阿立哌唑对精神分裂症患者糖代谢的影响

目的探讨阿立哌唑对精神分裂症患者糖代谢的影响。方法对60例服用氯氮平、60例服用阿立哌唑治疗的精神分裂症患者,治疗前和治疗第4、8、12周末测量空腹血糖或餐后2h血糖,比较2组患者糖代谢异常及糖尿病发生率。结果阿立哌唑导致糖代谢异常及糖尿病较氯氮平出现晚,发生率低,危害性小,2组差异有显著性(P<0.01);患者病程越长,药物剂量越大,治疗时间越长,糖代谢异常及糖尿病发生率越高。结论阿立哌唑对精神分裂症患者糖代谢的影响较小,治疗依从性高。     

抗精神病药治疗患者血糖、血脂代谢异常分析

目的:研究慢性精神分裂症住院患者糖脂代谢异常的临床特点及影响因素。方法:将137例慢性精神分裂症住院患者有无糖脂代谢异常分为伴糖代谢异常组及非伴糖代谢异常组和伴脂代谢异常组及非伴脂代谢异常组,以研究糖脂代谢异常相关因素。结果:137例患者中糖尿病发生率为7.3%,糖代谢异常发生率为27.74%血脂代谢异常发生率为70%,慢性精神分裂症患者之间腹型肥胖、高三酰甘油、糖代谢异常的构成比差异有统计学意义(P<0.05),高龄、使用抗精神病药时间越长,血脂、血糖代谢异常发生率越高(P<0.05)。结论:住院精神分裂症患者血糖、血脂代谢异常相互影响,治疗期间应定期监测血糖、血脂、体质量等与糖脂代谢有关指标,一旦发现异常应早期干预治疗。     

氯氮平与利培酮对精神病患者糖代谢影响的对照研究

目的 了解氯氮平与利培酮对糖代谢的影响。方法 回顾性调查使用氯氮平或利培酮治疗的住院精神病人,观察血糖变化,并分析影响糖代谢异常的相关因素(性别、年龄、药物剂量、诊断、病程等)。结果 在136例住院精神病人中,氯氮平组79例,糖代谢异常发生率为34.2％,糖尿病发生率为16.5％;利培酮组57例,糖代谢异常发生率3.5％,糖尿病发生率为0％;氯氮平与利培酮相比引起糖代谢异常有显著性差异(P<0.05)。随年龄增大可能引起糖代谢异常的几率增加(P<0.05)。结论 氯氮平比利培酮引起糖代谢异常的发生率高,临床上应予关注。     

抗精神病药治疗患者血糖、血脂代谢异常分

目的:研究慢性精神分裂症住院患者糖脂代谢异常的临床特点及影响因素. 方法:将137例慢性精神分裂症住院患者有无糖脂代谢异常分为伴糖代谢异常组及非伴糖代谢异常组和伴脂代谢异常组及非伴脂代谢异常组,以研究糖脂代谢异常相关因素. 结果:137例患者中糖尿病发生率为7.3%,糖代谢异常发生率为27.74%血脂代谢异常发生率为70%.慢性精神分裂症患者之间腹型肥胖、高三酰甘油、糖代谢异常的构成比差异有统计学意义(P<0.05),高龄、使用抗精神病药时间越长,血脂、血糖代谢异常发生率越高(P<0.05). 结论:住院精神分裂症患者血糖、血脂代谢异常相互影响,治疗期间应定期监测血糖、血脂、体质量等与糖脂代谢有关指标,一旦发现异常应早期干预治疗.     

精神分裂症住院患者糖脂代谢异常的相关因素调查

目的 了解住院精神分裂症患者伴发糖、脂代谢异常的相关因素.方法 采用横断面调查对住院时间1年以上的精神分裂症患者230例进行糖、脂代谢异常的相关因素调查.结果 230例患者中糖尿病发生率9.6%,糖耐量异常发生率25%.有无糖代谢异常患者之间超重、腹型肥胖、高甘油三酯血症的构成比差异有统计学意义(P＜0.05), Logistic回归分析显示,患者伴发糖代谢异常的高危因素是高文化程度、高体质量指数(BMI)、高甘油三酯,运动是保护性因素.脂代谢异常的发生率是50.4%.有无脂代谢异常患者间的超重、腹型肥胖、糖代谢异常、使用舒必利等的构成比差异有统计学意义(P＜0.05), Logistic回归分析显示,患者伴发脂代谢异常的高危因素是BMI、2h血糖和使用非典型抗精神病药物,住院时间是保护性因素.结论 住院精神分裂症患者糖、脂代谢异常相互影响,危险因素均主要涉及肥胖、非典型抗精神病约物等,应对危险因素进行必要干预.     

抗精神病药物与高血糖关系探讨

目的：了解分析目前在我院住院治疗的精神分裂症患者血糖增高情况及其与患者病程，服抗精神病药物等因素关系。方法：调查分析符合CCMD3诊断标准的住院精神分裂症患者中高血糖发生情况，以及分析患者患病病程，糖尿病家族史，抗精神病药物的使用情况等相关因素，并观察患者体重，体重指数，血糖变化。将精神分裂症患者高血糖发生率与脸群患病率进行比较，分析产生高血糖的相关因素。结果：165例精神分裂症住院患者中高血糖发生率16．4％，为普通人群患糖尿病率2．5％的7倍。长期服用抗精神病药物会引起体重、体重指数增加及患者高血糖的发生与病程长短，患者年龄，糖尿病家族史阳性等因素有关。患者的高血糖发生，服非经典与经典抗精神病药物相比较无显著差异。两种以上抗精神病药物联用者高血糖发生率高。结论：精神分裂症患者长期服抗精神病药物引起体重、体重指数增加及其高血糖的发生率远高于一般人群。精神分裂症患者血糖增高可能是长期服抗精神病药物所致的一种延迟性，慢性药物不良反应的表现。应引起临床工作者关注。     

精神分裂症患者伴发糖尿病的相关因素分析

目的 为了解住院精神分裂症患者伴发糖尿病的相关因素。方法 回顾性调查住院精神分裂症患者发生糖尿病与精神药物、体重、血糖及血脂等的相关性。结果 在1472例精神分裂症患者中伴发糖尿病者共162例(11．0％)，其发生与患者的年龄、病程、体重、甘油三酯、胆固醇及服用抗精神病药有相关性，而与性别无关。结论 患者年龄越大、病程越长糖尿病的发生率越高，长期使用抗精神病药可能会导致糖尿病，尤以氯氮平为甚。     

脑卒中后糖尿病和糖调节异常的临床研究

目的调查脑卒中患者中糖尿病和糖调节异常的发病情况，探讨口服葡萄糖耐量试验（OGTT）的临床意义。方法对2004年1月-2006年6月收治入院的547例脑卒中患者进行空腹血糖、糖化血红蛋白（GHbAlc）等检测，登记患者的临床资料，对既往未诊断糖尿病而空腹血糖在5．6～6．9mmol／L的患者在适当时候进行OGTT，糖代谢分类采用2003年美国糖尿病学会建议标准。结果547例脑卒中患者住院前糖尿病的诊断率为13.9％，住院后检查发现糖尿病的患病率34．4％，糖调节异常26．5％；脑梗死、脑出血、蛛网膜下腔出血糖尿病的伴发率分别为45．1％、20．5％、13．2％，糖调节异常的伴发率分别30．2％、23．2％、16．2％；227例空腹血糖在5．6～6．9mmol／L的患者中，OGTT检查后发现，19．8％患者可诊断为糖尿病，42.3％提示糖耐量异常。结论脑卒中患者合并高比例的糖尿病和糖调节异常；缺血性卒中发病率高于出血性卒中：空腹血糖在5．6～6．9mmol／L的患者中，OGTT可以发现大量的糖尿病和糖耐量异常患者。     

精神分裂症并发糖尿病的相关因素分析

目的了解住院精神分裂症患者并发糖尿病的相关因素。方法回顾性调查符合CCMD-3诊断标准的住院精神分裂症患者中的糖尿病发病情况以及抗精神病药物的使用情况等相关因素，并观察体重、血糖和血脂的变化。结果在302例精神分裂症患者中，并发糖尿病者为39例（12．91％），其发生与患者的年龄、病程、体重、血脂和阳性糖尿病家族史以及使用抗精神病药物有相关性。结论精神分裂症患者中糖尿病的发生率远高于普通人群，年龄较大、病程较长以及抗精神病药物的长期使用均可增加糖尿病的发生率。     

精神分裂症与糖尿病关系的探讨

目的：了解住院精神分裂症患者中糖尿病的发病情况及其与抗精神病药等因素的关系。方法：回顾性调查符合CCMD－2－R诊断标准的住院精神分裂症患者中的糖尿病发病情况以及抗精神病药的使用情况等相关因素,观察体重、血糖和血脂的变化。糖尿病的诊断按照 WHO关于糖尿病的诊断标准（1980年）作出。将精神分裂症患者中的糖尿病发生率与一般人群中的患病率进行比较,并分析影响糖尿病发生的相关因素。结果：在503例精神分裂症住院患者中,糖尿病的发生率为15．1％,为普通人群（2．5％）的6倍（x^2＝18．10,P＜0．01）。抗精神病药物可引起体重的显著增加(t＝5．45,P＜0．01）。糖尿病的发生与精神分裂症的持续病程、长期住院、患者的年龄以及阳性糖尿病家族史等因素有关。氯氮平对糖尿病的影响与其他抗精神药物无显著差异（x^2＝0．38,P＞0．05）。结论：精神分裂症患者中糖尿病的发生率远高于普通人群,抗精神病药物引起的体重增加可能与此有关,临床上应予以关注。     

血清瘦素与抗精神病药源性肥胖及糖尿病的相关性研究

目的　调查和探讨长期使用抗精神病药患者血瘦素水平及其与服用抗精神病药后体重 增加、肥胖及糖尿病之间的关系。方法　对符合入组标准的308例长期服用抗精神病药的精神分裂症 患者分为对照组、肥胖组、糖耐量减低组及糖尿病组,比较血清瘦素水平、胰岛素抵抗指数、血清甘油三 酯及总胆固醇水平。结果　(1)肥胖组、糖耐量减低组及糖尿病组患者的血清瘦素水平、胰岛素抵抗指 数、血清甘油三酯及总胆固醇水平均显著高于对照组(P<0.05)。(2)长期应用抗精神病药患者血瘦 素水平与体重指数、简易胰岛素抵抗指数、空腹血糖、血甘油三酯及胆固醇均呈极显著正相关(P<0.01 ～0.0001),而与餐后2h血糖水平及用药时间无相关性。结论　长期应用抗精神病药患者血瘦素水 平在肥胖、糖耐量降低及糖尿病患者中显著升高,且与体重指数、简易胰岛素抵抗指数、空腹血糖水平等 均呈显著正相关,提示高血清瘦素水平是长期应用抗精神病药所致的代谢紊乱综合征的重要指征之一。     

长期使用抗精神病药患者血清游离脂肪酸水平与有关因素研究

目的:探讨长期(1年以上)使用抗精神病药患者的血清游离脂肪酸(FFAs)水平,及其与空腹血糖和胰岛素抵抗之间的关系. 方法:调查308例长期使用抗精神病药住院患者,用比色法检测患者空腹血清FFAs,用放射免疫法测定患者血清胰岛素和瘦素. 结果:与长期使用抗精神病药有关的体质量(体重)增加或肥胖、糖耐量降低和糖尿病患者的血清FFAs水平显著高于对照组(P值分别为0.04, 0.01和0.022),且与空腹血糖、胰岛素抵抗均呈显著正相关(P值分别为0.005和0.04). 结论:长期使用抗精神病药的精神分裂症患者的高血清FFAs水平影响患者的糖代谢,并参与胰岛素抵抗乃至糖尿病的发生,是代谢紊乱综合征的重要特征之一.     

Glucose and lipid metabolism of long-term risperidone monotherapy in patients with schizophrenia

Risperidone has a relatively low risk of causing obesity and diabetes mellitus and is a first-line treatment for schizophrenia. The aim of the present study was to investigate glucose and lipid metabolism, and feeding-control parameters in schizophrenia patients treated with long-term risperidone monotherapy. Fifteen patients with paranoid-type schizophrenia who had been treated with risperidone and had Global Assessment of Function (GAF) scores >70 were selected and compared with healthy volunteers (n = 25). Single assessments of psychotic symptoms, side-effects, Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) score, bodyweight, body fat percentage and blood sampling were performed. Fasting blood glucose, insulin, hemoglobin A1c, homeostasis model assessment insulin resistance index (HOMA-IR), total cholesterol, triglyceride, high density lipoprotein (HDL)-, low density lipoprotein-cholesterol, adiponectin, prolactin and feeding-control parameters (ghrelin and leptin) were analyzed. The body fat percentage (P = 0.0018), body mass index (BMI) (P = 0.0150), fasting blood glucose (P = 0.0358), triglyceride (P = 0.0377), leptin (P = 0.0243), total ghrelin (P = 0.0067), active ghrelin (P = 0.0241) and prolactin (P < 0.0001) levels of patients treated with risperidone were significantly higher than those of healthy volunteers, while the HDL-cholesterol level (P = 0.0222) was significantly lower. Although the patients had very mild psychiatric symptoms and maintained functionally high levels, the glucose and lipid parameters were significantly impaired compared to healthy volunteers. A high level of plasma ghrelin might increase appetite, leading to exacerbation of metabolic impairment.     

长期服用抗精神病药对脂肪酸与血糖的影响

目的 :研究慢性精神分裂症患者长期服用抗精神病药物与空腹游离脂肪酸及空腹血糖的关系。　方法 :2 18例病程 >5年的慢性精神分裂症患者接受糖尿病流行病学调查 ,测定空腹血糖、餐后2h血糖及空腹游离脂肪酸。　结果 :糖尿病组空腹游离脂肪酸水平显著高于血糖正常组 ;相关分析显示 2 18例患者空腹游离脂肪酸与空腹血糖呈显著正相关 ;糖尿病组、血糖调节异常组 2项指标间无显著相关性 ;血糖正常组空腹游离脂肪酸与空腹血糖呈显著正相关。　结论 :长期服用抗精神病药可导致部分患者游离脂肪酸及血糖处于平衡失调状态     

Serum Free Fatty Acids and Glucose Metabolism, Insulin Resistance in Schizophrenia with Chronic Antipsychotics

BACKGROUND: Weight gain and type 2 diabetes mellitus (DM) are often linked to antipsychotics treatment. The aim of the study is to investigate serum free fatty acids (FFA) levels in schizophrenic patients who received long-term antipsychotics treatment, and to explore the associations between serum FFA and fasting blood glucose, and insulin resistance. METHODS: 308 inpatients with schizophrenia who met with the criteria of DSM-IV were recruited into this study, and were divided into four groups: control subjects, single obesity, impaired glucose tolerance (IGT) and type 2 DM according to different body mass index, fasting blood glucose level and 2-hour postprandial blood glucose. Serum FFA was measured with colorimetry. Serum insulin and leptin were measured with radioimmunoassay respectively. RESULTS: There was a significant elevation in serum FFA levels in schizophrenic patients who received long-term antipsychotics treatment, especially in single obesity, IGT, and DM groups. The elevated serum FFA was remarkably positive correlated with fasting blood glucose and insulin resistance. CONCLUSIONS: The study suggested the elevated serum FFA in schizophrenic patients with long-term antipsychotics treatment affected the blood glucose metabolism, may have played an important role in insulin resistance and type 2 DM, and was also an important trait of metabolic syndromes.     

住院精神疾病患者合并糖尿病的调查

目的：调查住院精神疾病患者合并糖尿病的情况，探索相关因素。方法：自制一般情况调查表，回顾性调查住院精神疾病患者的糖尿病患病情况，检测空腹血糖、餐后2小时血糖、血脂，计算体重指数。结果：2647例住院精神疾病患者中，213例合并糖尿病，患病率8．05％，为正常人群的3．22倍。213例中体重超重的占44．13％，肥胖的占40．38％，有28．63％的患者空腹血糖控制不佳，85．92％的患者餐后2小时血糖控制不佳。合并糖尿病与超重、肥胖、高血脂、高血压等因素相关。结论：精神疾病患者中糖尿病的患病率远高于普通人群，临床上应予以关注。     

Value of the oral glucose tolerance test in the evaluation of chronic idiopathic axonal polyneuropathy

BACKGROUND: An underlying cause is found in only 7% to 30% of patients with chronic idiopathic axonal polyneuropathy (CIAP). Diabetes mellitus, inherited disorders, toxin exposure, and primary amyloidosis are the most common identified causes of sensory neuropathies affecting both large and small myelinated fibers. Undiagnosed impaired fasting glucose metabolism has been associated with CIAP at a higher frequency rate than in the general population. This increased prevalence rate was identified using the 2-hour oral glucose tolerance test (2h-OGTT) and a previous version of the American Diabetes Association (ADA) guidelines. OBJECTIVES: To determine the prevalence of abnormal fasting glucose metabolism in patients with CIAP and to compare the value of determining fasting plasma glucose levels using revised (2003) ADA criteria with the 2h-OGTT for predicting abnormal fasting glucose metabolism. PATIENTS: In this 24-month retrospective study, 100 consecutive patients were identified with no known cause for CIAP, including diabetes mellitus, between January 2003 and January 2005. All had both a fasting plasma glucose test and a 2h-OGTT in addition to a complete neurological examination. Neurophysiological studies, computer-assisted sensory examination, and quantitative sudomotor axonal reflex testing were used to classify CIAP into subtypes according to nerve fiber involvement. RESULTS: The prevalence of undiagnosed abnormal fasting glucose metabolism was found to be nearly 2-fold higher (62%) in patients with CIAP than in similar age-matched general population groups (33%). Using the 2003 revised ADA criteria, 39 patients (39%) had abnormal fasting plasma glucose metabolism (36 with impaired fasting glucose, 3 with diabetes mellitus), while the 2h-OGTT provided an even higher diagnostic rate of 62% (62 patients; P<.001) of impaired fasting glucose metabolism (38 with impaired glucose tolerance, 24 with diabetes mellitus). The abnormal glucose metabolism rates were found to be similar across the 3 subtypes (sensorimotor, pure sensory, and small-fiber neuropathy) of CIAP (P = .60, .72, and .61). CONCLUSIONS: This study adds to emerging evidence that abnormal glucose metabolism may be a risk factor for CIAP. Even with revised (2003) ADA criteria, the 2h-OGTT provides additional diagnostic information to the health care professional in the evaluation of CIAP. Subtypes of CIAP are equally likely to have abnormal glucose metabolism.     

Gender differences in association of plasma adiponectin with obesity reflect resultant insulin resistance in non-diabetic Japanese patients with schizophrenia

Adipose tissues poorly produce adiponectin in the population with increased body fat mass and diabetes mellitus. It was investigated whether hypoadiponectinemia is associated with obesity and insulin resistance in patients with chronically medicated schizophrenia. A cross-sectional study was designed for 73 non-diabetic Japanese patients with schizophrenia. The patients aged <70 years with body mass index (BMI) > or =18.5 were selected. Anthropometrics and blood parameters including fat-derived cytokines were measured, and then the BMI and homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. The variables were compared between the non-obesity (BMI, 18.5-24.9) and obesity (> or = 25.0) groups, and between genders. Plasma adiponectin negatively correlated with BMI (r = -0.554, P < 0.0003) and HOMA-IR (r = -0.380, P = 0.007) in men, but not in women. The obesity group in men, as compared with the non-obesity group, showed significantly lower plasma adiponectin (P = 0.008) and higher HOMA-IR (P < 0.05), but not in women. Plasma leptin showed a significant positive correlation with BMI (r = 0.604, P < 0.0001 in men; r = 0.763, P < 0.0001 in women) and HOMA-IR (r = 0.618, P < 0.0001 in men; r = 0.679, P < 0.0001 in women). The mean plasma leptin in the obesity group was significantly higher than that in the non-obesity group (P < 0.01 in men; P < 0.01 in women). In contrast to plasma leptin, plasma adiponectin showed gender difference in relation to BMI and HOMA-IR.