目的 探讨伸展蛋白(syntaphilin,SNPH)基因与中国汉族人群精神分裂症(schizophrenia,SZ)之间的关联性.方法 采用TaqMan探针基因分型技术对389例SZ患者(病例组)和433例健康对照(对照组)的SNPH基因5个单核苷酸多态性(single nucleotide polymorphism,SNP)位点(rs3764714、rs3795139、rs3803947、rs3803949、rs6134520)进行基因分型及连锁不平衡分析.分析等位基因、基因型以及单倍型频率分布有无差异,比较两组不同遗传模式下基因型分布有无差异.结果 SNPH基因5个SNP位点连锁不平衡分析结果显示,5个位点可构成一个5个基因位点所组成的单倍型区块(D'>0.8).5个基因所组成的单倍型A-A-A-C-T、G-A-G-T-T、G-G-G-C-C频率分布在病例组与对照组间差异无统计学意义(P=0.978、P=0.535、P=0.524).SNPH基因5个SNP位点等位基因及基因型频率分布在病例组与对照组之间差异均无统计学意义.在共显性、显性、隐性及加性遗传模式下,该5个SNP位点基因型频率分布在病例组与对照组之间差异也无统计学意义.结论 在中国汉族人群中,SNPH基因可能不是SZ的易感基因.

Objective:To explore the relationship between negative symptoms and resting alpha-band power in patients with schizophrenia.Method:Thirteen patients with schizophrenia who met the ICD-10 diagnostic criteria were scanned by magnetoencephalography (MEG) in the eyes-closed resting state. The alpha-band powers were calculated using the short-time sliding window method in the time domain. The powers of eight brain regions include left frontal lobe,right frontal lobe,left temporal lobe,right temporal lobe,left parietal lobe,right parietal lobe,left occipital lobe and right occipital lobe. The average powers of these regions were obtained respectively. Clinical symptoms in patients with schizophrenia were assessed using the Positive and Negative Syndrome Scale (PANSS),which evaluated 30 items covering positive and negative symptoms and general psychopathology. The patients were then divided into the less negative symptom group (i.e.,a lower score than the median) and the highly negative symptom group (i.e., a higher score than the median) according to the negative symptom scores. A nonparametric rank sum test,Wilcoxon two-sample rank sum test,was used to compare the difference between the two groups in the total alpha power and the alpha powers of eight brain regions. Multivariate linear regression was then used to analyze the relationship between the alpha power of the right temporal region and negative symptoms. Analysis of covariance was used to control for the confounding effects of anxiety and depression and years of education on the negative symptoms. Kendall′s tau-b analysis was used to explore the correlation between the negative symptoms and the alpha powers of eight brain regions.Result:There was a significant difference ( Z=-2.143, P=0.032) in the alpha powers of the right temporal lobe between the two groups. The negative symptom scale score can be contributed by the changes of alpha power in the right temporal lobe, years of education,anxiety and depression factor scores and positive symptom scale score (corrected r2=0.894). The alpha power of the right temporal lobe had a significant effect on negative symptoms ( t=3.965, P=0.004). Conclusion:The negative symptoms of schizophrenic patients may be related to the abnormal alpha power in the right temporal lobe.

目的:探讨经皮迷走神经刺激(tVNS)联合阿戈美拉汀治疗难治性抑郁症(TRD)的临床疗效及机制.方法:选取100例TRD患者为研究对象,依据治疗方式不同分为对照组与观察组,每组各50例.对照组予以阿戈美拉汀治疗;观察组予以tVNS联合阿戈美拉汀治疗,疗程均为8周.比较两组患者治疗总有效率、汉密尔顿抑郁量表(HAMD)、比兹堡睡眠质量指数(PSQI)评分及血清5-羟色胺(5-HT)、去甲肾上腺素(NE)、脑源性神经营养因子(BDNF)水平和不良反应发生情况.结果:观察组患者治疗总有效率高于对照组(P<0.05).治疗2周、4周、8周后,观察组HAMD及PSQI评分均低于对照组(P<0.05).治疗8周后,观察组血清5-HT、NE、BDNF水平均高于对照组(P<0.05).两组患者不良反应发生率比较,差异无统计学意义(P>0.05).结论:tVNS联合阿戈美拉汀治疗TRD能够更好更迅速改善患者抑郁症状及睡眠状况,且安全性好,其机制可能与上调血清5-HT、NE、BDNF水平有关.

目的 探讨精神分裂症患者ABCB1基因多态性与经奥氮平治疗后体重、血糖、血脂变化的相关性.方法 前瞻性入组2017年7月至2018年12月住院的精神分裂症患者72例,单一服用奥氮平.采用Taqman探针基因分型技术对ABCB1基因rs1045642、rs2032582多态性进行分型.应用重复测量方差分析比较ABCB1基因rs1045642、rs2032582位点不同基因型间在基线期、治疗8周后体重、血糖、总胆固醇、甘油三酯、高密度脂蛋白(HDL)、低密度脂蛋白水平变化的差异.结果 rs1045642位点CC基因型患者治疗后较基线期体重增加、空腹血糖下降,差异均有统计学意义[分别为(62.76±9.42)kg比(58.95±12.03)kg,t=10.040,P<0.05;(5.08±1.28)mmol/L比(6.33±2.38)mmol/L,t=7.268,P<0.05],而CT、TT基因型患者治疗前后差异均无统计学意义(均P>0.05);rs1045642位点CC、TT基因型治疗后较基线期HDL下降[分别为(1.12±0.30)mmol/L比(1.31±0.57)mmol/L,t=6.530,P<0.05;(1.36±0.23)mmol/L比(1.54±0.19)mmol/L,t=10.161,P<0.05],差异均有统计学意义,而CT基因型治疗前后差异无统计学意义(P>0.05).rs2032582位点GG、TT基因型治疗后较基线期体重均增加[(62.57±10.61)kg比(59.23±12.20)kg,t=6.159,P<0.05;(60.19±6.93)kg比(57.31±8.97)kg,t=5.188,P<0.05],差异有统计学意义,GT基因型治疗前后差异无统计学意义(P>0.05);GG基因型治疗后较基线期血糖、HDL下降[分别为(5.19±1.39)mmol/L比(6.44±2.56)mmol/L,t=5.220,P<0.05;(1.18±0.30)mmol/L比(1.39±0.58)mmol/L,t=5.576,P<0.05],差异均有统计学意义,而GT、TT基因型治疗前后差异均无统计学意义(均P>0.05).结论 ABCB1基因多态性可能与精神分裂症患者经奥氮平治疗后体重增加、血脂代谢异常有相关性.

恶性综合征是抗精神病药物引起的一种少见而严重的不良反应,临床上以发热、肌张力增高、自主神经功能紊乱和精神状态改变为特征,如不能及时发现与治疗,死亡率较高.

目的 探讨碳酸锂联合喹硫平对双相障碍抑郁发作患者的疗效及氧化应激水平的影响.方法 选取2015年1月至2018年1月本院住院及门诊诊治的双相障碍抑郁发作患者60例,采用随机数字表法分为观察组和对照组,每组30例.对照组口服碳酸锂片,观察组服用碳酸锂片和富马酸喹硫平片,治疗8周.比较两组患者的临床疗效和氧化应激指标[超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)和丙二醛(MDA)]的变化.并采用17项汉密尔顿抑郁量表(HAMD-17)和杨氏躁狂量表(YMRS)对两组患者治疗前后抑郁和狂躁严重程度进行评价.结果 治疗8周后,观察组总有效率为73.33％(22/30),对照组为56.67％(17/30),差异有统计学意义(P＜0.05).治疗8周后,观察组HAMD-17评分显著低于对照组[(6.24±3.16)分vs (10.73 ±2.27)分,P＜0.05],两组YMRS评分差异无统计学意义(P＞0.05).治疗后,观察组SOD、GSH-Px水平显著高于对照组,MDA水平显著低于对照组,差异均有统计学意义(P＜0.05).观察组有效患者CAT水平显著高于无效患者(P＜0.05).治疗后观察组有效患者和无效患者SOD、GSH-Px、MDA水平差异无统计学意义(P＞0.05).观察组、对照组不良反应发生率分别为23.33％、20.00％,两组不良反应发生率差异无统计学意义(P＞0.05).结论 碳酸锂联合喹硫平对双相障碍抑郁发作患者临床疗效显著,能够显著改善患者氧化应激水平.

Objective To explore efficacy and safety paliperidone palmitate in female patients of schizophrenia.Methods 112 patients were indived into study group (female) and control group (male) according to gender,given orally paliperidone extended-release tablets for three days before injection,In the case of no allergic reaction,were injected with the first dose of 150mg of paliperidone palmitate injections,given fixed-dose 100mg at intervals of eight days,then monthly with dose of 75mg to 150 mg,no oral medications added.Change of psychiatric symptoms and therapeutic effect were assessed with the Positive and Negative Syndrome scale (PANSS) and Clinical Global Impression Scale (CGI-S).Safety was assessed with blood biochemistry in laboratory and Treatment Emergent Symptom Scale (TESS).The efficacy,adverse reactions and safety were evaluated before treatment and in the 1th weeks,4th weeks,8th weeks,16th weeks after treatment.Results The scores of PANSS and CGI-S both were decreased in the end of the 1th weeks,4th weeks,8th weeks,16th weeks after treatment.As compared with before treatment,PANSS total scores and CGI-S scores were significantly different (P＜0.05).34 patients had EPS and cholinergic response,10 patients had menstrual disorder.Conclusion Paliperidone palmitate injections begins to take effect after one weeks,reach to reliable effect after 4-8weeks,impact on body mass and menses,easily,lead to EPS and cholinergic response,result in menstrual disorder,but does not affect the continued use,obtain satisfactory clinical outcome,provides a new choice for long-term treatment.

近年来临床上广泛应用糖皮质激素,国外报道引起精神障碍的发生率为5％～10％,国内也有关于精神障碍的报道.临床上可见到地塞米松、可的松、泼尼松龙等治疗各种疾病时发生精神障碍.本文回顾总结了一例应用甲泼尼龙后出现严重精神障碍的诊断和治疗.

目的 对阿立哌唑和二甲双胍治疗氨磺必利所致的高催乳素血症的疗效进行研究,为临床相关治疗提供参考.方法 将2015年1月至2017年1月服用氨磺必利所致高催乳素血症的精神分裂症住院患者90例随机化分为阿立哌唑治疗组(5 mg/d)、二甲双胍治疗组(0.5 mg/d)和安慰剂组,分别于基线、治疗4周末、8周末测定患者血清催乳素(hyperprolactinemia,PRL)、白细胞介素1β(IL-1β)、神经生长因子(NGF),并使用阳性和阴性症状量表(positive and negative symptoms scale,PANSS)评定疗效.结果 与安慰剂组比较,阿立哌唑治疗组和二甲双胍治疗组均对氨磺必利所致的高催乳素血症有明显疗效,治疗后患者血清PRL、IL-1β及NGF水平、PANSS量表总分均明显下降(P<0.05),且阿立哌唑治疗组疗效更显著(P<0.05).结论 阿立哌唑和二甲双胍均对氨磺必利所致的高催乳素血症有显著疗效,阿立哌唑的疗效更优,可能与其调控血清IL-1β及NGF水平异常有关.

Objective To analyze routine examination results in the initial hospitalization of suspected mental disorder tramps,so as to provide reference of diagnosis and treatment for them.Methods To retrospective analyze routine examination results in the initial hospitalization of suspected mental disorder tramps who were sent to our hospital by Shanghai Rescue Station from July 2015 to March 2016.Results There are totally 101 tramps,74 males and 27 females included.66 cases (65 ％) were diagnosed as schizophrenia and acute schizophrenia mentally-disturbed obstacles.51 cases (50 ％) were diagnosed as ECG abnormal and 41cases (41％) were diagnosed as hypokalemia.57 cases (56 ％) were found that the white blood cells and/or neutrophil granulocytes were higher than upper limit of normal value.6 cases (6 ％) were diagnosed as diabetes,1 case (1％) was diagnosed as high-pressure and lcase (1％) was sudden death.Conclusion Due to special social conditions,the majority of patients combined with physical diseases and have higher abnormal rate of routine examination.It is important that mental health hospital complete the routine examinations of suspected mental disorder tramps before treatment.

Objective:To explore the effect of paliperidone extended release tablets on clinical efficacy, serum prolactin(PRL)level and body weight in first-episode female patients with schizophrenia. Method:Ac-cording to the order of admission and parallel cross grouping,98 first-episode female patients with schizophrenia were randomly divided into paliperidone group(48 cases)and amisulpride group(50 cases),and treated with corresponding drug for 12 weeks. The pateints were assessed by positive and negative syndrome scale(PAN-SS);the serum PRL level were detected before treatment and the end of 4th,8th,12th week after treatment;the body weight were measured before and after treatment. Results:After treatment,the total scores of PANSS were decreased significantly than before treatment in the two groups(all P ﹤ 0. 01),but there was no signifiant difference between the two groups;the serum PRL level was increased significantly(all P ﹤ 0. 01),and the in-crease in amisulpride group was more than paliperidone group(P ﹤ 0. 01);the body weight in the two groups was significantly increased than before treatment(all P ﹤ 0. 05),but there was no signifiant difference between the two groups. Conclusion:The clinical curative effect between paliperidone extended release tablets and amisulpride tablets is similar in first-episode female patients with schizophrenia. They both can result in serum PRL level and body weight.

目的:探讨棕榈酸帕利哌酮与奥氮平对精神分裂症患者疗效、血清催乳素(PRL)水平及体质量的影响. 方法:按照就诊顺序交叉将96例患者分成研究组(47例)和对照组(49例),分别应用棕榈酸帕利哌酮注射液及奥氮平治疗24周;治疗前、治疗4、8、12、24周末进行阳性与阴性症状评定量表(PANSS)、临床总体印象量表(CGI)、治疗中出现的症状量表(TESS)评定,同时检测血清PRL水平及体质量. 结果:治疗后两组PANSS、CGI评分较治疗前显著降低(P＜0.05或P＜0.01),但两组间差异无统计学意义;治疗后两组血清PRL水平及体质量较治疗前显著增加,且对照组明显高于研究组(P＜0.01或P＜0.05). 结论:棕榈酸帕利哌酮对精神分裂症患者疗效与奥氮平相当,短期应用对血清PRL水平及体质量的影响低于奥氮平.

目的:探讨棕榈酸帕利哌酮注射液与奥氮平片对精神分裂症患者疗效、社会功能、催乳素和体质量的影响.方法:采用双盲双模拟设计,按照就诊顺序交叉分成研究组(棕榈酸帕利哌酮)和对照组(奥氮平),采用阳性与阴性症状量表(PANSS)、临床总体印象量表疗效分量表(CGI-S)评定患者精神病症状与疗效的变化;采用人际和社会能力量表(PSP)评定生活质量和社会功能;采用药物副作用量表(TESS)、实验室检查、催乳素及体质量变化评价安全性.比较两组治疗前与治疗4,8,12和24周末的疗效、社会功能、不良反应、实验室检查、催乳素及体质量的变化.结果:治疗前,研究组与对照组的PANSS评分、PSP评分、催乳素和体质量没有统计学差异;治疗后,组间各周期PANSS和CGI评分比较无统计学差异;组间各周期PSP评分、催乳素和体质量有统计学差异(P＜0.01或P＜0.05).结论:棕榈酸帕利哌酮对精神分裂症患者的疗效与奥氮平相当,24周末对社会功能的影响优于奥氮平,对催乳素和体质量的影响较奥氮平小.

目的 评价棕榈酸帕利哌酮对精神分裂症患者疗效、血糖、血脂的影响.方法 对92例患者分为研究组(棕榈酸帕利哌酮)和对照组(奥氮平),研究组给予三天帕利哌酮片3mg/日口服,无药物过敏反应即予以棕榈酸帕利哌酮150mg肌肉注射;间隔8天注射100mg,之后每月一次,剂量75mg或100mg或150mg,无口服药补充;对照组予以奥氮平口服,起始日剂量5mg,最大剂量30mg;分别在治疗前与治疗第4、8、12、24周末采用阳性与阴性症状评定量(PANSS)、临床总体印象量表(CGI)评定精神症状与疗效的变化;同一时点监测血糖、血脂的变化.结果 研究组与对照组各时点PANSS、CGI评分与治疗前比较均有显著性差异(F1=4.226 P1=0.014 F2=4.823 P2=0.018),组间比较差异无显著性(F=2.126 P---0.172);两组血糖、血脂治疗后组间比较差异具有显著性(F=4.772P=0.017).结论 棕榈酸帕利哌酮治疗精神分裂症疗效与奥氮平相当;对血糖、血脂影响较奥氮平轻.

Objective To evaluate the effect of paliperidone palmitate on quality of life and insight in patients with schizophrenia.Methods 97 were given orally 6mg paliperidone tablets for three days before injection,in the case of no allergic reaction,were injected with 150mg paliperidone palmitate,were given 100mg injection at intervals of eight days,then were injected monthly with 75mg-150 mg dose.Change of psychiatric symptoms and therapeutic effect were assessed with the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression scale (CGI).Adverse reactions were evaluated with Treatment Emergent Symptoms Scale (TESS).Quality of life and insight were evaluated with Quality of Life Enjoyment and SatisfactionQuestionnaire(Q-LES-Q),andInsightandTreatmentAttitudeQuestionnaire(ITAQ).Monitoring blood biochemistry in laboratory.With the self-contrast method,to evaluate the efficacy and adverse reactions before treatment and.Results 72 patients were completed.The reduction rate of PANSS scores was 35.2％,51.2％,62.6％,75.3％ in the 4th,8th,12th,24th week after treatment after treatment.As compared with before treatment,Q-LES-Q scores、ITAQ scores were significantly increased in the 4th,Sth,12th,24th week after treatment (P＜0.01 or 0.05).Conclusion Paliperidone palmitate injections take effect obviously after 4 weeks,reach to satisfactory clinical effect,mildly adverse reaction,improves dramatically scores of Q-LES-Q and ITAQ,provides a new choice and possibility for long-term treatment and to restore social function.

目的 探讨棕榈酸帕利哌酮对精神分裂症患者生活质量的影响.方法 将98例患者分成研究组(棕榈酸帕利哌酮)和对照组(奥氮平),研究组口服三天帕利哌酮,无过敏即予棕榈酸帕利哌酮注射;首次150mg,间隔8天100mg,之后每月一次,剂量75～150mg;对照组口服奥氮平,剂量5mg～30mg,分别在治疗前与治疗后4、8、12、16周末采用阳性与阴性症状评定量(PANSS)、临床总体印象量表(CGI)评定精神症状与疗效的变化;生活质量和满意度自评问卷(Q-LES-Q)评定生活质量和满意度;副作用量表(TESS)、实验室、血生化、体质量评价安全性.结果 两组各时点PANSS、CGI、Q-LES-Q评分与治疗前比较均有显著性差异(P＜0.05或P＜0.01),PANSS、CGI组间比较差异无显著性(P＞0.05);Q-LES-Q治疗后组间比较差异有显著性(P＜0.05或P＜0.01),实验室、血生化无差异,体重、催乳素组间比较有差异.结论 棕榈酸帕利哌酮对精神分裂症疗效、副反应与奥氮平相当;对体重及催乳素影响较奥氮平轻,对生活质量和满意度优于奥氮平.

Objective:To explore the effect of paliperidone and risperidone on the serum prolactin level ( PRL)and body mass in patients with the first episode of schizophrenia. Method:130 cases of patients with first-episode schizophrenia were divided into 66 cases of paliperidone group(31 cases actually completed)and 64 cases of risperidone group(42 cases actually completed). They were treated respectively with risperidone and paliperidone with 12 weeks of observation. The efficacy were assessed with the positive and negative symp-toms scale( PANSS)before and after treatment,PRL and body mass were detected and the change were com-pared before and after treatment. Resuits:The total scores of the PANSS of the two groups were decreased sig-nificantly(all P<0. 01). The PRL and body mass were increased significantly after treatment(P<0. 05). The difference was not statistically significant between the two groups. Conciusion:Treatment efficacy of paliperi-done in patients with first-episode schizophrenia is equivalent to risperidone,the two drugs both can cause PRL and body mass increased.

我们将精神分裂症首发患者分别使用帕利哌酮和奥氮平治疗，监测疗效、代谢、体质量的变化，现报告如下。<br>　　1对象和方法<br>　　为2013年3月至2014年9月武汉市武东医院、上海市精神卫生中心、驻马店市精神卫生中心符合《国际疾病分类第10版》精神分裂症诊断标准；年龄18~58岁，首发住院患者。排除器质性、躯体疾病所致精神障碍；兴奋、激越、伤人、自伤；物质滥用及依赖；内分泌疾病及过度肥胖；孕妇及哺乳者。共126例，帕利哌酮组62例，完成33例，男18例，女15例；平均年龄（32.2±5.2）岁；平均病程（1.6±0.8）年。奥氮平组64例，完成40例，男24例，女16例；平均年龄（30.1±6.1）岁；平均病程（1.4±0.7）年。组间性别、年龄、病程及脱落率比较差异无统计学意义。治疗方案获得患者或监护人的知情同意。帕利哌酮起始剂量3 mg/d，最大剂量12 mg/d；奥氮平起始剂量5 mg/d，最大剂量30 mg/d。单一使用抗精神病药。治疗前和治疗4周、8周、12周清晨空腹静卧抽取静脉血送检，微粒酶免疫测定法定量测空服血糖（FBS）、胆固醇（TC）、三酰甘油（TG）及血清催乳素（PRL）；同时测量体质量；同日PANSS评分，减分率﹥25%为有效。采用SPSS15.0统计软件进行χ2检验及方差分析。

Objective To explore the influence of paliperidone extended release tablets and olanzapine on efficacy,metabolism and body mass in female patients with first-episode schizophrenia.Methods According to hospital order,96 cases of female patients with first-episode schizophrenia were randomly,parallel divided into study group (paliperidone) and control group (olanzapine),the changes of efficacy,fasting blood glucose,cholesterol,triglycerides,prolactin,body mass were compared with the two groups before treatment and at 4th week,at 8th week,at 12th week after treatment.Results 30 cases actually were completed in 47 cases of study group,and 33 cases actually were completed in 49 cases of control group.the difference of Positive and Negative Syndrome Scale score (PANSS),fasting blood glucose,cholesterol,triglycerides,prolactin,body mass between the study group and control group before treatment was not statistically significant (P＞0.05);the difference of Positive and Negative Syndrome Scale score (PANSS),fasting blood glucose,triglycerides was not statistically significant in each periods between the study group and the control group after treatment (P＞0.05);the difference of cholesterol,prolactin,body mass were statistically significant between the study group and the control group after treatment (P＜0.01 or P＜0.05).Conclusion Paliperidone makes equal to olanzapine on curative efficacy in patients with firstepisode schizophrenia,similar to olanzapine on fasting blood glucose,triglycerides at 12th week after treatment,elevated cholesterol and prolactin levels,less effective on body mass than olanzapine.

Objective:To explore the influence of Aripiprazole and Risperidone on serum prolactin levels and body weight in first-episode schizophrenia patients.Methods:According to illness after the initial assessment by clinicians,in accordance with the hospital order and stochastic parallel cross classification,153 patients with first-episode schizophrenia patients were randomly divided into study group(Aripiprazole) and control group(Risperidone).To compare serum prolactin level and weight change between the two groups before treatment and after treatment of 4 weeks,8 weeks,12 weeks and 24 weeks.Results: In 76 cases of the study group,53 cases actually were finished,In 77 cases of the control group,56 cases actually were finished.Between the research group and the control group before treatment in serum prolactin levels and body weight,there was no statistically significant difference(P>0.05).In the study group before and after treatment,in serum prolactin level and body weight,comparative differences was not statistically significant(P>0.05).In the control group before and after treatment in serum prolactin level and body weight comparative differences show statistical significance(P<0.01).Conclusions: Effect on serum prolactin level and body weight of schizophrenia patients with the first episode in the study group is small.Effect in the control group on serum prolactin level and body weight in patients is obvious.The drug therapy to patients with first episode schizophrenia illustrates affirmative treatment effect and small effect on serum prolactin level and body weight.Long-term therapy may reduce the risk of accidents,improve treatment compliance,reduce recurrence.