摘要
目的分析首发未用药的精神分裂症患者伴发代谢紊乱的临床状况，并探讨其病理生理机制。方法选择首发未用药的非高血压、非糖尿病的精神分裂症患者120例，检测患者的腰围、体质量指数（BMI）、空腹血糖血脂、胰岛素浓度等，采用稳态模型评估指数和国际糖尿病联盟（IDF）代谢综合征全球标准评估胰岛素抵抗（IR）和代谢综合征的发生，同时，采用阳性和阴性症状量表（PANSS）评定精神分裂症的严重程度。结果120例首发精神分裂症患者中，中心性肥胖者占28．3％，胰岛素分泌不足占20％，IR占35％，10．83％达到IDF代谢综合征标准，年长的女性患者发生代谢紊乱更明显。腰围与BMI呈正相关（r=0．758，P〈0．01），均与年龄、体质量、FBG、TC、TG浓度呈正相关，与病程、FINS浓度无相关性；IR指数与腰围（r=0．207，P〈0．05）和FINS浓度呈正相关，与其他指标无相关性；各代谢指标，IR指数等与PANSS总分和各亚分差异无统计学意义（P〉0．05）。结论首发未用药的精神分裂症伴胰岛素抵抗和代谢综合征的发生率高，值得重视，有必要建立针对中心性肥胖、胰岛素抵抗和脂质代谢紊乱的早期干预模式。
Objective The aim of this sdudy was to analyse the metabolic abnormalities in first episode,drug-free schizophrenia, and discuss the pathophysiologie mechanisms. Methods 120 patients with the first-episode and drug-free schizophrenics, who met CCMD-3 and excluded hypertension and diabetes, were measured the BMI, waistline, the fasting blood glucoses （FBG） and insulin concentration （ FIC ）, the cholesterol and TG before treatment. Subjects were assessed for the presence of insulin resistance using homeostasis model assessment（HOMA） and metabolic syndrome according to the criteria by the International Diabetes Federation （IDF） ,and we rated the positive and negative symptoms scales （PANSS）. Results Metabolic abnormalities were already present in first-episode patients, 28.3 % with eentricity fatness, 20% with the lower FIC, 35% with insulin resistance,and 10. 83% achieving the criteria of metabolic syndrome, and much higher rates of metabolic abnormalities were observed in the older and female subjects. In patients, there were significantly correlations between waistline and body mass index （BMI） （n = 120, r = 0. 758,P 〈 0. 01 ）. They were also positively related to the age, weight, the FBG, TG and cholesterol concentration, but had no relationship to the durations and FIC. The index of insulin resistance was positively related to waistline （ r = 0. 207, P 〈 0. 05 ） and the fasting insulin concentration. The metabolic indexes were negatively related to the P, N, G and the totoal scores of PANSS （P 〉 0.05 ）. Conclusion The current data suggested that the high incidence of the insulin resistance and metabolic syndrome be a major problem for the first-epside schizophrenia patients. We should build the early interference models for metabolic abnormalities including the centricity fatness, the insulin resistance and lipid abnormalities in first-epside schizophrenia patients.
出处
《中国临床实用医学》
2008年第3期1-3,共3页
China Clinical Practical Medicine
基金
广州市医药卫生科技基金资助项目（项目编号：2006-YB-114,2007A23）
广东省中医药局建设中医药强省科研课题资助项目（项目编号：2007213）
