稳定期精神分裂症患者血清总胆汁酸水平与认知功能的相关性及其对认知损害的预测价值

Correlation between serum total bile acid levels and cognitive function in patients with stable schizophrenia and its predictive value for cognitive impairment

中文关键词:  稳定期精神分裂症  认知功能  胆汁酸  中国简版神经认知成套测验（C-BCT）

英文关键词:Stable schizophrenia  Cognitive impairment  Total Bile Acid  C-BCT

中文摘要:

      背景 稳定期精神分裂症患者普遍存在持续的认知功能受损。急性期患者血清总胆汁酸（TBA）水平与认知功能受损相关，但稳定期患者血清TBA与多维度认知功能的关系尚不明确。目的 探讨稳定期精神分裂症患者血清TBA水平与认知功能的相关性及其对认知受损的预测价值，为及时识别与客观评估认知功能受损提供血清学依据。方法 采用横断面研究，选取2024年3月—12月在盐城市第四人民医院住院的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）精神分裂症诊断标准的稳定期患者为研究对象（n=137）。采用中国简版神经认知成套测验（C-BCT）评估认知功能，并依据该评分将患者分为认知正常组（n=28）、轻度受损组（n=28）、中度受损组（n=47）和重度受损组（n=34）。采集患者空腹肘静脉血，使用酶循环法检测血清TBA水平。采用Spearman相关分析考查血清TBA水平与整体及各维度认知功能的关系。采用二元Logistic回归模型（调整年龄、性别、病程等协变量）分析血清TBA与整体及各维度认知功能受损的预测能力。采用受试者工作特征（ROC）曲线评估血清TBA水平对整体认知功能受损的预测价值。结果 四组血清TBA水平比较，差异有统计学意义（H=18.677，P<0.01），中度、重度受损组血清TBA水平均高于认知正常组（调整后P均<0.01）。血清TBA水平与患者整体认知功能分级呈正相关（r=0.354，P＜0.05），与连线测试T分（r=-0.328，P＜0.05）、持续操作T分（r=-0.247，P＜0.05）、数字广度T分（r=-0.265，P＜0.05）和符号编码T分（r=-0.221，P＜0.05）均呈负相关。二元Logistic回归分析显示，血清TBA水平是稳定期精神分裂症患者整体认知受损的独立危险因素（OR=1.322，95% CI：1.021~1.713，P=0.034），尤其对信息处理速度维度的认知功能受损具有更强的预测能力（OR=1.325，95% CI：1.057~1.661，P=0.015）。血清TBA预测稳定期精神分裂症患者整体认知功能受损的AUC为0.738，敏感性和特异性分别为60.61%和78.64%。结论 稳定期精神分裂症患者血清TBA水平与整体认知功能分级及信息处理速度、注意力、工作记忆、执行功能相关。血清TBA水平升高是整体认知功能受损和信息处理速度损害的独立影响因素，并对整体认知功能受损具有中等预测价值。

英文摘要:

      Background Persistent cognitive impairment is prevalent among patients with stable schizophrenia. While serum total bile acid (TBA) levels are associated with cognitive impairment in patients during the acute phase, the relationship between serum TBA and multidimensional cognitive function in patients in the stable phase remains unclear. Objective To investigate the correlation between serum TBA level and cognitive function in patients with stable schizophrenia, and its predictive value for cognitive impairment, thereby providing a serological basis for the timely identification and objective assessment of cognitive impairment. Methods A cross-sectional study was conducted, enrolling 137 stable-phase patients with schizophrenia who were hospitalized at Yancheng Fourth People’s Hospital from March to December 2024, all meeting the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Cognitive function was assessed using the Chinese Brief Cognitive Test (C-BCT). Patients were categorised into groups based on scores: normal cognitive function (n=28), mild impairment (n=28), moderate impairment (n=47), and severe impairment (n=34). Fasting blood samples were collected from the patients' antecubital veins, and serum TBA levels were measured using an enzymatic cycle assay. Spearman’s correlation analysis was employed to investigate the relationship between TBA levels and overall cognitive function as well as cognitive function across various dimensions. A binary logistic regression model (adjusted for covariates such as age, sex and disease duration) was used to analyse the predictive ability of TBA for cognitive impairment in terms of overall function and across various dimensions. The diagnostic value of TBA for overall cognitive impairment was assessed using receiver operating characteristic (ROC) curves. Results There was a statistically significant difference in serum TBA levels between the four groups (H=18.677, P<0.01); TBA levels in both the moderate and severe cognitive impairment groups were higher than those in the group with normal cognitive function (adjusted P<0.01). Serum TBA level positively correlated with overall cognitive function grading in patients with stable schizophrenia (r=0.354, P<0.05), and negatively correlated with Trail Making Test T-scores (r=-0.328, P<0.05), Continuous Performance Test T-scores (r=-0.247, P<0.05), digit span T-scores (r=-0.265, P<0.05), and symbol coding T-scores (r=-0.221, P<0.05). Binary logistic regression analysis revealed that serum TBA levels were an independent risk factor for overall cognitive impairment (OR=1.322, 95% CI: 1.021~1.713, P=0.034), and were particularly predictive of cognitive impairment in the information processing speed domain (OR=1.325, 95% CI: 1.057~1.661, P=0.015). Serum TBA level demonstrated an AUC of 0.738 for predicting overall cognitive impairment in patients with stable schizophrenia, with a sensitivity of 60.61% and specificity of 78.64%. Conclusion In patients with stable schizophrenia, serum TBA levels are associated with overall cognitive function grading, as well as with information processing speed, attention, working memory and executive function. Elevated serum TBA levels are independent predictors of overall cognitive impairment and impaired information processing speed, and have moderate predictive value for overall cognitive impairment.