武汉地区FES患者骨质疏松状况及危险因素分析

Status and risk factors of osteoporosis in patients with FES in Wuhan

目的研究分析武汉地区首发精神分裂症(first-episode schizophrenia,FES)患者患骨质疏松症(osteoporosis,OP)状况及危险因素。方法将2020年1月至2021年6月于武汉地区精神科专科联盟机构就诊的450例FES患者纳入观察组;另选择同期健康体检的443例正常人作为对照组。统计观察组患者OP发生情况,比较观察组与对照组骨密度测量结果和骨代谢指标水平,分析影响FES患者OP发生的危险因素。结果观察组骨量正常比例低于对照组,骨量减少及OP比例高于对照组(P<0.05);骨代谢指标水平低于对照组(P<0.05);血糖指标水平高于对照组(P<0.05),两组血脂指标比较差异无统计学意义(P>0.05);单因素分析结果显示性别、年龄、精神分裂症病程、体质量指数(body mass index,BMI)、吸烟史、日均运动时长、合并糖尿病、高血脂、冠心病均与首发精神分裂症患者OP的发生相关(P<0.05);多因素Logistic回归分析结果显示女性、年龄≥60岁、精神分裂症病程≥2年、BMI≥24 kg/m 2、既往有吸烟史、日均运动时长<30 min、合并糖尿病、合并高血脂均为影响首发精神分裂症患者OP发生的独立危险因素(P<0.05)。结论武汉地区FES患者存在骨代谢异常的情况,相较正常人群OP发生风险较高,糖脂代谢异常可能是导致OP发生的危险因素之一,临床应针对患者糖脂代谢平衡状态进行积极干预。

Objective To study and analyze the status and risk factors of osteoporosis(OP)in patients with first-episode schizophrenia(FES)in Wuhan.Methods A total of 450 patients with FES treated in Wuhan Psychiatric Association were enrolled as observation group between January 2020 and June 2021,while other 443 healthy controls during the same period were enrolled as control group.The occurrence of OP in observation group was statistically analyzed.The bone mineral density(BMD)and levels of bone metabolism indexes between the two groups were compared.The risk factors of OP were analyzed.Results The proportion of cases with normal bone mass in observation group was lower than that in control group,while proportion of cases with osteopenia and OP were higher than those in control group(P<0.05).The levels of bone metabolism indexes in observation group were lower than those in control group(P<0.05),while levels of blood glucose indexes were higher than those in control group(P<0.05).There was no significant difference in blood lipid indexes between the two groups(P>0.05).The result of univariate analysis showed that gender,age,course of schizophrenia,body mass index(BMI),smoking history,average daily exercise time,diabetes mellitus,hyperlipidemia and coronary heart disease are all related to OP in FES patients(P<0.05).The result of multivariate Logistic regression analysis showed that female gender,age≥60 years,schizophrenia duration≥2 years,BMI≥24 kg/m 2,previous smoking history,average daily exercise time<30 min,diabetes mellitus and hyperlipidemia were all independent risk factors of OP(P<0.05).Conclusion There is abnormal bone metabolism in FES patients in Wuhan.Compared with the normal people,OP risk is relatively higher.Abnormal glucose-lipid metabolism may be one of the risk factors for OP.Clinically,active interventions should be conducted based on balance of glucose-lipid metabolism.