长期服用抗精神病药物的精神分裂症患者的糖代谢异常相关分析

Analysis of abnormal glucose metabolism in patients with schizophrenia treated with long-term antipsychotics

目的调查长期服用抗精神病药物治疗的精神分裂症患者糖代谢异常的发生率及相关影响因素。方法通过运用苏州市广济医院医疗大数据平台按照本次研究的入组标准选取在2010年3月至2020年3月期间住院治疗的精神分裂症患者3010例,其中女1552例,男1458例。获取的一般信息有性别、年龄、文化程度、病程、住院时间等。检验指标有空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、载脂蛋白A、载脂蛋白B和脂蛋白a。通过卡方检验、t检验对伴或不伴糖代谢异常两组之间的影响因素、血脂水平进行分析,通过多因素logistic回归分析对该组患者的糖代谢异常影响因素进行分析。结果在长期服用抗精神病药物治疗的精神分裂症患者中,发生糖代谢异常有604例,发生率为20.07%。高龄、文化程度低、病程长、反复住院的长期服用抗精神病药物的精神分裂症患者更易发生糖代谢异常(P<0.05)。该组患者的糖代谢异常的精神分裂症患者的起病年龄、三酰甘油(TG)、总胆固醇(TC)、载脂蛋白A、载脂蛋白B水平均显著高于糖代谢正常的患者(P<0.05)。多因素Logistic回归分析显示,患者发生糖代谢异常的危险因素依次为载脂蛋白B(OR=2.431,95%CI:1.139~5.188)、总胆固醇(TC)(OR=1.255,95%CI:1.124~1.403)、年龄(OR=1.032,95%CI:1.021~1.042)、病程(OR=1.021,95%CI:1.009~1.034);保护性因素为住院时间(OR=0.997,95%CI:0.996~0.999)。结论长期服用抗精神病药物的精神分裂症患者更易发生糖代谢异常,在临床工作中应提高对该类患者躯体健康的关注度,减少患者糖代谢疾病的发生。

Objective To investigate the incidence and influencing factors of abnormal glucose metabolism in patients with schizophrenia treated with long-term antipsychotics.Methods Using the medical big data platform of Suzhou Guangji Hospital,3010 patients with schizophrenia hospitalized from March 2010 to March 2020 were extracted according to the enrollment criteria,including 1552 females and 1458 males.Chi-square test and t-test were used to perform univariate analysis on the influencing factors and blood lipid levels in patients.Logistic regression analysis was used to perform multivariate analysis on abnormal glucose metabolism in patients.Results Among the patients with schizophrenia treated with long-term antipsychotics,604 patients had abnormal glucose metabolism with an incidence rate of 20.07%.Patients with advanced age,low education level,long course of disease,and repeated hospitalization were more likely to have abnormal glucose metabolism(P<0.05).The age of onset,and levels of triglycerides,total cholesterol,apolipoprotein A,and apolipoprotein B in patients with schizophrenia with abnormal glucose metabolism were significantly higher than those with in patients with normal glucose metabolism(P<0.05).Multivariate logistic regression analysis showed that the risk factors for abnormal glucose metabolism were apolipoprotein B(OR=2.431,95%CI:1.139-5.188),total cholesterol(OR=1.255,95%CI:1.124-1.403),age(OR=1.032,95%CI:1.021-1.042),and course of disease (OR=1.021, 95%CI:1.009-1.034), and the protective factor was hospital stay (OR=0.997, 95%CI: 0.996-0.999). Conclusion Patients with schizophrenia treated with long-term antipsychotics are more likely to have abnormal glucose metabolism. In clinical practice, attention should be paid to the physical health of patients to reduce the occurrence of glucose metabolism diseases.