Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany.
Transl Psychiatry. 2021 Dec 8;11(1):621. doi: 10.1038/s41398-021-01751-7.
Multiple lines of evidence indicate that immunological and inflammatory alterations contribute at least in a subgroup to the pathophysiology of schizophrenia. In this retrospective chart review, we investigated whether clinical factors contribute to altered cerebrospinal fluid (CSF) findings in schizophrenia-spectrum disorders. Clinical data from electronic medical records of patients with psychotic disorders (ICD-10: F20-F29) who received routine CSF diagnostics at the Department of Psychiatry and Psychotherapy, LMU Munich, Germany, were included. Chi² tests for dichotomous outcomes and independent t tests for continuous outcomes were used to compare differences between groups. A total of 331 patients were included in the analyses (43.2% female and 56.8% male). The mean age was 37.67 years (±15.58). The mean duration of illness was 71.96 months (±102.59). In all, 40% (128/320) were first-episode psychosis (FEP) patients and 60% (192/320) were multi-episode psychosis (MEP) patients. Elevated CSF protein levels were found in 19.8% and elevated CSF/serum albumin ratios (Q) in 29.4% of the cases. Pleocytosis was found in 6.1% of patients. MEP patients showed significantly higher mean Q compared with FEP patients (t = -2.75, p = 0.006), which did not remain significant after correcting for age. Q elevation occurred more frequently in men (X = 14.76, p = <0.001). For treatment resistance, family history, and cMRI alterations, no significant differences in CSF-related outcomes were detected. Our work extends other retrospective cohorts confirming a relevant degree of CSF alterations in schizophrenia-spectrum disorders and shows the difficulty to relate these alterations to clinical and disease course trajectories. More research is needed to develop treatment response predictors from CSF analyses.
多项证据表明,免疫和炎症改变至少在亚组中导致精神分裂症的病理生理学变化。在这项回顾性图表研究中,我们研究了临床因素是否会导致精神分裂症谱系障碍患者的脑脊液(CSF)检查结果发生改变。该研究纳入了在德国慕尼黑大学精神病学和心理治疗系接受常规 CSF 诊断的精神障碍患者(ICD-10:F20-F29)的电子病历中的临床数据。采用卡方检验进行二分类结果比较,采用独立样本 t 检验进行连续结果比较。共有 331 例患者纳入分析(43.2%为女性,56.8%为男性)。患者的平均年龄为 37.67 岁(±15.58)。平均病程为 71.96 个月(±102.59)。共有 40%(128/320)为首发精神病患者(FEP),60%(192/320)为反复发作精神病患者(MEP)。19.8%的患者 CSF 蛋白水平升高,29.4%的患者 CSF/血清白蛋白比值(Q)升高。6.1%的患者存在脑脊液白细胞增多。MEP 患者的平均 Q 值明显高于 FEP 患者(t=-2.75,p=0.006),但在校正年龄后差异无统计学意义。Q 值升高在男性中更为常见(X=14.76,p<0.001)。对于治疗抵抗、家族史和 cMRI 改变,CSF 相关结果无显著差异。我们的工作扩展了其他回顾性队列研究,证实了精神分裂症谱系障碍患者存在相当程度的 CSF 改变,并表明将这些改变与临床和疾病过程轨迹联系起来具有一定难度。需要进一步研究以从 CSF 分析中开发出治疗反应预测因子。