Guo-Xin Xu, Run-Da Li, Pei-Yu Cao, Yu-Ting Li, Yi-Lin Tang, Ying-Bo Dong, Yu-Xiu Sui
Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China.
Duke University, Durham, USA.
BMC Psychiatry. 2025 Jul 1;25(1):634. doi: 10.1186/s12888-025-07037-2.
Exploring whether ultra-brief pulse electroconvulsive therapy (ECT) reduces the occurrence of postoperative delirium in patients with schizophrenia (SCZ), and its effects on cholinesterase, inflammatory markers, and hippocampal neural metabolites.
From August 2022 to August 2023, inpatients at the Affiliated Brain Hospital of Nanjing Medical University diagnosed with SCZ according to the International Statistical Classification of Diseases and Related Health Problems (Tenth Edition ICD-10) and aged 18-55 years were studied. Patients were randomly divided into ultra-brief pulse (UBP) and brief pulse (BP) groups, receiving ultra-brief pulse ECT (pulse width 0.25 ms) or brief pulse ECT (pulse width 1.0 ms). Assessments were conducted before and 24 h after ECT sessions, including evaluations of delirium, psychiatric symptoms, magnetic resonance spectroscopy (MRS) for hippocampal metabolites, and serum markers. Delirium was assessed using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (ICU-CAM). MRS measured changes in hippocampal metabolites, including N-acetyl-aspartate (NAA), creatinine (Cr), myo-inositol (MI), and choline (Cho). Serum markers included twelve cytokines, C-reactive protein (CRP), and cholinesterase (ChE). Statistical analyses used chi-square tests and independent sample t-tests.
No significant differences were found between the UBP and BP groups in baseline demographic and clinical data, cholinesterase levels, inflammatory markers, hippocampal spectra, ECT sessions, and BPRS scores post-treatment. However, the incidence of delirium was significantly different between UBP and BP groups (χ = 3.49, p = 0.046), with the BP group having a higher incidence of delirium. Post-treatment, cholinesterase levels in the UBP group were significantly higher than those in the BP group (t = 0.52, p < 0.001). Levels of CRP, IL-6, IL-8, IL-10, IL-1β, and TNF-α were significantly lower in the UBP group compared to the BP group. Right hippocampal NAA/Cr and left hippocampal NAA/MI levels were significantly lower in the UBP group than in the BP group post-treatment.
Compared with BP ECT, UBP ECT may reduce the incidence of delirium post-treatment in SCZ without a significant difference in efficacy. The higher cholinesterase levels in the UBP group suggest that UBP ECT may reduce neuronal asynchronous depolarization, cholinergic disorder, and pro-inflammatory responses, thereby reducing the impact on delirium. These findings provide partial scientific evidence for elucidating the mechanisms underlying ECT.
探讨超短脉冲电休克治疗（ECT）是否能降低精神分裂症（SCZ）患者术后谵妄的发生率，及其对胆碱酯酶、炎症标志物和海马神经代谢物的影响。
2022年8月至2023年8月，对南京医科大学附属脑科医院中根据《国际疾病和相关健康问题统计分类（第十版，ICD - 10）》诊断为SCZ且年龄在18 - 55岁的住院患者进行研究。患者被随机分为超短脉冲（UBP）组和短脉冲（BP）组，分别接受超短脉冲ECT（脉冲宽度0.25毫秒）或短脉冲ECT（脉冲宽度1.0毫秒）。在ECT治疗前和治疗后24小时进行评估，包括谵妄评估、精神症状评估、海马代谢物的磁共振波谱（MRS）分析以及血清标志物检测。使用里士满躁动镇静量表（RASS）和重症监护病房谵妄评估方法（ICU - CAM）评估谵妄。MRS测量海马代谢物的变化，包括N - 乙酰天门冬氨酸（NAA）、肌酸（Cr）、肌醇（MI）和胆碱（Cho）。血清标志物包括12种细胞因子、C反应蛋白（CRP）和胆碱酯酶（ChE）。统计分析采用卡方检验和独立样本t检验。
UBP组和BP组在基线人口统计学和临床数据、胆碱酯酶水平、炎症标志物、海马波谱、ECT治疗次数及治疗后简明精神病评定量表（BPRS）评分方面均无显著差异。然而，UBP组和BP组的谵妄发生率存在显著差异（χ = 3.49，p = 0.046），BP组的谵妄发生率更高。治疗后，UBP组的胆碱酯酶水平显著高于BP组（t = 0.52，p < 0.001）。与BP组相比，UBP组的CRP、白细胞介素 - 6（IL - 6）、白细胞介素 - 8（IL - 8）、白细胞介素 - 10（IL - 10）、白细胞介素 - 1β（IL - 1β）和肿瘤坏死因子 - α（TNF - α）水平显著更低。治疗后，UBP组右侧海马NAA/Cr和左侧海马NAA/MI水平显著低于BP组。
与BP ECT相比，UBP ECT可能降低SCZ患者治疗后谵妄的发生率，且疗效无显著差异。UBP组较高的胆碱酯酶水平表明，UBP ECT可能减少神经元异步去极化、胆碱能紊乱和促炎反应，从而降低对谵妄的影响。这些发现为阐明ECT的潜在机制提供了部分科学证据。
