首发精神分裂症患者持续缓解的预测因素分析

摘要

目的：探讨首发精神分裂症患者1年持续缓解的临床与认知预测因素。方法：44例首发精神分裂症患者给予抗精神病药治疗1年，并在基线期采集患者人口学和临床资料，同时采用阳性与阴性症状量表（ PANSS）评估疾病症状以及霍普金斯词语学习测验中文修订版（ HVLT-R）、Stroop词色测验、彩色连线测验、词语流利测验中文版（ VFT：VFL和VFC）评估认知功能；在治疗后4、8、12、24、36周和1年时随访，从第8周末至1年期间，历次访视PANSS量表8个核心条目评分均≤3分者被视为持续缓解（持续缓解组），其他患者视为病情波动（病情波动组）。结果：42例患者完成1年随访，其中24例（57.1%）患者持续缓解；与病情波动组（18例）比较，持续缓解组具有未治疗精神病期（ DUP）较短、阴性症状较轻、阳性症状较重、HVLT-R和VFC得分较高的特点（P<0.05或P<0.001）。多元Logistic回归分析表明持续缓解的患者具有DUP短（OR：0.791，95%CI：0.629~0.995；P=0.003）、阴性症状分低（OR：0.775，95%CI：0.609~0.987；P=0.012）及阳性症状分高（OR：1.706，95%CI：1.040~2.800；P=0.004）是持续缓解的独立预测因素。结论：DUP短、阴性症状较轻、阳性症状较重是首发精神分裂症患者持续缓解的独立预测因素。%Objective:The aim of this study was to identify the clinical and cognitive predictors of clinical sustained remission in patients with first episode schizophrenia( FES). Method:Forty-four patients with first episode schizophrenia( FES)were treated with antipsychotics for one year. At baseline,the basic socio-demo-graphic and clinical variables were collected. In addition,the psychotic symptoms were evaluated with the posi-tive and negative symptom scale( PANSS ),and the cognitive functions were evaluated with Hopkins verbal learning test revised( HVLT-R),Stroop color word test,color trails test,and verbal fluency test( VFT:VFL and VFC). The follow-up visits were scheduled at week 4,8,12,24,36 and 1 year. The patients were regarded as having sustained remission if they were scored≤3 on each of the 8 core symptoms of PANSS throughout the vis-its between week 8 and 1 year(24 patients);otherwise they were regarded as having symptom fluctuations(18 patients). Results:Forty-two patients completed 1-year follow-up study,and 24 of them(57. 1%)met the criteria of sustained remission at the end of the study. Compared with patients in symptom fluctuations group,pa-tients in sustained remission group had shorter duration of untreated psychoses( DUP),less negative symptoms, more positive symptoms,higher scores in HVLT-R and VFC(P<0. 05 or P<0. 001). Logistic regression analy-sis showed that shorter DUP(OR:0. 791,95%CI:0. 629-0. 995,P =0. 003),less negative symptoms(OR:0. 775,95%CI:0. 609-0. 987,P=0. 012)and more positive symptoms(OR:1. 706,95%CI:1. 040-2. 800,P=0. 004)were independent predictors of sustained remission. Conclusion:Shorter DUP,less negative symp-toms,more positive symptoms can independently predict sustained remission of FES.