Impact of abnormal metabolic-immunoinflammatory pathway on splenomegaly in patients with chronic schizophrenia and exploration of risk factors: case-control study

Objective This study aimed to identify risk factors for splenomegaly in chronic schizophrenia patients and clarify associations among metabolic−immunoinflammatory pathways, psychiatric symptoms and splenomegaly. The findings will help optimize somatic monitoring and intervention strategies. Methods A case−control design was used. A total of 426 patients were assigned to splenomegaly (n= 165) and non−splenomegaly (n= 261) groups according to abdominal ultrasound. Demographic data, clinical information, and antipsychotic use were collected. Mental symptoms were assessed by the Positive and Negative Syndrome Scale. Hematological indicators were detected, and abdominal ultrasound was performed to evaluate spleen morphology and fatty liver occurrence. SPSS 24.0 was used for statistical analysis, including univariate analysis and binary logistic regression to screen influencing factors of splenomegaly. Results The splenomegaly group had significantly higher levels of lipoprotein(a), cholesterol, triglycerides, HbA1c, CRP, IL-6 and β2-microglobulin than the non-splenomegaly group (all p < 0.05). The incidence of fatty liver and PANSS negative symptom score were significantly higher in the splenomegaly group, while the usage rate of aripiprazole was lower ( p< 0.05 ). Binary logistic regression showed that HbA1c (OR = 1.797, p = 0.046) and PANSS negative symptom score (OR = 2.258, p = 0.003) were independently associated with splenomegaly. Aripiprazole use was associated with lower odds of splenomegaly (OR = 0.656, p = 0.041). Conclusion Splenomegaly in chronic schizophrenia patients is closely linked to metabolic abnormalities and immunoinflammatory activation. Prominent negative symptoms are independently associated with splenomegaly and may serve as an early warning signal. Aripiprazole use is independently associated with reduced odds of splenomegaly.