双相情感障碍患者内分泌代谢状况与冲动攻击行为的相关性

Correlation between endocrine metabolism and impulsive aggressive behavior in patients with bipolardisorder

目的分析内分泌代谢状况对双相情感障碍患者冲动攻击行为的影响,为患者防治方案的制定提供依据。方法纳入2018年4月至2019年12月新疆维吾尔自治区人民医院收治的106例双相情感障碍患者作为研究组,收集同期体检中心健康人群109例作为对照组,检测所有受试者内分泌代谢状况;依据有无冲动攻击行为将双相情感障碍患者分为有冲动攻击行为组与无冲动攻击行为组,分析内分泌代谢指标间的相关性及其分别与冲动攻击行为的关系。结果研究组促肾上腺皮质激素及促甲状腺激素水平分别为(29.56±2.75)pg/ml、(3.60±1.22)μIU/ml,低于对照组;皮质醇、三碘甲状腺原氨酸、甲状腺素水平分别为(102.95±6.41)nmol/L、(1.51±0.64)ng/ml、(82.66±16.34)ng/ml,高于对照组(P<0.05)。106例患者发生冲动攻击行为23例;有冲动攻击行为组促肾上腺皮质激素、促甲状腺激素水平分别为(27.85±2.03)pg/ml、(2.64±1.03)μIU/ml,低于无冲动攻击行为组;皮质醇、三碘甲状腺原氨酸、甲状腺素水平分别为(103.86±4.36)nmol/L、(1.71±0.60)ng/ml、(89.69±16.12)ng/ml,高于无冲动攻击行为组(P<0.05)。相关性分析发现,各内分泌代谢相关指标之间均有明显相关性(P<0.05)。回归分析结果显示,内分泌异常代谢是双相情感障碍患者合并冲动攻击行为的影响因素(OR=1.197、1.776、1.024、1.903、7.414,均P<0.001)。绘制ROC曲线显示,各内分泌代谢指标预测双相情感障碍合并冲动攻击行为风险的AUC均>0.80,均有一定预测价值。结论内分泌异常代谢可能是双相情感障碍患者合并冲动攻击行为的影响因子,可考虑通过检测内分泌代谢状况,来预测患者冲动攻击行为发生风险,以指导双相情感障碍患者冲动攻击行为的早期风险预测及合理干预。

Objective To analyze the impact of endocrine metabolism on impulsive aggressive behaviorof patients with bipolar disorder, and to provide a basis for the future prevention and treatment of such diseases.Methods The medical records of 106 patients with bipolar disorder admitted to Xinjiang Uiger MunicipalPeople's Hospital from April 2018 to December 2019 were retrospectively analyzed as research group, andclinical data of 109 healthy people from the physical examination center during the same period were collectedas control group. The endocrine metabolism status were detected. According to whether they had impulsiveaggression behavior, the patients with bipolar affective disorder were divided into impulsive aggression behaviorgroup and non-impulsive aggression behavior group. The correlation between endocrine metabolism indicatorsand their relationship with impulsive aggression behavior were analyzed respectively. Results The levelsof ACTH and TSH in the research group were (29.56±2.75) pg/ml and (3.60±1.22) μIU/ml respectively,which were lower than those in the control group. The levels of cortisol, triiodothyronine and thyroxine were (102.95±6.41) nmol/L, (1.51±0.64) ng/ml, (82.66±16.34) ng/ml respectively, which were higher than thosein the control group (P < 0.05). Among 106 patients, 23 patients had impulsive aggressive behavior. The levels ofACTH and TSH in the impulsive aggressive behavior group were (27.85±2.03) pg/ml and (2.64±1.03) μIU/mlrespectively, which were lower than those in the non-impulsive aggressive behavior group. The levels of cortisol,triiodothyronine, and thyroxine were (103.86±4.36) nmol/L, (1.71±0.60) ng/ml, and (89.69±16.12) ng/mlrespectively, which were higher than those in the non-impulsive aggressive behavior group (P < 0.05).Correlation analysis found that there were significant correlations between the various endocrine metabolismrelated indicators (P< 0.05). Regression analysis results showed that abnormal endocrine metabolism was aninfluencing factor of impulsive aggressive behavior in patients with bipolar disorder (OR=1.197,1.776,1.024,1.903,7.414, all P< 0.001). The ROC curve was drawn and showed that the AUC results of the risk of bipolardisorder combined with impulsive aggressive behavior predicted by each endocrine metabolism index were allhigher than 0.80, which had certain predictive value. Conclusions Abnormal endocrine metabolism may bethe influencing factor of impulsive aggression in patients with bipolar disorder. It can be considered to predictthe risk of impulsive aggression in patients with bipolar disorder by detecting endocrine metabolism status, soas to guide the early risk prediction and reasonable intervention of impulsive aggressive behavior in patients withbipolar disorder.