慢性精神分裂症患者的心血管病10年预期发病风险及其影响因素调查

The 10-year Risk Estimation of Cardiovascular Disease Events and Its Influencing Factors in Patients with Chronic Schizophrenia

目的:了解慢性精神分裂症患者缺血性心血管病10年预期发病风险(10YR-ICVD)及其影响因素。方法:横断面调查353例精神分裂症患者,年龄55~64岁,其中长期抗精神病药物治疗的慢性精神分裂症患者(慢病组)261例和首次发病、未治疗者(对照组)92例,收集相关资料,采用中国10YR-ICVD简易预测模型计算10YR-ICVD风险值,并以Logistic回归分析其危险因素。结果:353例患者10YR-ICVD绝对风险值≤10%、10%~20%、≥20%分别为278例(78.8%)、31例(8.8%)、44例(12.5%)。以10%为界值,在全年龄段、55~59岁、60~64岁年龄段,慢病组中高危10YR-ICVD患病率分别为26.1%、21.7%、29.8%,均高于对照组的7.6%、6.2%、10.7%,差异均有统计学意义(χ^2=13.83、7.27、4.34,P=0.000、0.007、0.037)。Logistic回归分析提示高龄、高收缩压、肥胖、糖尿病共病、高胆固醇血症和末次复发未治疗时间均是慢病组患者10YR-ICVD的危险因素。结论:慢性精神分裂症患者的10YR-ICVD风险高于首次发病者,而长期抗精神病药物治疗不再增加中老年期慢性精神分裂症患者的10YR-ICVD风险,末次病情复发而持续未治疗状态将增加其危害性。

Objective:To investigate the 10-year’s risk estimation of cardiovascular disease events(10YR-ICVD)and its influencing factors in patients with chronic schizophrenia.Method:A cross-sectional survey by using a self-designed questionnaire was conducted.The study included 353 patients with schizophrenia aged from 55 to 64 years,261 of which were chronic and had received long-term antipsychotics treatment(chronic group)and the others were first-episode,drug-naive patients(control group).10YR-ICVD was measured by a simplified tool of evaluating the 10-year risk of ICVD in Chinese.Logistic regression analysis was performed on relevant risk factors.Result:Of the 353 cases,278(78.8%)had a low level of≤10%,31(8.8%)had a intermediated level of 10%-20%,and 44(12.5%)had a high level of≥20%in 10YR-ICVD.The chronic group had significantly higher 10YR-ICVD prevalence(26.1%vs 7.6%)than the control group in a cutoff of 10%,and this result was also observed in the subgroup of 55-59 years old(21.7%vs 6.2%),or of 60-64 years old(29.8%vs 10.7%),the differences were statistically significant(χ^2=13.83,7.27,4.34,P=0.000,0.007,0.037).Logistic regression analysis indicated that duration of untreated psychosis in latest relapse,together with older age,high body mass index,diabetic comorbidity,elevated systolic blood pressure and increased serum total cholesterol level,were independent risk factors for 10YR-ICVD.Conclusion:There is a significantly higher cardiovascular risk estimation in chronic schizophrenia than in early schizophrenia.Not long-term antipsychotics prescription but relapse of illness and continuance with untreated psychosis would be likely to increase the 10YR-ICVD in senile and pre-senile patients with chronic schizophrenia.