精神分裂症视网膜特征及潜在机制的研究进展

doi:10.3969/j.issn.1674-8115.2025.05.013

摘要/Abstract

摘要：

精神分裂症的诊断通常依赖于临床症状的评估，而客观生物标志物的寻找对于疾病的诊断和治疗尤为重要。由于视网膜可以反映中枢神经系统的状态，越来越多的研究开始关注神经精神疾病的视网膜特异性改变。该综述总结了近年精神分裂症患者视网膜神经层、血管特征及电生理特征的相关研究，发现精神分裂症患者常表现出视网膜神经节细胞-内丛状层、视网膜神经纤维层变薄，且视网膜各层的变化情况在精神分裂症疾病的不同阶段表现不一。对眼底血管的研究提示，精神分裂症患者存在视网膜血管密度和微血管形态结构改变。视网膜电图的相关研究提示，精神分裂症急性期患者多表现出视锥细胞a波振幅降低，而遗传高风险人群常表现出视杆细胞b波振幅的降低趋势。但目前精神分裂症的视网膜相关研究在研究方向上多着眼于临床表现，相关机制研究较少，且研究结果并不一致。该综述尝试针对视网膜神经层、微循环、电生理改变，探讨包括逆行跨突触变性假说、神经递质紊乱、遗传、脑结构改变、代谢等在内的潜在病理生理机制，以期为精神分裂症的病理生理机制及客观生物标志物的寻找提供新的思路。

关键词: 精神分裂症, 视网膜, 光学相干断层扫描, 眼底照相, 视网膜电图

Abstract:

The diagnosis of schizophrenia usually relies on the assessment of clinical symptoms, and the search for objective biomarkers is particularly important for the diagnosis and treatment of the disease. Since the retina can reflect the state of the central nervous system, more and more studies are focusing on retina-specific alterations in neuropsychiatric disorders. This review summarizes recent studies on the retinal nerve layer, vascular characteristics, and electrophysiological features in patients with schizophrenia, showing that patients with schizophrenia often have thinner retinal ganglion cell-inner plexiform layer and retinal nerve fiber layer. The changes in the retinal layers vary in different stages of schizophrenia. Studies of the fundus vasculature in schizophrenic patients have also suggested the presence of altered retinal vascular density and microvascular morphology in schizophrenic patients. Studies of electroretinography suggest that patients in the acute phase of schizophrenia tend to exhibit reduced a-wave amplitudes of cone cells, while those at genetic high risk often show a tendency for reduced b-wave amplitudes of rod cells. However, the current retina-related studies in schizophrenia mostly focus on clinical manifestations, with fewer studies on related mechanisms and inconsistent findings. This review attempts to discuss a variety of potential pathophysiological mechanisms, including trans-synaptic retrograde degeneration hypothesis, neurotransmitter disturbance, genetics, brain structural changes, and metabolism, in the context of the retinal nerve layer, microcirculation, and electrophysiology alterations, in order to provide new insights into the pathophysiological mechanisms and objective biomarkers of schizophrenia.

Key words: schizophrenia, retina, optical coherence tomography, fundus photography, electroretinography

中图分类号:

R749.3

邢雨茜, 程影, 陈剑华. 精神分裂症视网膜特征及潜在机制的研究进展[J]. 上海交通大学学报（医学版）, 2025, 45(5): 639-645.

XING Yuxi, CHENG Ying, CHEN Jianhua. Progress in retinal features and underlying mechanisms in schizophrenia[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(5): 639-645.

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