氯氮平和利培酮对首发精神分裂症偏执型患者细胞因子水平的影响

目的 了解氯氮平、利培酮对首发精神分裂症偏执型患者细胞因子的影响,探讨细胞因子与精神病理之间的关系。方法 对58例首发精神分裂症偏执型患者给予氯氮平或利培酮治疗,分别于治疗前和治疗后第4周末、8周末、6月末用酶联免疫吸附法检测患者血清白细胞介素(IL)-6、2、18和α-肿瘤坏死因子(TNFα)浓度,用阳性与阴性症状量表(PANSS)评估精神症状。结果 利培酮组患者IL-6和IL-2水平于4周末、TNFα水平于8周末、IL-18水平于6月末均较治疗前显著下降(P<0.01或0.05);氯氮平组患者IL-2水平于4周末、IL-6和IL-18水平于6月末均较治疗前显著下降(P<0.01或0.05)。治疗前IL-6水平与阳性症状分呈正相关(r=0.386, P<0.01),IL-2水平与总分、阳性症状分呈正相关(r=0.338、0.305, P<0.01、0.05),TNFα水平与总分呈正相关(r=0.283, P<0.05)。8周末血清IL-2、IL-6变化率与阳性症状变化率呈正相关(r=0.268、0.375, P<0.05、0.01),6月末IL-6、TNFα变化率与总分变化率呈正相关(r=0.365、0.362, P<0.05)。治疗前IL-6与IL-2、TNFα与IL-18呈正相关(r=0.356、0.291, P<0.01、0.05),8周末TNFα与IL-6呈正相关(r=0.332, P<0.01),6月末IL-6与IL-2变化率呈正相关(r=0.391, P<0.05)。结论 氯氮平和利培酮有相似的免疫抑制作用,血清细胞因子与精神分裂症精神病理之间有一定关系。

Effect of clozapine and risperidone on serum cytokine levels in patients with first-episode paranoid schizophrenia

Objectives To study the effects of clozapine and risperidone on serum cytokine levels in patients with first-episode paranoid schizophrenia, and explore the role of the cytokines in the psychopathological basis of the illness.Methods Fifty-eight patients with first-episode paranoid schizophrenia were treated with either clozapine or risperidone, and before and at the end of the 4th, 8th weeks and 6th months after the medication respectively, the serum levels of interleukin (IL)-6, 2, 18,and tumor necrosis factor (TNF)α were measured with enzyme-linked immunosorbent assay (ELISA). The Positive and Negative Syndrome Scale (PANSS) was used to evaluate the psychotic symptoms.Results In patients treated with risperidone, the levels of serum IL-6 and IL-2 after 4 weeks, TNFα after 8 weeks, and IL-18 after 6 months were all significantly lowered in comparison with the pretreatment levels (P<0.01 or 0.05). In clozapine group, the levels of IL-2 after 4 weeks and IL-6 and IL-18 after 6 months were lowered significantly (P<0.01 or 0.05). Before the medication, serum IL-6 level was positively correlated with Positive Syndrome scores (r=0.386, P<0.01), IL-2 with the total score and Positive Syndrome scores (r=0.338, 0.305; P<0.01, 0.05), and TNFα with the total score (r=0.283, P<0.05). The changes of IL-2 and IL-6 after 8 weeks was positively correlated with the change of Positive Syndrome scores (r=0.268, 0.375; P<0.05, 0.01). Six months after the medication, the change in IL-6 and TNFα levels was positively correlated with the change of total score (r=0.365, 0.362; P<0.05). Before treatment, IL-6 was positively correlated with IL-2 levels (r=0.356, P<0.01), and TNFα with IL-18 levels (r=0.291, P<0.05). TNFα was positively correlated with IL-6 levels (r=0.332, P<0.01) 8 weeks after the medication. The changes in IL-6 was positively correlated with the those in IL-2 levels 6 months after the medication (r=0.391, P<0.05).Conclusion Clozapine and risperidone have similar immunosuppression actions and may affect serum IL-6 levels in patients with paranoid schizophrenia, in the psychopathology of which the cytokines play their roles of various importance.