首发未用药精神分裂症患者的糖代谢研究
|
摘要
目的精神分裂症患者2型糖尿病患病率显著高于普遍人群。文中探讨首发精神分裂症患者糖代谢的情况及其影响因素。方法根据美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准收集兰州市第三人民医院首发未用药的汉族精神分裂症住院患者58例。使用简明精神病量表、汉密尔顿抑郁量表及异常不自主运动评定量表评估患者精神症状及严重程度,同时收集兰州大学第二医院60名符合入组标准和排除标准的汉族正常人作为对照组。所有研究对象均在晨空腹状态下检测空腹血糖浓度(fasting plasma glucose,FPG)并行口服葡萄糖耐量试验,同时测量身高、体重、腰围、臀围,并计算腰臀比和体重指数(BMI)。结果患者组与对照组在性别、年龄、饮食习惯、活动量、BMI以及受教育年限等方面差异均无统计学意义(P>0.05)。患者组平均FPG(5.29±0.83)mmol/L显著高于对照组(4.37±0.54)mmol/L;服糖后2 h血糖浓度(6.89±0.98)mmol/L显著高于对照组(5.97±0.82)mmol/L,差异均有统计学意义(P<0.05)。患者组空腹血糖受损者8例(13.8%),对照组2例(3.3%),差异无统计学意义(χ2=2.921,P>0.05);患者组糖耐量异常者11例(18.9%),对照组3例(5.0%),差异有统计学意义(χ2=4.25,P<0.05)。糖耐量正常与异常的患者在精神症状、病情严重程度等方面差异无统计学意义(P>0.05)。结论首发未用药精神分裂症患者的糖代谢存在异常,其糖耐量减低发生率高于正常人。为早期识别并干预精神分裂症患者的糖代谢异常,对该类患者常规检测糖代谢相关指标,特别是口服葡萄糖耐量试验具有重要意义。
Objective The prevalence rate of type 2 diabetes mellitus in schizophrenia patients were significantly higher than normal people. The study examined the glucose metabolism in first-episode,drug-naive patients with schizophrenia. Methods Case-control study was employed. According to the 4th edition of American Diagnostic and Statistical Manual of Mental Disorders,58first-episode,drug-naive patients with schizophrenia hospitalized in our hospital were collected for the study. Brief psychiatric rating scale,Hamilton depressive scale and assessment of abnormal involuntary movement were used to assess the mental state and the degree of illness. Meanwhile,60 hospitalized Han patients in the Second Hospital of Lanzhou University were selected as the control group.Fast plasma glucose( FPG) were detected in the morning on each patient along with oral glucose tolerance test( OGTT). Measurements were also made on height,body weight,waist circumference,hip circumference,as well as WHR and body mass index( BMI).Results No significant difference was found in gender,age,diet habit,activity,BMI and the number of education years between the groups( P > 0. 05). The average FPG of the patient group was higher than that of the control group( 5. 29 ± 0. 83 mmol / L vs 4. 37 ±0. 54 mmol / L); postprandial 2 hour glucose of the patient group was significantly higher than that of the control group( 6. 89 ± 0. 98)mmol / L vs 5. 97 ± 0. 82 mmol / L,P < 0. 05). Statistical difference in the incidence of impaired glucose tolerance( IGT) was found between the two groups,8 paitents in patient group( 13. 8%),2 in control group( 3. 3%)( χ2= 4. 25,P < 0. 05). Patients with normal and abnormal glucose tolerance showed no difference in mental state and illness degree( P > 0. 05). Conclusions First-episode,drug-naive patients with schizophrenia have more impaired fasting glucose tolerance than normal people. In order to identify and intervene the abnormal glucose metabolism of schizophrenia patients,it is of great importance to measure relation index to glucose metabolism,especially the oral glucose tolerance test.
Objective The prevalence rate of type 2 diabetes mellitus in schizophrenia patients were significantly higher than normal people. The study examined the glucose metabolism in first-episode,drug-naive patients with schizophrenia. Methods Case-control study was employed. According to the 4th edition of American Diagnostic and Statistical Manual of Mental Disorders,58first-episode,drug-naive patients with schizophrenia hospitalized in our hospital were collected for the study. Brief psychiatric rating scale,Hamilton depressive scale and assessment of abnormal involuntary movement were used to assess the mental state and the degree of illness. Meanwhile,60 hospitalized Han patients in the Second Hospital of Lanzhou University were selected as the control group.Fast plasma glucose( FPG) were detected in the morning on each patient along with oral glucose tolerance test( OGTT). Measurements were also made on height,body weight,waist circumference,hip circumference,as well as WHR and body mass index( BMI).Results No significant difference was found in gender,age,diet habit,activity,BMI and the number of education years between the groups( P > 0. 05). The average FPG of the patient group was higher than that of the control group( 5. 29 ± 0. 83 mmol / L vs 4. 37 ±0. 54 mmol / L); postprandial 2 hour glucose of the patient group was significantly higher than that of the control group( 6. 89 ± 0. 98)mmol / L vs 5. 97 ± 0. 82 mmol / L,P < 0. 05). Statistical difference in the incidence of impaired glucose tolerance( IGT) was found between the two groups,8 paitents in patient group( 13. 8%),2 in control group( 3. 3%)( χ2= 4. 25,P < 0. 05). Patients with normal and abnormal glucose tolerance showed no difference in mental state and illness degree( P > 0. 05). Conclusions First-episode,drug-naive patients with schizophrenia have more impaired fasting glucose tolerance than normal people. In order to identify and intervene the abnormal glucose metabolism of schizophrenia patients,it is of great importance to measure relation index to glucose metabolism,especially the oral glucose tolerance test.
引文
[1]Subramaniam M,Chong SA,Pek E,et al.Diabetes mellitus and impaired glucose tolerance in patients with schizophrenia[J].Can J Psychiatry,2003,48(5):345-347.
[2]彭瑛,黄远帅,邓正华,等.精神分裂症患者血清差异microRNA谱的检测[J].医学研究生学报,2014,27(12):1290-1293.
[3]Dixon L,Weiden P,Delahanty J,et al.Prevalence and correlates of diabetes in national schizophrenia samples[J].Schizophr Bull,2000,26(4):903-912.
[4]Ryan MC,Collins P,Thakore JH.Impaired fasting glucose tolerance in first-episode drug-naive patients with schizophrenia[J].Am J Psychiatry,2003,160(2):284-289.
[5]Godin G,Shephard RJ.A simple method to assess behavior in the community[J].Can J Appl Sports Sci,1985,10:141-146.
[6]Subramaniam M,Chong SA,Pek E.Diabetes mellitus and impaired glucose tolerance in patients with schizophrenia[J].Can J Psychiatry,2003,48(5):345-347.
[7]Lamberti J,Crilly J,Mahara JK,et al.Prevalence of adult-onset diabetes among outpatients receiving antipsychotic drugs[J].Schizophr Res,2003,60:360.
[8]金文胜,潘长玉.糖耐量减低和空腹血糖受损:定义及干预的现状[J].中华内分泌代谢杂志,2003,19附录:1-8.
[9]Spelman LM,Walsh PI,Sharifi N,et al.Impaired glucose tolerance in first-episode drug-naive patients with schizophrenia[J].Diabet Med,2007,24(3):481-485.
[10]陈大春,李艳丽,王宁,等.首发精神分裂症患者糖代谢异常病例对照研究[J].中国神经精神疾病杂志,2009,35(8):490-492.
[11]Knowler WC,Barrett-Connor,Fowler SE,et al.Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin[J].N Engl J Med,2002,346(6):393-403.
[12]Becker KG.The common variants/multiple disease hypothesis of common complex genetic disorders[J].Med Hypotheses,2004,62(2):309-317.
[13]张六平,李文杰,易正辉,等.精神分裂症伴发2型糖尿病与色氨酸羟化酶基因多态性关联研究[J].临床精神医学杂志,2010,20(1):4-6.
[14]Zhao JY,Xiong MM,Huang W,et al.An autosomal genomic scan for loci linked to type 2 diabetes in northern Han Chinese[J].J Mol Med(Berl),2005,83(3):209-215.
[15]Brambilla F,Guastalla A,Guerrini A,et al.Glucose-insulin metabolism in chronic schizophrenia[J].Dis Nerv Syst,1976,37:98-103.
[16]Mukherjee S,Decina P,Bocola V,et al.Diabetes mellitus in schizophrenic patients[J].Compr Psychiatry,1996,37:68-73.
[17]Mukherjee S,Roth SD,Sandyk R,et al.Persistent tardive dyskinesia and neuroleptic effects on glucose tolerance[J].Psychiatry Res,1989,29:17-27.
[2]彭瑛,黄远帅,邓正华,等.精神分裂症患者血清差异microRNA谱的检测[J].医学研究生学报,2014,27(12):1290-1293.
[3]Dixon L,Weiden P,Delahanty J,et al.Prevalence and correlates of diabetes in national schizophrenia samples[J].Schizophr Bull,2000,26(4):903-912.
[4]Ryan MC,Collins P,Thakore JH.Impaired fasting glucose tolerance in first-episode drug-naive patients with schizophrenia[J].Am J Psychiatry,2003,160(2):284-289.
[5]Godin G,Shephard RJ.A simple method to assess behavior in the community[J].Can J Appl Sports Sci,1985,10:141-146.
[6]Subramaniam M,Chong SA,Pek E.Diabetes mellitus and impaired glucose tolerance in patients with schizophrenia[J].Can J Psychiatry,2003,48(5):345-347.
[7]Lamberti J,Crilly J,Mahara JK,et al.Prevalence of adult-onset diabetes among outpatients receiving antipsychotic drugs[J].Schizophr Res,2003,60:360.
[8]金文胜,潘长玉.糖耐量减低和空腹血糖受损:定义及干预的现状[J].中华内分泌代谢杂志,2003,19附录:1-8.
[9]Spelman LM,Walsh PI,Sharifi N,et al.Impaired glucose tolerance in first-episode drug-naive patients with schizophrenia[J].Diabet Med,2007,24(3):481-485.
[10]陈大春,李艳丽,王宁,等.首发精神分裂症患者糖代谢异常病例对照研究[J].中国神经精神疾病杂志,2009,35(8):490-492.
[11]Knowler WC,Barrett-Connor,Fowler SE,et al.Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin[J].N Engl J Med,2002,346(6):393-403.
[12]Becker KG.The common variants/multiple disease hypothesis of common complex genetic disorders[J].Med Hypotheses,2004,62(2):309-317.
[13]张六平,李文杰,易正辉,等.精神分裂症伴发2型糖尿病与色氨酸羟化酶基因多态性关联研究[J].临床精神医学杂志,2010,20(1):4-6.
[14]Zhao JY,Xiong MM,Huang W,et al.An autosomal genomic scan for loci linked to type 2 diabetes in northern Han Chinese[J].J Mol Med(Berl),2005,83(3):209-215.
[15]Brambilla F,Guastalla A,Guerrini A,et al.Glucose-insulin metabolism in chronic schizophrenia[J].Dis Nerv Syst,1976,37:98-103.
[16]Mukherjee S,Decina P,Bocola V,et al.Diabetes mellitus in schizophrenic patients[J].Compr Psychiatry,1996,37:68-73.
[17]Mukherjee S,Roth SD,Sandyk R,et al.Persistent tardive dyskinesia and neuroleptic effects on glucose tolerance[J].Psychiatry Res,1989,29:17-27.