精神分裂症患者伴发代谢综合征早期血清学诊断的试验研究

目的 探讨首发未服药精神分裂症患者血压、血糖、血脂、空腹胰岛素及血清肿瘤坏死因子-a(TNF-a)、醛固酮(ALD)水平随病程变化的影响,进而探讨精神分裂症与代谢综合征(MS)之间的关系,为精神分裂症患者早期诊断MS提供实验室依据.方法 对80例首发未服药精神分裂症患者行血压、体重、血脂、空腹血糖、空腹胰岛素的动态监测,并设立健康对照组(同期我院门诊健康体检者)60例.同时在各个时间点采用酶联免疫吸附实验(ELISA)检测两组血清TNF-a、ALD水平.结果 精神分裂症组血压、体重、血脂、空腹血糖值均高于健康对照组,而空腹胰岛素水平低于健康对照组(P＜0.05);精神分裂症组TNF-a、ALD值均高于健康对照组(P＜0.05),且随病程进展上述数据呈递增趋势(P＜0.05).结论 ①精神分裂症患者在早期即可出现糖脂代谢的异常及胰岛素抵抗,精神分裂症与MS可能存在某种关联;②精神分裂症患者血清TNF-a、ALD变化与疾病进展成正相关,在一定程度上可反映患者体内炎症血管活化情况,故临床上动态观察血清TNF-a、ALD水平有助于为精神分裂症患者早期诊断MS.     

High prevalence of the metabolic syndrome among a Swedish cohort of patients with schizophrenia

Several cardiovascular risk factors have been linked to antipsychotic treatment and cardiovascular mortality is increased in these patients compared to the general population. The full metabolic syndrome (or its components) is associated with an increased risk of cardiovascular disorders. The prevalence of the metabolic syndrome was investigated using a cross-sectional study design in a cohort of 269 patients, aged 20-69 years, with schizophrenia living in Northern Sweden, and was defined according to the criteria of the National Cholesterol Education program. The prevalence of the metabolic syndrome was 34.6% (95% CI = 28.8-40.3) and highest (43%; 95% CI = 32-53) for participants aged 40-49 years. Clozapine treated subjects reached the highest prevalence of the metabolic syndrome (48%; 95% CI = 34-62). The prevalence was similar for men (32.8%; 95% CI = 25.8-39.8) and women (38.0%; 95% CI = 27.9-48.2). Men had a high prevalence of hypertension (49.2%; 95% CI = 41.7-56.6) and women had high prevalence of low high-density lipoprotein cholesterol (40.2%; 95% CI = 30.0-50.4) and abdominal obesity (75.0%; 95% CI = 66.0-84.0). Subjects with the metabolic syndrome had significantly higher mean body mass index (BMI) (P < 0.001), HbA1c (P = 0.002), and fasting serum insulin (P < 0.001) compared to non-metabolic syndrome subject. Subjects with the metabolic syndrome had also significantly more often a positive history of cardiovascular diseases compared to non-metabolic syndrome subjects (25.8% versus 12.5%; P = 0.01). Of all study subjects 36.8% were obese (BMI > 30). These results clearly show that the metabolic syndrome and its components are highly prevalent in patients with schizophrenia. Physicians treating patients with schizophrenia are recommended to monitor the components included in the metabolic syndrome.     

住院精神分裂症患者伴发代谢综合征的调查分析

目的调查住院精神分裂症患者代谢综合征的发生率,分析与代谢综合征有关的危险因素。方法以2008年1月—12月郑州市第八人民医院符合CCMD-3诊断标准的精神分裂症患者出院病例为研究对象,代谢综合征的诊断标准采用2004年医学会糖尿病分会代谢综合症标准。了解精神分裂症患者代谢综合症的发生率,用Logistic回归分析影响发生的相关因素。结果符合条件共入组完成726例,精神分裂症患者中代谢综合征患病率32.3%。代谢综合征患病相关的危险因素有年龄、氯氮平及精神分裂症的病程(P<0.05)。Logistis回归分析结果显示,精神分裂症患者伴发代谢综合症的危险因素是高龄,病程。结论与普通人群相比,精神分裂症患者具有较高的代谢综合症患病风险,可能的危险因素有高龄,病程长和服用氯氮平等。     

780例长期住院精神分裂症患者代谢综合征患病调查

调查长期住院精神分裂症患者代谢综合征患病情况。于2015年4—7月采用自制调查表收集资料,调查我院普通病房长期住院的精神分裂症患者伴发代谢综合征的情况,并采用单因素与多因素法分析精神分裂症伴代谢综合征患病的影响因素。调查精神分裂症患者780例,其中伴代谢综合征者（病例组）280例,占35.90%;非代谢综合征者（对照组）500例,占64.10%。病例组BMI、SBP、DBP、TG和FBG水平均显著高于对照组（P＜0.05）,HDL-C水平显著低于对照组（P＜0.05）。病例组SQLS评分均显著高于对照组（P＜0.05）,SSPI评分显著低于对照组（P＜0.05）。单因素分析结果显示,精神分裂症患者代谢综合征与性别、年龄、病程、抗精神病用药具有紧密的关系,其中女性、年龄＞40岁、病程＞10年及服用氯氮平或奥氮平治疗的患者代谢综合征患病比例显著增高（P＜0.05）。经多因素Logistic回归分析显示,性别、年龄、病程及服用氯氮平或奥氮平是精神分裂症患者伴发代谢综合征的独立危险因素（P＜0.05）。长期住院精神分裂症患者代谢综合征临床指标异常改变,严重影响生活质量,其中女性、高龄与病程＞10年及服用氯氮平或奥氮平是疾病的危险因素,对于上述危险人群应警惕代谢综合征的出现。     

超声检查对肥厚型心肌病病人发生心房颤动的预测价值

目的 评价超声检查对肥厚型心肌病病人发生心房颤动的预测价值。方法 选取2013年1月至2017年3月济宁医学院附属医院就诊的肥厚型心肌病病人作为研究对象,收集病人临床资料及超声检查结果;根据随访期间有无新发房颤将研究对象分为房颤组和无房颤组,比较其临床特点并采用多因素logistic回归分析肥厚型心肌病病人发生房颤的危险因素。结果 共321例肥厚型心肌病病人入选,其中发生房颤38例。房颤组与无房颤组在年龄［([51.47±10.98])比([45.54±11.84])岁］、最大室壁厚度(21.0比17.0 mm)、左房面积(32.0比19.0 cm2)、二尖瓣舒张早期血流速度与二尖瓣环运动速度之比(E/e’)(18.0比11.5)及肺动脉收缩压(32.0比30.0 mmHg)均差异有统计学意义(均P＜0.05)。多因素logistic回归分析发现,E/e’和左房面积是肥厚型心肌病病人房颤发生的独立危险因素。ROC曲线显示左房面积和E/e’的最佳截断点分别为28 cm2和17。结论 E/e’≥17和左房面积≥28 cm2是肥厚型心肌病病人发生房颤的独立预测因子。     

Second generation antipsychotic-induced mitochondrial alterations: Implications for increased risk of metabolic syndrome in patients with schizophrenia

Metabolic syndrome (MetS) is seen more frequently in persons with schizophrenia than in the general population, and these metabolic abnormalities are further aggravated by second generation antipsychotic (SGA) drugs. Although the underlying mechanisms responsible for the increased prevalence of MetS among patients under SGA treatment are not well understood, alterations in mitochondria function have been implicated. We performed a comprehensive evaluation of the role of mitochondrial dysfunction in the pathophysiology of drug-induced MetS in schizophrenia. We found a downregulation in genes encoding subunits of the electron transport chain complexes (ETC), enzyme activity, and mitochondrial dynamics in peripheral blood cells from patients at high-risk for MetS. Additionally, we evaluated several markers of energy metabolism in lymphoblastoid cell lines from patients with schizophrenia and controls following exposure to antipsychotics. We found that the high-risk drugs clozapine and olanzapine induced a general down-regulation of genes involved in the ETC, as well as decreased activities of the corresponding enzymes, ATP levels and a significant decrease in all the functional parameters of mitochondrial oxygen consumption in cells from patients and controls. We also observed that the medium-risk SGA quetiapine decreased oxygen consumption and respiratory control ratio in controls and patients. Additionally, clozapine and olanzapine induced a downregulation of Drp1 and Mfn2 both in terms of mRNA and protein levels. Together, these data suggest that an intrinsic defect in multiple components of oxidative metabolism may contribute to the increased prevalence of MetS in patients under treatment with SGAs known to cause risk for MetS.     

The association between HTR2C gene polymorphisms and the metabolic syndrome in patients with schizophrenia

The use of antipsychotics is associated with metabolic side effects, which put patients with schizophrenia or related disorders at risk for cardiovascular morbidity. The high interindividual variability in antipsychotic-induced metabolic abnormalities suggests that genetic makeup is a possible determinant. In this cross-sectional study, we investigated whether genotypes of the HTR2C receptor are associated with the metabolic syndrome in patients using antipsychotics. Patients were identified from a schizophrenia disease management program. In this program, patients' blood pressure, triglycerides, high-density lipoprotein-cholesterol, and waist circumference are measured regularly during follow-up. The primary end point of our study was the prevalence of the metabolic syndrome as classified by a modified version of the National Cholesterol Education Program's Adult Treatment Panel III. Primary determinants were polymorphisms in the HTR2C receptor gene (HTR2C:c.1-142948[GT]n, rs3813928 [-997 G/A], rs3813929 [-759 C/T], rs518147 [-697 G/C], and rs1414334 [C > G]). The included patients (n = 112) mainly (>80%) used atypical antipsychotics (clozapine, olanzapine, and risperidone). Carriership of the variant alleles of the HTR2C polymorphisms rs518147, rs1414334, and HTR2C:c.1-142948(GT)n was associated with an increased risk of the metabolic syndrome (adjusted odds ratio [OR], 2.62 [95% confidence interval {CI}, 1.00-6.85]; OR, 4.09 [95% CI, 1.41-11.89]; and OR, 3.12 [95% CI, 1.13-8.16]), respectively. Our findings suggest that HTR2C genotypes are associated with antincreased risk of metabolic syndrome in patients taking antipsychotics.     

Suicide attempts in a prospective cohort of patients with schizophrenia treated with sertindole or risperidone

The incidence of suicide attempts (fatal and non-fatal) was analysed in a prospective cohort of patients with schizophrenia randomly assigned to sertindole (4905 patients) or risperidone (4904 patients) in a parallel-group open-label study with blinded classification of outcomes (the sertindole cohort prospective study — SCoP). The total exposure was 6978 and 7975 patient-years in the sertindole and risperidone groups, respectively. Suicide mortality in the study was low (0.21 and 0.28 per 100 patients per year with sertindole and risperidone, respectively). The majority (84%) of suicide attempts occurred within the first year of treatment. Cox's proportional hazards model analysis of the time to the first suicide attempt, reported by treating psychiatrists and blindly reviewed by an independent expert group according to the Columbia Classification Algorithm of Suicide Assessment (both defining suicide attempts by association of suicidal act and intent to die), showed a lower risk of suicide attempt for sertindole-treated patients than for risperidone-treated patients. The effect was statistically significant with both evaluation methods during the first year of randomized treatment (hazard ratios [95% CI]: 0.5 [0.31–0.82], p = 0.006; and 0.57 [0.35–0.92], p = 0.02, respectively). With classification by an independent safety committee using a broader definition including all incidences of intentional self-harm, also those without clear suicidal intent, the results were not significant. A history of previous suicide attempts was significantly associated with attempted suicides in both treatment groups.     

Effects of canrenone in patients with metabolic syndrome

Background: Metabolic syndrome is becoming a common disease due to a rise in obesity rates among adults.

Objectives: The aim was to evaluate the effects of canrenone compared to placebo on metabolic and inflammatory parameters in patients affected by metabolic syndrome.

A total of 145 patients were treated with placebo or canrenone, 50 mg/day, for 3 months and then 50 mg b.i.d. till the end of the study.

Blood pressure, body weight, body mass index, fasting plasma glucose (FPG), fasting plasma insulin, HOMA-IR, lipid profile, plasma aldosterone, brain natriuretic peptide, high-sensitivity C-reactive protein (Hs-CRP), tumor necrosis factor-α (TNF-α) and M value were evaluated.

Results: A decrease of blood pressure was observed in canrenone group compared to baseline; moreover, systolic blood pressure value recorded after 6 months of canrenone therapy was lower than the one recorded with placebo. Canrenone gave a significant decrease of FPI and HOMA index, and an increase of M value both compared to baseline and to placebo. Canrenone also decreased triglycerides and FPG was not observed with placebo. Canrenone also decreased plasma aldosterone, Hs-CRP and TNF-α compared to baseline and to placebo.

Conclusion: Canrenone seems to be effective in reducing some factors involved in metabolic syndrome and in improving insulin-resistance and the inflammatory state observed in these patients.     

The relationship between serum uric Acid concentration and metabolic syndrome in patients with schizophrenia or schizoaffective disorder

ABSTRACT: Higher prevalence rates of metabolic syndrome (MetS) in patients with schizophrenia are getting more and more attention. Uric acid (UA) has been frequently reported to be associated with MetS in the general population. Sex difference in this relationship is inconsistent. As a selective antioxidant, UA has also been found to be reduced in patients with schizophrenia, and this effect may be prominent in men. With the inconsistent presentations, higher rate of MetS but possible lower UA concentrations, the aim of this study was to investigate the relationship by sexes between serum UA concentrations and prevalence of MetS in patients with schizophrenia or schizoaffective disorder. A total of 637 patients, 342 male and 295 female, were enrolled from 36 psychiatric rehabilitation institutions. Cross-sectional anthropometrical data, biochemical analysis, and serum UA were measured. Serum UA concentrations were divided into quartiles by sexes. Modified National Cholesterol Education Program Adult Treatment Panel III criteria for Asians were used as diagnosis of MetS. After adjustment, higher UA concentrations are associated with hypertriglyceridemia, low high-density lipoprotein cholesterol level, and high blood pressure in men and with hypertriglyceridemia in women. Significantly higher odds ratios for MetS in the UA third (4.02; 95% confidence interval, 1.33-12.1) and fourth quartiles (9.28; 95% confidence interval, 2.90-29.8) compared with the lowest quartile were found in men but not in women after adjustment. These results suggest that lower UA concentrations in male patients with schizophrenia or schizoaffective disorder are associated with lower risk of MetS.     

代谢综合征患者Hs-CRP、Fib与胰岛素抵抗的关系

目的观察代谢综合征患者血浆超敏C反应蛋白、纤维蛋白原水平与胰岛素抵抗的关系,探讨炎症反应在代谢综合征患者胰岛素抵抗发生中的作用。方法选择代谢综合征患者加例和正常健康对照组30例,分别测定血浆超敏C反应蛋白、纤维蛋白原等指标;计算稳态模型胰岛素抵抗指数（HO-MA．IR）。比较其水平的差异,并进行相关性分析。结果代谢综合征组的HOMA-IR较正常健康对照组明显升高（P〈0．05）;血浆超敏C反应蛋白、纤维蛋白原水平等也明显升高,差异具有统计学意义（P〈0．05）。相关结果显示：代谢综合征患者组高敏C反应蛋白、纤维蛋白原与HOMA．IR正相关（r=0．465,0．381,P〈0．05）。结论代谢综合征患者存在血浆超敏C反应蛋白水平的异常和明显的胰岛素抵抗,炎症反应可能在代谢综合征患者胰岛素抵抗的发生中发挥了重要的作用。     

代谢综合征患者腹股沟疝无张力修补术前一次性预防性使用抗生素的前瞻性研究

目的 探讨代谢综合征(MS)患者腹股沟疝修补术前是否需预防性使用抗生素.方法 采用随机双盲、前瞻性研究方法,以2010年7月至2012年12月中山市四家二级医院外科收治的186例MS需行腹股沟疝修补手术的患者为研究对象,对照组(n=93)术前30 min一次性给予头孢唑林1.5g加0.9％氯化钠注射液20 ml静脉注射,观察组(n=93)仅给予0.9％氯化钠注射液20ml静脉注射.结果 术后发生手术部位感染,对照组有5例,观察组有6例.两组术后发生手术部位感染、体温正常天数差异均无统计学意义(均P＞0.05).但观察组、对照组内体质量指数(WBI)＞ 30的患者发生感染的概率高于25≤WBI≤30的患者,差异均有统计学意义(17.24％与1.56％、12.90％与1.61％,x2=4.69、4.87,均P＜0.05);空腹血糖(FPG)＞ 12.0 mmol/L的患者发生感染概率高于6.1≤FPG≤12.0 mmol/L的患者,差异均有统计学意义(15.30％与1.64％、13.33％与1.59％,x2=4.81、5.13,均P＜0.05).结论 MS患者行腹股沟疝无张力修补术,无需应用抗生素预防术后外科部位的感染(SSI).但重度肥胖、血糖较高(FPG＞ 12.0 mmol/L)的患者有必要在术前预防性使用抗生素,减少术后SSI的发生.     

Decision making as a predictor of first ecstasy use: a prospective study

Rationale  Ecstasy (±3,4-methylenedioxymethamphetamine) is a widely used recreational drug that may damage the serotonin system and may entail neuropsychological dysfunctions. Few studies investigated predictors for ecstasy use. Self-reported impulsivity does not predict the initiation of ecstasy use; the question is if neuropsychological indicators of impulsivity can predict first ecstasy use. Objective  This study tested the hypothesis that a neuropsychological indicator of impulsivity predicts initiation of ecstasy use. Materials and methods  Decision-making strategy and decision-making reaction times were examined with the Iowa Gambling Task in 149 ecstasy-naive subjects. The performance of 59 subjects who initiated ecstasy use during a mean follow-up period of 18 months (range, 11–26) was compared with the performance of 90 subjects that remained ecstasy-naive. Results  Significant differences in decision-making strategy between female future ecstasy users and female persistent ecstasy-naive subjects were found. In addition, the gap between decision-making reaction time after advantageous choices and reaction time after disadvantageous choices was smaller in future ecstasy users than in persistent ecstasy-naives. Conclusion  Decision-making strategy on a gambling task was predictive for future use of ecstasy in female subjects. Differences in decision-making time between future ecstasy users and persistent ecstasy-naives may point to lower punishment sensitivity or higher impulsivity in future ecstasy users. Because differences were small, the clinical relevance is questionable.     

Homocysteine levels in adolescent schizophrenia patients

Homocysteine is a sulfur containing amino acid that has been widely investigated for its putative role in cardiovascular and neuropsychiatric disorders. It has been suggested that homocysteine has implications especially in young, male schizophrenia patients. In this prospective case-control study, we compared plasma homocysteine levels in a group of adolescent schizophrenia inpatients (aged 14–21 years; n = 23) to normal healthy controls (n = 51). Mean plasma homocysteine levels were significantly higher in the patient group than in the control group (15.40 ± 2.00 and 9.78 ± 0.33 μmol/L, respectively, p < 0.032). The difference was almost entirely attributable to the male schizophrenia subgroup (18.18 ± 5.65 in male patients vs. 10.31 ± 5.33 μmol/L in female patients). The group × sex interaction was statistically significant (p = 0.0035). These data indicate that a subgroup of male adolescent schizophrenia patients has high homocysteine blood levels. The role of homocysteine in the pathophysiology of adolescent-onset schizophrenia merits further investigation.     

代谢综合征患者血清IL-8水平变化与胰岛素抵抗的相关性

目的探讨代谢综合征（metabolic syndrome,Ms）患者血清白细胞介素-18（Interleukin -18,IL-18）水平与胰岛素抵抗（insulin resistance,IR）的关系。方法选择代谢综合征患者40例和正常健康（C）对照组30例,测定受试者空腹血清IL-18、体质量、腰围、血压、血糖、血脂及胰岛素等参数,计算稳态模型胰岛素抵抗指数（HOMA—IR）。结果MS组IL-18、BMI、SBP、DBP、FBG、2hPG、FINS、TG、Homa-IR均明显高于对照组,且差异有显著性（P〈0．05）,代谢综合征组HDL—C明显低于对照组,差异有显著性（P〈0．05）;IL-18水平与Homa—IR呈显著正相关（r=0．413P〈0．05）。结论MS患者血清IL-18水平均明显升高,且与IR程度明显相关,代谢综合征、胰岛素抵抗与体内炎症反应有关。     

Psychopathology, coronary heart disease and metabolic syndrome in schizophrenia spectrum patients with deficit versus non-deficit schizophrenia: Findings from the CLAMORS study

The objective of this study was to compare coronary heart disease (CHD) risk and metabolic syndrome (MS) prevalence in patients with deficit (DS) and non-deficit schizophrenia treated with antipsychotics. A total of 1452 antipsychotic-treated outpatients meeting criteria for schizophrenia, schizophreniform or schizoaffective disorder were included in this cross-sectional multicentre study. CHD risk was assessed by SCORE (10-year cardiovascular death) risk score, and metabolic syndrome was assessed according to NCEP-ATP III criteria. A total of 1452 patients (863 men, 60.9%), 40.7 ± 12.2 years (mean ± SD) were included. DS was found in 404 patients (35.1%). Patients with DS were older, more frequently male and obese, more likely to be receiving sickness benefits, and had longer illness duration and fewer previous hospitalisations. Furthermore, DS patients had higher negative PANSS scores (56.3% vs. 40.6% of patients with PANSS-N > 21). High/very high risk of fatal CHD according to SCORE function (≥ 3%) was significantly higher in DS [11.8% (95% CI: 8.8-15.5) vs. 6.0% (95% CI: 4.4-8.1), (p < 0.05)]. Schizophrenia spectrum patients with DS were more obese and had a higher CHD risk than non-deficit patients.