精神分裂症伴发糖尿病的生化指标临床研究

Biochemical indicators in schizophrenia with diabetes

目的探讨影响精神分裂症合并糖尿病的主要生物风险指标,建立判别模型。方法选取新入院尚未使用抗精神病药或停用抗精神病药2周以上的精神分裂症患者,分为合并2型糖尿病研究组40例,无糖尿病的病例对照组58例,进行临床一般指标、血糖、血脂等生化检测,并与56例正常对照进行协方差比较和多变量判别分析。结果研究组血清空腹血糖(FPG)为(10.1±5.5)mmol/L、三酰甘油(TG)1.1～3.1mmol/L(中位数1.9mmol/L)、促卵泡刺激素(FSH)6.2～61.3IU/L(中位数13.8IU/L),较病例对照组[(5.2±1.1)mmol/L、0.7～1.4mmol/L(中位数1.0mmol/L)、4.7～13.0IU/L(中位数7.4IU/L)]和健康对照组[(5.4±0.7)mmol/L、0.6～1.5mmol/L(中位数0.8mmol/L)、4.2～13.0IU/L(中位数7.8IU/L)]高;而低密度脂蛋白胆固醇(LDL-C)较后2组低。判别分析指标风险性大小依次为年龄、TG、LDL-C、游离甲状腺素(FT4)、FSH、尿素(Ur)、总胆固醇(TC),其中年龄、TG、FSH、Ur与并发糖尿病呈正相关,LDL-C、FT4呈负相关;模型预测总正确率、回代率分别为90.1%、92.3%。结论精神分裂症患者年龄及血清TG、FSH、Ur增高、LDL-C降低及FT4、TC值相对减低可能是并发糖尿病的生物风险因素,临床医师宜及早监测上述主要危险因素。

Objective： To explore the main biological risk indexes that impact on schizophrenia with diabetes and to set up model of discriminant analysis. Methods： Newly hospitalized schizophrenia patients never exposed to antipsychotics （APS） or discontinued APS for more than two weeks were selected and divided into 2 groups： 40 cases with 2DM as study group and 58 cases of NDM as controls. General clinical parameters were examined, including blood sugar, lipids and other biochemical tests. Results were compared to those of 56 normal controls, using muhitude ANCOVA and multivariate discriminant analysis. Results： Fasting plasma glucose [ FPG, （ 10.1 ± 5.5 ） mmol/L] , triglyceride （ TG, 1.1 - 3. lmmol/L , MQ = 1.91 mmol/L）, follicle stimulating hormone （FSH,6.24 -61.3 IU/L, MQ = 13.8 IU/L） were higher in study group than in NDM group and normal control,while low density lipoprotein cholesterol （LDL -C） was lower in study group than in the later two groups. The risk factors as showed by discrimination index from strong to weak were age, TG, LDL - C, free thyroxine（ FF4 ） , FSH, urea （Ur） and total cholesterol （TC）. Among them, FPG, TG, FSH and Ur were positively correlated to complicating diabetes, and LDL - C and FY4 werenegatively correlation to complicating diabetes. The overall accuracy rate and back substitution rate of the predictive model was 94.7% and 95.3% respectively. Conclusion： The biological risk factors for schizophrenia with diabetes may be the older ages, higher serum FPG, TG, FSH, Ur, lower LDL - C and relatively lower FT4 and TC. Clinicians should monitor the main risk factors mentioned above as early as possible.