双相障碍患者共病代谢综合征的风险及危险因素分析

Comorbid metabolic syndrome and its risk factors of patients with bipolar disorder

目的 探讨双相障碍患者共病代谢综合征的风险及其危险因素.方法 共纳入符合DSM-Ⅳ-TR双相障碍诊断标准的患者206例（双相障碍组）,以及性别、年龄、受教育程度与之匹配的健康对照者167名（对照组）.采用自制问卷收集一般人口学资料、临床信息、血脂血糖等生化指标进行组间比较.以2007年《中国成人血脂异常防治指南》为代谢指标的诊断依据,采用国际体力活力问卷对活力水平进行分组及组间比较.采用二项Logistics回归分析对双相障碍共病代谢综合征的独立危险因素进行分析.结果 双相障碍组共病代谢综合征发生率（25.7％与9.6％,x2=14.90,P＜0.01）高于对照组,相关的代谢指标体质量指数（F=1 1.70,P＜0.01）、甘油三酯（F=12.17,P＜0.01）、甘油三酯/高密度脂蛋白胆固醇比值（F=16.17,P＜0.01）、收缩压（F=37.81,P＜0.01）、舒张压（F=57.89,P＜0.01）均高于对照组,但总胆固醇、低密度脂蛋白胆固醇、空腹血糖、糖化血红蛋白以及高脂血症发生率2组差异均无统计学意义.双相障碍组较对照组在生活方式上多食（x2=19.38,P＜0.01）、荤食（x2=14.67,P＜0.01）和失眠（x2=24.12,P＜0.01）的比例较高,但活力水平分组2组间差异无统计学意义.二项Logistics回归分析显示体质量指数（OR=1.526,P＜0.01）、性别（OR=8.162,P＜0.01）及总用药时间（OR=1.011,P＜0.01）是双相障碍共病代谢综合征的独立危险因素.结论 双相障碍患者存在高发代谢综合征的风险,性别、体质量指数以及用药时间可能为主要的危险因素.

Objective This report aimed at exploring the risk factors impact on metabolic co-morbidities of bipolar disorder （BD）.Methods An cross-sectional study was conducted on a total of 206 inpatients and outpatients mnet the DSM-Ⅳ-TR criteria for BD,meanwhile matched 167 healthy controls in age,gender and education.Self-made questionnaire was used to collect data such as general demographic data,clinical information,blood lipid and glucose indexes.The criterion of metabolic syndrome （MetS） and hyperlipidemia was referred to the Chinese adult dyslipidemia prevention guideline proposed at 2007,the international physical activity questionnaire was used to assess activity level,then compaed between groups.And the Chi-square test,one-way analysis of variance and binary Logistic regression analysis were used in our statistical analysis.Results The rate of MetS in BD group was higher than control group significantly （25.7% vs.9.6%,x2=14.90,P〈0.01）,and so was the related metabolic components include body mass index （BMI） （F=11.70,P〈0.01）,triglyceride （F=12.17,P〈0.01）,the ratio of triglyceride/high-density lipoprotein-C （F=16.17,P〈0.01）,systolic pressure （F=37.81,P〈0.01）,diastolic pressure （F=57.89,P〈 0.01）,but no difference was found in total cholesterol,low density lipoprotein,blood-glucose,glycated hemoglobin and hyperlipidemia.BD group showed significantly more eating food （x2=19.38,P〈0.01）,meaty （x2=14.67,P〈0.01） and insomnia （x2=24.12,P〈0.01）,but no difference was found in levels of activity.A binary logistic regression analysis showed BMI （OR=1.562,P〈0.01）,gender（OR=8.162,P〈0.01）and total duration （OR=1.011,P〈0.01） were major independent risk factors for MetS.Conclusion It indicafed higher risk of comorbid with MetS in BD patients.Gender,BMI,and total medication time may be the main risk factors.