NLR, RDW, hs-CRP, Hcy and ANA may be highly expressed in schizophrenic patients and have a certain impact on the disorder of glucose and lipid metabolism. In addition, the above indicators may also have some auxiliary diagnostic value for schizophrenia, and are expected to become potential biomarkers for early detection and prevention of schizophrenia and its accompanying glycolipid metabolism disorders.ObjectiveTo detect the expression of NLR, RDW, hs-CRP, Hcy and ANA in patients with schizophrenia, analyze their relationship with various dimensions of schizophrenia (different stages of onset, different clinical characteristics and before and after antipsychotic treatment) and accompanying abnormal glucose and lipid metabolism.To explore the efficacy of the above indexes in the auxiliary diagnosis of first-episode and recurrent schizophrenia, so as to seek the clinical value of these inflammatory indexes in schizophrenia.Methods114 schizophrenic patients treated in Beijing Huilongguan Hospital from January to December 2019 were selected as case group, and 48 healthy subjects were selected as control group. The levels of NLR, RDW, hs-CRP and Hcy at admission were detected and recorded, and the first-episode and recurrent patients were grouped with normal controls. The above indicators were compared and analyzed between the first episode、recurrence and the normal control group, and then the receiver operating characteristic curve ( ROC curve ) was used to analyze the auxiliary diagnostic value of high expression indicators in the case group for schizophrenia; The case group was divided into different subgroups according to clinical characteristics, and the levels of NLR, RDW, hs-CRP, Hcy were compared among all groups; Forty-eight patients were selected from the case group who received standard treatment of first-line second-generation antipsychotic drugs for 1 month, and the levels of NLR, RDW, hs-CRP and Hcy were compared before and after treatment; The univariate and multivariate binary logistic regression analysis were used to analyze the relationship between the above inflammatory indexes and the abnormal glucose and lipid metabolism in patients in the case group; The serum of 77 patients in the case group from April to October 2019 was collected at admission, and ANA was detected and compared with normal controls.ResultsCompared with the normal control group, NLR and Hcy in the first-episode schizophrenia group increased significantly (p<0.05), and NLR, RDW, hs-CRP and Hcy in the recurrent schizophrenia group also increased significantly (p<0.05). In addition, RDW and hs-CRP in the recurrent schizophrenia group increased significantly compared with the first-episode schizophrenia group (p<0.05); ROC curve analysis showed that NLR, Hcy alone and in combination had diagnostic value for first-episode schizophrenia (the areas under the ROC curve were 0.789, 0.774 and 0.853 respectively), and NLR, RDW, hs-CRP and Hcy alone and in combination had diagnostic value for recurrent schizophrenia (the areas under the ROC curve were 0.788, 0.669, 0.739, 0.795 and 0.918 respectively); The comparison of clinical subgroups of schizophrenia showed that the RDW of women was higher than that of men (p<0.05), the Hcy of men was higher than that of women (p<0.05), the hs-CRP in patients over 50 years old was higher than that in patients between 30 to 50 years old (p<0.05), the hs-CRP was higher in patients with first untreated period ≥1 year than that in patients with < 1 year (p<0.05), the NLR was higher in patients with recurrent disease duration ≥ 10 years than that in patients with disease duration < 10 years (p<0.05); After antipsychotic treatment, the NLR level of 48 patients decreased significantly compared with that before treatment (p<0.05), but there was no difference in hs-CRP, RDW and Hcy before and after treatment (p>0.05); Logistic regression analysis showed that hs-CRP was an independent risk factor for abnormal lipid metabolism in schizophrenic patients (OR=1.254, p<0.05). NLR and age were independent risk factors for abnormal fasting blood glucose metabolism in schizophrenic patients (OR was 1.642 and 1.060, respectively, p<0.05); The comparison of ANA positive rate showed that there was no difference between schizophrenia group and normal control group (p>0.05).ConclusionIn schizophrenic patients, the expression level of inflammatory indexes in patients with long course and recurrence is higher, suggesting that the inflammatory state may develop with the disease process, and the level of NLR after antipsychotic treatment is lower than that before treatment, suggesting that antipsychotics have an effect on NLR in schizophrenic patients; In addition, inflammatory indexes are also related to the risk of abnormal glucose and lipid metabolism in schizophrenic patients. Close monitoring of NLR and hs-CRP may help to evaluate and prevent the occurrence of glucose and lipid metabolism disorders in patients with schizophrenia; In clinical diagnosis, the single and combined detection of inflammatory indexes NLR, hs-CRP, RDW and Hcy has diagnostic value for schizophrenia, and the value of combined detection is greater than that of single detection. Key Words: Schizophrenia, Inflammatory index, Antinuclear antibody, Lipid metabolism, Glucose metabolism |
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