ω-3脂肪酸对首发精神分裂症急性期疗效的研究

摘要/Abstract

摘要： 目的本研究旨在探讨服用深海鱼油补充ω-3脂肪酸对首发精神分裂症急性期患者改善精神病性症状与减轻代谢综合征发生风险的关系。方法选取2021年9月—2022年9月淄博市精神卫生中心收治的符合ICD-10精神分裂症诊断标准并且服用抗精神病药物的54例患者,按照随机数表法分为鱼油组（30例）和安慰剂组（24例）。在治疗前及治疗后第4、8、12周对两组患者进行阳性与阴性症状量表（Positiveand Negative Syndrome Scale,PANSS）、外显攻击行为量表（Modified Overt Aggression Scale,MOAS）、简明精神病评定量表（Brief Psychiatric Rating Scale,BPRS）评估,同时应用精神分裂症认知功能成套测验（MATRICS Consensus Cognitice Battery,MCCB）评价两组患者治疗前后的认知功能,并采集患者血液生化指标,记录患者血胆固醇、甘油三酯、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）水平。结果两组患者PANSS、BPRS、MOAS评分在第4周均降低,两组比较,差异无统计学意义（P>0.05）;第8、12周鱼油组评分明显低于安慰剂组,差异有统计学意义（P<0.05）。血胆固醇、甘油三酯、LDL在第4周均升高,两组比较,差异无统计学意义（P>0.05）;在第8、12周安慰剂组升高幅度低于鱼油组,差异有统计学意义（P<0.05）。HDL在第4周均降低,两组比较,差异无统计学意义（P>0.05）;在第8、12周鱼油组降低幅度低于安慰剂组,差异有统计学意义（P<0.05）。干预后,两组患者MCCB评分各项指标均升高,且鱼油组患者MCCB各项评分均高于安慰剂组,差异有统计学意义（P<0.05）。结论每日服用深海鱼油补充ω-3脂肪酸对首发精神分裂症急性期患者的精神症状改善明显,特别是减少冲动攻击行为和改善患者的认知功能,并且能够减轻代谢综合征发生风险。

关键词: ω-3脂肪酸, 首发精神分裂症, 冲动攻击, 认知功能, 代谢综合征

Abstract: Objective The purpose of this study is to explore the supplementation of deep-sea fish oil ω- The relationship between the improvement of psychiatric symptoms and the reduction of the risk of metabolic syndrome in patients with first-episode schizophrenia in the acute phase of 3 fatty acids. Methods From September 2021 to September 2022, 54 patients who met the ICD-10 diagnostic criteria for schizophrenia and took antipsychotic drugs in Zibo Mental Health Center were randomly assigned to fish oil group (n=30) and placebo group (n=24). Before treatment and at the 4th, 8th and 12th weeks after treatment, the patients in the two groups were scored with Positive and Negative Syndrome Scale (PANSS), Modified Over Aggression Scale (MOAS) and Brief Psychiatric Rating Scale (BPRS), at the same time, the cognitive function scores of the two groups of patients before and after treatment were evaluated with the schizophrenia cognitive function assessment scale (MCCB), and the blood biochemical indicators of the patients were collected, and the levels of blood cholesterol, triglycerides, High-density lipoprotein (HDL), low-density lipoprotein (LDL) were recorded. Results The results showed that the PANSS, BPRS, and MOAS scores of both groups of patients decreased at week 4, and there was no statistically significant difference between the two groups (P>0.05); at weeks 8 and 12, the score of the fish oil group was significantly lower than that of the placebo group, and there was a statistical difference between the two groups (P<0.05). Blood cholesterol, triglycerides, and LDL all increased at week 4, and there was no statistically significant difference between the two groups (P>0.05); at weeks 8 and 12, the placebo group was higher than the fish oil group, and there was a statistical difference between the two groups (P<0.05). HDL decreased at week 4, and there was no statistically significant difference between the two groups (P>0.05); at weeks 8 and 12, the decrease in fish oil group was lower than that in placebo group, and there was a statistical difference between the two groups (P<0.05). after the intervention, the related indicators of MCCB scores of patients in both groups increased to varying degrees, and the scores of Working memory, speech learning and problem reasoning dimensions of patients in the fish oil group increased significantly compared with those in the placebo group (P<0.05). Conclusion Take deep-sea fish oil every day ω-3 fatty acids significantly improve the mental symptoms of first-episode schizophrenia patients in the acute phase, especially reducing impulsive and aggressive behavior, improving cognitive function, and reducing the risk of metabolic syndrome.

Key words: Omega-3 fatty acids, first episode schizophrenia, impulsive and aggressive acts, cognitive function, metabolic syndrome

中图分类号:

R749.3

张天伟, 王圣海, 李晓青, 陈静, 孙平. ω-3脂肪酸对首发精神分裂症急性期疗效的研究[J]. 中华养生保健, 2023, 41(23): 17-21.

ZHANG Tian-wei, WANG Sheng-hai, LI Xiao-qing, CHEN Jing, SUN Ping. ω- A Study on the Efficacy of 3 Fatty Acids in the Acute Phase of First-Episode Schizophrenia[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(23): 17-21.

参考文献

[1] LICHTENSTEIN P, YIP B H, BJORK C, et al.Common genetic determinants of schizoPhrenia and biPolar disorder in Swedish families: a PoPulation-based study[J]. Lancet,2009,373(9659):234-239.
[2] SAMELE C, PATEL M, BOYDELL J, et al.Physical illness and lifestyle risk factors in PeoPle with their first Presentation of Psychosis[J]. Soc Psychiatry Psychiatr Epidemiol,2007,42(2):117-24.
[3] 周敏,肖川,杨珉,等.精神分裂症并发2型糖尿病常见危险因素的Meta分析[J].中南大学学报(医学版),2019,40(3):241-249.
[4] 冯燕霞,杨发.不同抗精神病药物对精神分裂症患者的临床影响及糖脂代谢的变化[J].国际检验医学杂志,2019,38(19):2749-2751.
[5] LEE S, GURA K M, KIM S, et al.Current clinical aPPlications of omega-6 and omega-3 fatty acids[J]. Nutr Clin Pr,2020,(21):323-341.
[6] PUSCEDDU M M, NOLAN Y M, Green H F, et al.The Omega-3 Polyunsaturated fatty acid docosahexaenoic acid (DHA) reverses corticosterone-induced changes in cortical neurons[J]. Int J Neuro Psycho Pharmacol,2019(6):1-19.
[7] 管晓枫,胡欣怡,陆峥.精神分裂症诊断标准更新与分类变化[J].重庆医科大学学报,2021,46(7):760-763.
[8] RUIZ-LEóN A M, LAPUENTE M, ESTRUCH R, et al. Clinical advances in immunonutrition and atherosclerosis: A review[J]. Front. Immunol, 2019(10):837.
[9] PEET M, BRIND J, RAMCHAND C N, et al.Two double-blind Placebo-controlled Pilot studies of eicosaPentaenoic acid in the treatment of schizoPhrenia[J]. SchizoPhrenia research, 2001,49(3):243-251.
[10] MELLOR J E, LAUGHARNE J D, PEET M.SchizoPhrenic symPtoms and dietary intake of n-3 fatty acids[J]. Schizo Phrenia research, 1995,18(1):85-86.
[11] YAO J.Abnormalities of fatty acid metabolism in red cells, Platelets and brain in schizo Phrenia[J]. Phos Pholi Pid S Pectrum Disorders in Psychiatry and Neurology, 2nd edition Marius Press, Lancashire,UK,PP,2003:193-212.
[12] BUYDENS-BRANCHEY L, BRANCHEY M, McMakin D L, et al. Polyunsaturated fatty acid status and aggression in cocaine addicts[J]. Drug Alcohol DePend,2003,71(3):319-323.
[13] SILVER J M,YUDOFSKY S C.The Overt Aggression Scale: overview and guiding Princi Ples[J]. NeuroPsychiatr. Clin. Neurosci,1991,3(2):S22-S29.
[14] XIE B, ZHENG Z P.Modifified Overt Aggression Scale[J]. Chin J Behav Med Brain Sci,2001(10):200-202.
[15] ROBINSON D G, GALLEGO J A, JOHN M, et al.A Potential role for adjunctive omega-3 Polyunsaturated fatty acids for dePression and anxiety symPtoms in recent onset Psychosis: Results from a 16week randomized Placebo-controlled trial for ParticiPants concurrently treated with risPeridone [J/OL]. SchizoPhr Res [2018-09-18].
[16] AMMINGER G, SCHAFER M.Indicated Prevention with omega-3 fatty acids in adolescents at ultra-high risk for Psychosis-rationale, methods, and 3-months outcome[J]. SchizoPhr Res,2006,(86):S97-S98.
[17] PEET M, BRIND J, RAMCHAND C, et al.Two double-blind Placebo-controlled Pilot studies of eicosaPentaenoic acid in the treatment of schizoPhrenia[J]. SchizoPhr Res,2001,49(3):243-251.
[18] BERGER G, PROFFIFITT T, WOOD S, et al.Ethyl-eicosaPentaenoic acid (E-EPA) suPPlementation in early Psychosis. A double blind randomized Placebo-controlled add on study in 80 drug-naive fifirst ePisode Psychosis Patients[J]. Int J Neuro Psycho Pharmacol,2004,70:S422-S423.
[19] FUSAR-POLI P, BERGER G.EicosaPentaenoic acid interventions in schizoPhrenia: meta -analysis of randomized, Placebo - controlled studies[J].
J Clin Psycho Pharm,2012,32(2):179-185.
[20] 徐磊,蔡菡,王定祥,等.氯氮平治疗精神分裂症对病人糖脂代谢认知功能及相关因子水平的影响[J].蚌埠医学院学报,2023,48(2):251-255.
[21] 贾敏,董倩,王崴,等.急性期治疗对精神分裂症认知功能的影响及与症状变化的相关性[J].科学技术与工程,2019,19(28):76-80.
[22] CADENHEAD K S, MINICHINO A, KELSVEN S, et al.Metabolic abnormalities and low dietary Omega 3 are associated with symPtom severity and worse functioning Prior to the onset of Psychosis: Findings from the North American Prodrome Longitudinal Studies Consortium[J/OL]. Schizo Phr Res[2018-09-21].
[23] MOSSAHEB N, PAPAGEORGIOU K, SCHAFER M R, et al.Changes in triglyceride levels in ultra -high risk for Psychosis individuals treated with omega -3 fatty acids[J]. Early Interv Psychia,2018,12(1):30-36.
[24] 汤翠青,王育红,林永雄,等.ω-3脂肪酸对精神分裂症代谢综合征的早期干预研究[J].黑龙江中医药,2019,48(4):332-333.
[25] 徐丽华,张天宏,陈刚,等.Omaeg-3多不饱和脂肪酸干预精神分裂症的临床研究进展[J].中国神经精神疾病杂志,2019,44(10):633-636.