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首发和反复发作精神分裂症谱系障碍的脑脊液异常:临床和人口统计学变量的影响。

Cerebrospinal fluid abnormalities in first- and multi-episode schizophrenia-spectrum disorders: impact of clinical and demographical variables.

机构信息

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.

出版信息

Transl Psychiatry. 2021 Dec 8;11(1):621. doi: 10.1038/s41398-021-01751-7.

Abstract

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.

摘要

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。

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