Objective: To explore the relationship of serum level of homocysteine (Hcy) and insulin resistance with cognitive function in first-episode drug-free schizophrenics. Methods: A total of 80 first-episode drug-free schizophrenics (schizophrenia group) from the First Affiliated Hospital of Zhengzhou University and 70 healthy individuals (control group) were enrolled.The serum concentration of Hcy was measured by the enzymatic cycling assay, the concentration of serum fast blood-glucose(FPG) by glucose oxidase method and fast insulin (FINS) by electrical chemiluminescence immunoassay.Then insulin resistance index was calculated in the form of HOMA-IR.Positive and Negative Syndrome Scale (PANSS) was used to evaluate the mental symptoms and Matrics Consensus Cognitive Battery (MCCB) was used to evaluate the cognitive function. Results: (1) The serum level of Hcy in schizophrenia group [(24±6) μmoL/L]was significantly higher than that in control group[(16±4) μmoL/L] (P<0.001). And the serum level of FINS in schizophrenia group [(8.0±2.1) mU/L] was significantly higher than that in control group[(6.0±1.3) mU/L] (P<0.001). The HOMA-IR of schizophrenia group (1.6±0.5) was higher than that of control group (1.3±0.4) (P<0.001). The serum level of Hcy in schizophrenia group had positive correlations with serum FINS level, HOMA-IR and negative symptoms (r=0.365, 0.354 and 0.233, all P<0.05). In comparison with the control group , scores were significantly lower in the seven domains of cognitive function in the schizophrenia group (all P<0.05). (2) In schizophrenia group, the serum level of Hcy had a negative correlation with Information processing rate P points, Attentional facilitating P points , and Verbal learning P points (r=-0.231, -0.339, -0.255, all P<0.05); the serum level of FINS was negatively related to Attentional facilitating P points, Working memory P pointsand Visual memory P points (r=-0.317, -0.309, -0.318, all P<0.05); HOMA-IR had a negative correlation with Attentional facilitating P points, Working memory P points, and Visual memory P points (r=-0.286, -0.224, -0.266, all P<0.05). After the influencing factors were adjusted by multiple regression, the associations of serum Hcy level with Information processing rate P points, Attentional facilitating P points and Verbal learning P points were still evident, and HOMA-IR was still related with Attentional facilitating P points and Visual memory P points (all P<0.05). Conclusion: The increase of serum Hcy and insulin resistance in first-episode schizophrenics, both have some relevance with cognitive dysfunction.
目的： 探讨首发未用药精神分裂症患者血清同型半胱氨酸水平、胰岛素抵抗与认知功能的关系。 方法： 选取2016年3月至2017年5月至郑州大学第一附属医院精神科就诊的首发未用药精神分裂症患者(患者组)80例和同期的健康志愿者(健康对照组)70名，采用循环酶法测定受试者血清同型半胱氨酸(Hcy)、葡萄糖氧化酶法测定受试者空腹血糖(FPG)、放射免疫法测定空腹血浆胰岛素(FINS)，采用稳态模型胰岛素抵抗指数(HOMA-IR)评价受试者胰岛素抵抗情况，阳性和阴性症状量表(PANSS)评定患者组入组时精神症状，精神分裂症认知功能成套测验(MCCB)评估患者组入组时的认知功能，并对健康对照组进行认知功能评定。 结果： (1)患者组血清Hcy水平[(24±6) μmoL/L]高于健康对照组[(16±4) μmoL/L](P<0.001)；血清FINS水平患者组[(8.0±2.1) mU/L]高于健康对照组[(6.0±1.3) mU/L](P<0.001)；HOMA-IR值患者组(1.6±0.5)高于健康对照组(1.3±0.4)(P<0.001)；相关分析显示，患者组血清Hcy水平和FINS水平、HOMA-IR值及阴性症状分均呈正相关(r＝0.365、0.354、0.233，均P<0.05)。与健康对照组相比，患者组在认知功能七大领域中的得分下降较为明显(均P<0.05)。(2)在患者组中，血清Hcy水平与认知功能七大领域中的信息处理速度(SOP)P分、注意与警觉(CPT-IP)P分和词语学习(HVLT)P分均呈负相关(r＝－0.231、－0.339、－0.255，均P<0.05)，血清FINS水平与认知功能七大领域中CPT-IP P分、工作记忆(WMS-Ⅲ)P分和HVLT P分均呈负相关(r＝－0.317、－0.309、－0.318，均P<0.05)，HOMA-IR值与CPT-IP P分、WMS-Ⅲ P分和BVMT P分均呈负相关(r＝－0.286、－0.224、－0.266，均P<0.05)。经多元回归调整影响因素后，患者组血清Hcy水平与认知功能七大领域中的SOP P分、CPT-IP P分和HVLT P分的关联依然明显，HOMA-IR值与CPT-IP P分和BVMT P分仍存在相关性(均P<0.05)。 结论： 首发精神分裂症患者血清同型半胱氨酸水平升高、胰岛素抵抗与精神分裂症认知功能损害程度存在一定相关性。.
Keywords: Cognitive function; Homocysteine; Insulin resistance; Schizophrenia.