血清可溶性肿瘤坏死因子受体与精神分裂症短期疗效的关系
Association between serum soluble tumor necrosis factor receptor and short-term treatment response in first-episode schizophrenia

摘要：目的 分析首发精神分裂症患者血清内可溶性肿瘤坏死因子受体(sTNFR)水平与临床特征和短期治疗效果的关系，评估sTNFR作为抗精神病药短期疗效标记物的价值。方法 符合国际疾病分类标准第10版(ICD-10)中精神分裂症诊断标准的首发精神分裂症患者49名，并选取与病例组人口统计特征无统计学差异的健康对照66名；采用酶联免疫吸附法(ELISA)检测所有受试对象的血清sTNFR1和sTNFR2浓度；采用阳性和阴性症状量表(PANSS)评估精神分裂症患者组的精神病理症状，并对其中完成随访的26名患者，评估药物治疗6周后的短期疗效。并进一步分析与sTNFR1和sTNFR2的相关性。结果 精神分裂症患者治疗前血清sTNFR1和sTNFR2水平高于对照组(P<0.0001)。sTNFR1与治疗前后PANSS阳性症状总分(治疗前rs=0.56，P<0.001；治疗后rs=0.41，P=0.007)及PANSS总分正相关(治疗前rs=0.42，P=0.004；治疗后rs=0.27，P=0.034)，而sTNFR2与治疗前后PANSS各项得分均不相关(P>0.05)。此外，治疗6周后有治疗效应组血清内sTNFR1浓度低于无治疗效应组(P<0.0001)，sTNFR1下降水平与药物疗效相关(rs=0.679，P<0.01)。结论 首发精神分裂症患者血清sTNFR1和sTNFR2升高，血清sTNFR1上调与症状严重程度有相关性，治疗后血清sTNFR1下降程度可预测抗精神病药的短期疗效。
ABSTRACT: Objective To explore the role of soluble tumor necrosis factor receptors (TNFR) 1 and 2 in the diagnosis of schizophrenia and the prediction of short-term therapeutic effect of antipsychotics. Methods ELISA was used to detect serum sTNFR1 and sTNFR1 concentrations in the patients with schizophrenia before (n=49) and after six-week treatment (n=26), as well as in the healthy controls. The positive and negative syndrome scale (PANSS) was used to measure initial symptom severity and the therapeutic effect of antipsychotics. Then, the correlation of PANSS score with sTNFR1 and sTNFR1 levels was analyzed. Results Both serum sTNFR1 and sTNFR2 levels were higher in the patients with schizophrenia than in the controls (P<0.001). Serum sTNR1 was significantly associated with the total score of PANSS and the score of positive syndrome of PANSS (rs: 0.27-0.56, P<0.034). Moreover, the responders to six-week treatment with antipsychotics displayed significantly decreased serum sTNFR1 concentration than those non-responders (P<0.0001), and the decrease in sTNFR1 concentration along with the treatment showed a positive correlation with improvement in PANSS (rs=0.679, P<0.01). Conclusion The abnormally higher serum sTNFR1 level may be closely correlated with the symptom severity and the alteration in serum sTNFR1 level has a predictive value for the therapeutic response to psychotics