| Objective1.To invesitigate the correlation between insulin resistance and cognitive function and different cognitive dimensions in first-episode schizophrenia,and to verify the rationality of the hypothesis that insulin resistance is at the crossroads of cognitive impairment and glucose metabolism disorder in schizophrenia.2.Combined with the basis of previous research,to observe the distribution of TCM syndrome factors in patients with schizophrenia,and to explore the correlation between different syndrome factors and insulin resistance and cognitive function,and to establish a relationship with TCM syndromes on the basis of the above hypothesis.3.Through the 3-year follow-up of patients with schizophrenia,the changes of cognitive function and its dynamic correlation with TCM syndrome factors were observed.Methods1.A total of 87 first-episode schizophrenia patients treated in the Department of Psychiatry,Changping District Hospital of traditional Chinese and Western Medicine from September 2019 to March 2021 were selected as the case group and 87 healthy people as the control group.Positive and Negative Symptom Scale(PANSS)was used to evaluate the psychopathological symptoms of patients.MATRICS Consensus Cognitive Battery(MCCB)was used to evaluate the cognitive function,and it consists of 7 cognitive dimensions and 9 tests.The laboratory indexes related to glucose and lipid metabolism,such as fasting blood glucose(FBG)and fasting insulin(FINS),were collected by the electronic medical system,and the HOMA-IR value was calculated.The cutting point of IR was judged by the fourth point of the HOMA-IR value of the control group.The case group was divided into IR group(n=51)and non-IR group(n=36).The data of each group were input into SPSS23.0 for statistical analysis.2.Using the method of epidemiological investigation,this study included 87 first-episode schizophrenia patients in the first part of the study and 285 patients with schizophrenia collected by multiple centers in the previous study.The evaluation form of TCM syndrome factors of schizophrenia was used to collect four diagnostic information,including 40 items of clinical symptoms,14 items of tongue and 6 kinds of pulse.We use the method of factor analysis to extract syndrome factors,observe the distribution characteristics of them,and analyze the correlation between TCM syndrome factors and HOMA-IR and cognitive function.3.128 patients with schizophrenia were enrolled in Changping District Hospital of Integrated Traditional Chinese and Western Medicine from May 2017 to March 2018,and a total of 36 patients were face-to-face interviewed after 3 years.All patients' cognitive function were assessed using the MATRICS Consensus Cognitive Battery.According to the changes of the total score of MCCB from baseline to follow-up,the patients were divided into cognitive decline group(n=19)and non-cognitive decline group(n=17).The changes of cognitive function and their correlation with TCM syndrome elements after 3-year follow-up were compared between the two groupsResults1.The levels of FINS and HOMA-IR in the case group were significantly higher than those in the healthy control group(P<0.01),but there was no significant difference in other baseline data and metabolic indexes.The total scores of SS,BVMT-R and MCCB in the IR group were significantly lower than those in the non-IR group,suggesting that IR has a significant effect on working memory,visual learning and memory in patients with schizophrenia,and leads to a decrease in the overall cognitive level.There was no significant difference in PANSS score between IR group and non-IR group(P>0.05).The results of correlation analysis showed that HOMA-IR was negatively correlated with MCCB total score,working memory,visual learning and memory(r=-0.227,r=-0.272,r=-0.282,P<0.05),and the results of multiple regression analysis showed that HOMA-IR was correlated with total score of MCCB(t=-2.343,p=0.022),working memory(t=-2.200,p=0.031),visual learning and memory(t=-2.122,p=0.037)2.The top 5 of the 40 clinical symptoms were fatigue(42.97%),palpitation(38.38%),weak breath(37.30%),chest tightness(36.22%),insomnia and dreaminess(31.89%).Among the pulse conditions,sunken pulse(39.19%)and string pulse(31.35%)have the highest frequency.The proportion of light tongue color was the highest(49.46%),the proportion of tongue with tooth marks was the highest(23.24%),and the proportion of thin white tongue coating was the highest(37.03%).After factor analysis,seven syndrome factors of qi deficiency(27.83%),qi stagnation(18.91%),phlegm(16.76%),yin deficiency(12.70%),yang deficiency(8.91%),fire(8.10%)and blood stasis(6.76%)were obtained.the most common disease sites were liver,spleen,kidney and heart.Among the 27 first-episode schizophrenic patients with phlegm syndrome,there were significant differences in the HOMA-IR(P=0.017,P<0.05)and BVMT-R(P=0.037,P<0.05)between the IR group(n=17)and the non-IR group(n=10),suggesting that there was a correlation between phlegm syndrome and insulin resistance and the cognitive dimension of working memory.3.the total score of MCCB in the cognitive decline group was significantly lower than that in the non-cognitive decline group(P<0.05).The proportion of phlegm syndrome in the cognitive decline group was significantly higher than that in the baseline(P<0.05),and the evolution of syndrome elements showed a trend from single syndrome element to compound syndrome elements(P<0.01).The cognitive dimensions with a large proportion of decline are visual memory and verbal memory,in which the decline of visual memory may be related to phlegm-dampness,and the decline of speech memory may be related to qi deficiency,but the difference of both is not statistically significant.Conclusions1.First-episode schizophrenia patients have insulin resistance,which will aggravate the impairment of cognitive function,working memory,visual memory and other cognitive dimensions.2.The main TCM syndrome factors of patients with schizophrenia are qi deficiency,qi stagnation and phlegm.Phlegm syndrome is correlated with insulin resistance and cognitive dimension of working memory.it may be an important pathological factor to aggravate the impairment of cognitive function in patients with schizophrenia.3.The cognitive function of patients with schizophrenia will decrease in varying degrees with the progress of the disease.In this process,syndrome factors tend to be intermingled deficiency and excess,and combine with each other.Phlegm syndrome is related to the progressive decline of cognitive function in schizophrenia,and in various cognitive dimensions,phlegm syndrome may be closely related to visual memory impairment.4.The rationality of the hypothesis that insulin resistance is at the crossroads of glucose metabolism disorder and cognitive impairment in schizophrenia was verified,and the relationship between TCM syndrome and hypothesis was established. |
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