摘要目的:探讨首次发病精神分裂症患者犬尿氨酸代谢通路异常及其与血糖-胰岛素水平的关系。方法:纳入160例首次发病精神分裂症患者（患者组）和122名年龄、性别、受教育程度与之相匹配的健康对照者（对照组）。采用液相色谱-串联质谱法测定血清中色氨酸、犬尿氨酸、犬尿喹啉酸、喹啉酸的水平，同时测定所有受试者的空腹血浆葡萄糖及空腹血浆胰岛素水平，采用独立样本 t检验或Mann Whitney U检验进行组间比较；采用双变量相关、偏相关分析空腹血浆葡萄糖-胰岛素代谢指标与犬尿氨酸代谢物之间的关系。 结果:与对照组相比，患者组空腹血浆葡萄糖水平升高［5.5（4.8，6.4）mmol/L与5.1（4.8，5.4）mmol/L， Z=-3.93， P<0.01］，空腹血浆胰岛素水平下降［（6.2±2.9）pmol/L与（7.2±4.0）pmol/L， t=-2.45， P=0.015］；患者组色氨酸［11 449.5（10 053.5，12 828.5）nmol/L与 16 780.0（13 735.0，18 997.5）nmol/L， Z=-10.69， P<0.01］，犬尿氨酸［252.2（208.7，307.4）nmol/L与637.8（355.5，827.4）nmol/L， Z=-11.02， P<0.01］，犬尿喹啉酸［5.0（3.7，6.9）nmol/L与11.0（8.5，14.3）nmol/L， Z=-11.48， P<0.01］和喹啉酸［39.7（31.0，47.3）nmol/L与53.2（44.7，68.6）nmol/L，Z=-8.29， P<0.01］水平均显著低于对照组。相关分析显示首次发病精神分裂症患者胰岛素水平与犬尿喹啉酸水平呈正相关（ r=0.46， P<0.01）。 结论:精神分裂症患者犬尿氨酸代谢通路水平降低，并可能与高胰岛素-葡萄糖代谢风险相关。

abstractsObjective:To investigate the relationship between the abnormality of kynurenine metabolic pathway and the glucose-insulin level in first-episode schizophrenia.Methods:In this study, a total of 160 first episode patients with schizophrenia and 122 age-, gender-, education-matched healthy controls were recruited. Serum levels of tryptophan, kynurenine, kynurenic acid and quinolinic acid were measured using liquid chromatography-tandem mass spectrometry. Meanwhile, fasting plasma glucose and fasting plasma insulin levels were measured in all subjects. The independent sample t test or Mann Whitney U test were used for comparison between groups. The relationships between fasting plasma glucose-insulin metabolism measures and indexes of kynurenine metabolites were investigated by the bivariate correlation and partial correlation. Results:The first episode patients with schizophrenia had higher levels of fasting plasma glucose (5.5(4.8, 6.4) mmol/L vs. 5.1(4.8, 5.4) mmol/L, Z=-3.93, P<0.01) and lower levels of fasting plasma insulin ((6.2±2.9) pmol/L vs. (7.2±4.0) pmol/L, t=-2.45, P=0.015) than the healthy controls. The levels of tryptophan (11 449.5(10 053.5, 12 828.5) nmol/L vs. 16 780.0 (13 735.0, 18 997.5) nmol/L, Z=-10.69, P<0.01), kynurenine (252.2(208.7, 307.4) nmol/L vs. 637.8 (355.5, 827.4) nmol/L, Z=-11.02, P<0.01), kynurenic acid (5.0(3.7, 6.9) nmol/L vs. 11.0 (8.5, 14.3) nmol/L, Z=-11.48, P<0.01) and quinolinic acid (39.7(31.0, 47.3) nmol/L vs. 53.2(44.7,68.6) nmol/L, Z=-8.29, P<0.01) in the first episode patients with schizophrenia were significantly lower than those in the healthy controls. Furthermore, our results showed that kynurenic acid levels was positive correlated with fasting plasma insulin levels ( r=0.46, P<0.01) in the first episode patients with schizophrenia. Conclusions:The level of kynurenine metabolic pathway in patients with schizophrenia is decreased, which is associated with the risk of hyperinsulinemic glucose metabolism.