摘要
目的研究N-甲基-D-天冬氨酸受体(NMDAR)抗体水平对首发精神分裂症患者认知功能和服药依从性的影响。方法回顾性收集自2021年1月至2024年1月于南京医科大学附属脑科医院住院治疗的90例首发精神分裂症患者的临床资料,根据血清NMDAR抗体水平的四分位数分析结果,将患者分为高NMDAR组(n=58,血清NMDAR抗体水平>23.5 ng/mL)和低NMDAR组(n=32,血清NMDAR抗体水平≤23.5 ng/mL)。所有患者均接受阿立哌唑治疗2个月。分别于治疗前、治疗2个月后采用精神分裂症认知功能测量与治疗研究共识认知功能成套测验(MCCB)评估患者认知功能,于治疗2个月后采用Morisky服药依从性量表(MMAS-8)评估患者服药依从性。比较两组间的认知功能与服药依从性差异,并通过Pearson相关性分析对血清NMDAR抗体水平与认知功能及服药依从性的关系进行分析。结果治疗前,高NMDAR组患者的视觉学习与记忆、言语学习与记忆、推理与问题解决能力、注意力与警觉性、处理速度等MCCB各项评分分别为(35.15±4.28)、(33.15±3.69)、(34.23±3.57)、(32.17±3.59)、(35.26±4.12)分,均明显低于低NMDAR组[(40.63±4.45)、(39.58±3.61)、(40.28±3.59)、(40.45±4.41)、(40.71±3.74)分],差异均有统计学意义(P<0.05)。治疗2个月后,两组患者MCCB各项评分比较,差异均无统计学意义(P>0.05)。治疗2个月后,高NMDAR组患者的MMAS-8评分为(4.58±1.23)分,明显低于低NMDAR组[(6.47±1.55)分],差异有统计学意义(P<0.05)。Pearson相关性分析表明,血清中NMDAR抗体水平与首发精神分裂症患者治疗前的MCCB评分及治疗后的MMAS-8评分均呈负相关(r=-0.512、-0.598、-0.613、-0.681、-0.607、-0.591,P<0.05)。结论首发精神分裂症患者的NMDAR抗体水平与认知功能和服药依从性密切相关,NMDAR功能减退可能导致患者认知功能和服药依从性降低,上述结果为干预措施的制定提供了重要依据。
Objective To study the effect of N-methyl-D-aspartate receptor(NMDAR)antibodies levels on cognitive function and medication adherence in patients with first-episode schizophrenia.Methods The clinical data of 90 patients with first-episode schizophrenia who were hospitalized in Brain Medicine Affiliated to Nanjing Medical University from January 2021 to January 2024 were retrospectively collected.According to the results of quartile analysis of serum NMDAR antibodies level,the patients were divided into the high NMDAR group(n=58,serum NMDAR antibodies level>23.5 ng/mL)and the low NMDAR group(n=32,serum NMDAR antibodies level≤23.5 ng/mL).All patients received aripiprazole for 2 months.The measurement and treatment research to improve cognition in schizophrenia consensus cognitive battery(MCCB)was used to assess cognitive function before and after 2 months of treatment,and the Morisky medication adherence scale(MMAS-8)was used to assess medication compliance after treatment.The differences in cognitive function and medication compliance between the two groups were compared,and the relationship between serum NMDAR antibodies level and cognition and medication compliance was analyzed by Pearson correlation analysis.Results Before treatment,the MCCB scores of visual learning and memory,verbal learning and memory,reasoning and problem solving ability,attention and vigilance,and processing speed in the high NMDAR group were(35.15±4.28),(33.15±3.69),(34.23±3.57),(32.17±3.59),and(35.26±4.12)points,respectively,which were significantly lower than those in the low NMDAR group[(40.63±4.45),(39.58±3.61),(40.28±3.59),(40.45±4.41),(40.71±3.74)points],and the differences were statistically significant(P<0.05).After 2 months of treatment,there were no statistically significant differences in MCCB scores between the two groups(P>0.05).After 2 months of treatment,the MMAS-8 score of the high NMDAR group was(4.58±1.23)points,which was significantly lower than that of the low NMDAR group[(6.47±1.55)points],and the difference was statistically significant(P<0.05).Pearson correlation analysis showed that serum NMDAR antibodies level was negatively correlated with MCCB score before treatment and MMAS-8 score after treatment(r=-0.512,-0.598,-0.613,-0.681,-0.607,-0.591;P<0.05).Conclusion The level of NMDAR antibodies in patients with first-episode schizophrenia is closely related to cognitive function and medication adherence,and the decline of NMDAR function may lead to a decrease in cognitive function and medication adherence,which provides an important basis for the formulation of interventions.
作者
袁宵
姜明霞
侯春婷
刘晓雪
徐国新
YUAN Xiao;JIANG Mingxia;HOU Chunting(Department of Psychiatry,Brain Medicine Affiliated to Nanjing Medical University,Nanjing Jiangsu 210000,China)
出处
《临床和实验医学杂志》
2025年第22期2432-2436,共5页
Journal of Clinical and Experimental Medicine
基金
国家自然科学基金面上项目(编号:81571639)。
