Yuan X X, Zhu Q Y, Liang H B, Hei G R, Li X, Pang L J, Li H H, Li H, Song X Q
Department of Psychiatry, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2016 Jul 19;96(27):2155-60. doi: 10.3760/cma.j.issn.0376-2491.2016.27.009.
To explore hormone such as follicle-stimulating hormone (FSH), luteinizing (LH), prolactin (PRL), estradiol (E2), progesterone (PROG) and testosterone (TESTO) levels in first-episode drug-free schizophrenics, and the relationship between clinical symptoms and sex hormones, in order to further study the pathogenesis of schizophrenia.
Eighty-one first-episode drug-free schizophrenics including thirty-nine male and forty-two female from First Affiliated Hospital of Zhengzhou University and seventy healthy subjects (thirty male and forty female) were enrolled.Serum levels of hormone were measured using electrical chemiluminescence immunoassay, and Positive and Negative Syndrome Scale (PANSS) was used to evaluate the mental symptoms and Matrics Consensus Cognitive Battery (MCCB) was used to evaluate cognitive function.
(1) The serum levels of PRL in male patients group ((24±9) ng/ml) was higher than that of control group ((10±3) ng/ml) (P<0.05), the serum levels of E2, TESTO of male patients group ((29±10) ng/ml), ((3.2±1.7) ng/ml) was lower than that of control group ((35±11) ng/ml), ((4.4±1.6) ng/ml) (P<0.05); The serum levels of PRL, TESTO of female patients group ((29±16) ng/ml), ((0.5±0.4) ng/ml) were dramatically higher than that of control group ((13±5) ng/ml), ((0.3±0.1) ng/ml) (P<0.05), the serum levels of E2 of female patients group ((51±40) ng/ml) was lower than that of control group ((63±66) ng/ml) (P=0.05). (2) The serum levels of PRL, E2, TESTO in male patients group were negatively associated with negative symptoms (r=-0.478,-0.443,-0.576, P<0.05), PRL were negatively related to positive symptoms (r=-0.542, P<0.05); In female patients group, the serum levels of PRL were negatively associated with negative symptoms (r=-0.343, P<0.05), the serum levels of E2 was negatively related to positive symptoms, general psychopathology grade, total PANSS grade (r=-0.351,-0.487,-0.405, P<0.05), TESTO had a positive correlation with positive symptoms (r=0.445, P<0.05). (3) In male patients group, PRL had an negative correlation with working memory P point, reasoning and problem solving P points (r=-0.384,-0.374, P<0.05), the serum levels of E2 was positively related to Information processing rate P points, Visual memory P points, Reasoning and problem solving P points (r=0.379, 0.336, 0.407, P<0.05), TESTO had a positive correlation with Information processing rate P points, Visual memory P points, Reasoning and problem solving P points (r=0.564, 0.513, 0.552, P<0.05). In female patients group, PRL had an negative correlation with working memory P point, Reasoning and problem solving P points and social cognition P points (r=-0.303,-0.358,-0.368, P<0.05), the serum levels of E2 was positively related to working memory, Reasoning and problem solving P points, social cognition P points (r=0.376, 0.453, 0.355, P<0.05).
Our study shows that first-episode drug-free schizophrenics have hormone secretion abnormal, which suggests that hypothalamus-hypophysis-gonad axis may probably involve in physiopathologic mechanism of first-episode medicine-free schizophrenics.Slightly elevated serum PRL level may be the reaction of stress response in first-episode medicine-free schizophrenics.Endogenous testosterone and estradiol may protect cognitive function against recession, and declining of testosterone and estradiol in blood is the hazards of cognitive dysfunction in first-episode drug-free male schizophrenics. PRL, E2, TESTO may be one of the measurements of the severity of clinical symptoms.
探讨首发未用药精神分裂症患者卵泡刺激素（FSH）、黄体生成素（LH）、催乳素（PRL）、雌二醇（E2）、孕酮（PROG）及睾酮（TESTO）等激素水平，以及临床症状与性激素之间的关系，以进一步研究精神分裂症的发病机制。
选取郑州大学第一附属医院81例首发未用药精神分裂症患者（男性39例，女性42例）及70例健康对照者（男性30例，女性40例）。采用电化学发光免疫分析法测定血清激素水平，采用阳性与阴性症状量表（PANSS）评估精神症状，采用矩阵一致性认知成套测验（MCCB）评估认知功能。
（1）男性患者组血清PRL水平（（24±9）ng/ml）高于对照组（（10±3）ng/ml）（P<0.05），男性患者组血清E2、TESTO水平（（29±10）ng/ml）、（（3.2±1.7）ng/ml）低于对照组（（35±11）ng/ml）、（（4.4±1.6）ng/ml）（P<0.05）；女性患者组血清PRL、TESTO水平（（29±16）ng/ml）、（（0.5±0.4）ng/ml）显著高于对照组（（13±5）ng/ml）、（（0.3±0.1）ng/ml）（P<0.05），女性患者组血清E2水平（（51±40）ng/ml）低于对照组（（63±66）ng/ml）（P=0.05）。（2）男性患者组血清PRL、E2、TESTO水平与阴性症状呈负相关（r=-0.478，-0.443，-0.576，P<0.05），PRL与阳性症状呈负相关（r=-0.542，P<0.05）；女性患者组血清PRL水平与阴性症状呈负相关（r=-0.343，P<0.05），血清E2水平与阳性症状、一般精神病理学分、PANSS总分呈负相关（r=-0.351，-0.487，-0.405，P<0.05），TESTO与阳性症状呈正相关（r=0.445，P<0.05）。（3）男性患者组PRL与工作记忆P分、推理及解决问题P分呈负相关（r=-0.384，-0.374，P<0.05），血清E2水平与信息处理速度P分、视觉记忆P分、推理及解决问题P分呈正相关（r=0.379，0.336，0.407，P<0.05），TESTO与信息处理速度P分、视觉记忆P分及推理及解决问题P分呈正相关（r=0.564，0.513，0.552，P<0.05）。女性患者组PRL与工作记忆P分、推理及解决问题P分及社会认知P分呈负相关（r=-0.303，-0.358，-0.368，P<0.05），血清E2水平与工作记忆、推理及解决问题P分、社会认知P分呈正相关（r=0.376，0.453，0.355，P<0.05）。
本研究表明首发未用药精神分裂症患者存在激素分泌异常，提示下丘脑-垂体-性腺轴可能参与首发未用药精神分裂症的病理生理机制。血清PRL水平轻度升高可能是首发未用药精神分裂症患者应激反应的表现。内源性睾酮和雌二醇可能保护认知功能免受衰退影响，血液中睾酮和雌二醇水平下降是首发未用药男性精神分裂症患者认知功能障碍的危险因素。PRL、E2、TESTO可能是临床症状严重程度的衡量指标之一。
