精神分裂症伴代谢综合征患者心脏自主神经功能分析

Cardiac autonomic nerve function in schizophrenia patients with metabolic syndrome

目的探讨精神分裂症伴代谢综合征患者心脏自主神经功能状况,并分析其影响因素,以减少患者心源性猝死的发生。方法 168例符合ICD-10精神分裂症诊断标准的患者分为78例精神分裂症伴有代谢综合征组(A组)和90例精神分裂症不伴有代谢综合征组(B组),对其分别进行24 h动态心电图检查,分析其心率变异性(HRV),并与92例正常对照组(C组)进行对比。结果 A组和B组LF、HF、SDNN、SDANN、RMSSD、PNN50值均明显低于C组,差异有统计学意义(P<0.05),且B组LF、HF、SDNN、SDANN、RMSSD、PNN50值明显高于A组,差异有统计学意义(P<0.05)。排除精神分裂症自身的影响,Logistic回归分析显示HRV值的影响因素为病程(OR=1.864,95%CI 1.110~3.128)、年龄(OR=1.170,95%CI 1.018~2.491)、抗精神病药物种类(OR=2.419,95%CI 0.976~1.835)、腹部肥胖(OR=2.425,95%CI1.347~4.366)、血压值(OR=1.263,95%CI 1.575~3.937)、血糖值(OR=3.376,95%CI 1.359~2.923)、血脂值(OR=2.178,95%CI 1.492~6.756)。结论精神分裂症伴代谢综合征患者存在明显心脏自主神经功能异常,排除精神分裂症自身的影响,其他可能的危险因素是病程、年龄、抗精神病药物种类、腹部肥胖、血压值、血糖值、血脂值。

Objective To explore the state of cardiac autonomic nerve function in schizophrenia patients with metabolic syndrome and analyze its influence factors and to reduce the occurrence of sudden cardiac death of the patients. Methods A total of 168 cases of patients according with the ICD-10 schizophrenia diagnostic criteria were divided into group A （78 cases of schizophrenia with metabolic syndrome ）, group B （90 cases of schizophre- nia without metabolic syndrome ） and another 92 normal cases were included as control group （group C ）. Twenty- four hours dynamic electrocardiogram was conducted respectively and the heart rate variability （HRV） was ana- lyzed. Results Values of LF, HF, SDNN, SDANN, RMSSD and PNN50 in group A and group B were much low- er than those in group C and they were statistically significant （P 〈 0.05）. Values of LF, HF, SDNN, SDANN, RMSSD and PNN50 in group B were much higher than those in group A and they were statistically significant （P 〈 0.05 ）. Excluding the influence of schizophrenia, logistic regression analysis showed that the influence factors of HRV values were course of the disease（OR = 1.864, 95%CI 1.110~ 3.128） , age （OR = 1.170, 95%CI 1.018 2.491 ）, types of antipsychotic drugs （OR = 2.419,95%CI 0.976 ~ 1.835）, abdominal obesity （OR = 2.425,95% CI 1.347 ~ 4.366）, blood pressure value（OR = 1.263,95%C1 1.575 - 3.937）, blood glucose value （OR = 3.376, 95%CI 1.359 ~ 2.923） and blood lipid value （OR = 2.178,95%CI 1.492- 6.756）. Conclusions Schizophrenia patients with metabolic syndrome have obvious cardiac autonomic nerve dysfunction. Excluding the influence of schizophrenia itself, the other possible risk factors include course of the disease, age, types of antipsychotic drugs, abdominal obesity, blood pressure value, blood glucose value and blood lipid value.