糖化血红蛋白对伴糖尿病的精神分裂症患者认知功能的影响  

Effect of HbA1c on cognitive function in schizophrenia with diabetes

作　　者：张保华[1] 刘可智 韩笑乐[1] 边云[1] 辛立敏[1] 朱晓昱[1] 杨清艳[1] 杨兴洁[1] 王志仁[1] 陈大春[1] 卞清涛[1] 江述荣[1] 

机构地区：[1]北京回龙观医院,北京100096 [2]西南医科大学临床医学院/附属医院,四川泸州646000

出　　处：《四川精神卫生》2018年第1期19-23,共5页Sichuan Mental Health

基　　金：首都临床特色应用研究专项基金(Z171100001017022);四川省科技厅四川省应用基础研究项目(2017JY0324);泸州市科技局项目[2016-S-67(7/23)]

摘　　要：目的探讨糖化血红蛋白(Hb A1c)对伴糖尿病的精神分裂症患者认知功能的影响。方法共入组符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)的精神分裂症诊断标准患者323例,按照1999年世界卫生组织糖尿病诊断标准,分为伴糖尿病的精神分裂症组(n=124)和不伴糖尿病的精神分裂症组(n=199)。采用重复性成套神经心理状态测验(RBANS)评定认知功能,采用阳性和阴性症状量表(PANSS)评定临床症状,检测空腹血糖、糖化血红蛋白和血脂。结果伴糖尿病的精神分裂症患者与不伴糖尿病的精神分裂症患者RBANS总评分比较差异有统计学意义[(70.73±16.68)分vs.(75.93±15.63)分,P<0.05]。伴糖尿病精神分裂症患者比不伴糖尿病精神分裂症患者的空腹血糖和糖化血红蛋白水平高[(6.14±1.58)mmol/L vs.(5.20±0.57)mmol/L,(6.53±1.22)mmol/L vs.(5.91±0.62)mmol/L,P均<0.01]、发病晚[(26.41±7.38)岁vs.(24.85±6.32)岁,P<0.05]、低密度脂蛋白低[(2.64±0.57)mmol/L vs.(2.83±0.58)mmol/L,P<0.01]。在伴糖尿病的精神分裂症患者中,糖化血红蛋白水平与即刻记忆、视觉广度、言语功能、注意功能、延迟记忆和RBANS总评分均呈负相关(r=-0.447^-0.187,P<0.05或0.01),而不伴糖尿病的精神分裂症患者没有这种相关性。多元回归分析显示,Hb A1c水平是伴糖尿病的精神分裂症患者的视觉广度、注意功能和RBANS总评分的影响因素(P均<0.01)。结论伴糖尿病的精神分裂症患者认知功能比不伴糖尿病的精神分裂症患者受损更严重,Hb A1c水平升高会损害伴糖尿病的精神分裂症患者的认知功能。Objective To investigate the effect of Hb A1 c on cognitive function in schizophrenia patients with diabetes.Methods A total of 323 patients who met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders,fourth edition( DSM-IV) were enrolled. According to the 1999 WHO diagnostic criteria for diabetes,they were divided into the schizophrenia group with diabetes( n = 124) and the schizophrenia group without diabetes( n = 199). Cognitive function was evaluated with Repeatable Battery for the Assessment of Neuropsychological Status( RBANS). Positive and Negative Syndrome Scale( PANSS) was used to assess the clinical symptoms,and fasting glucose,Hb A1 c and lipid levels were measured. Results The RBANS scores of the two groups was significantly different [( 70. 73 ± 16. 68) vs.( 75. 93 ± 15. 63),P < 0. 05]. The fasting glucose and Hb A1 c levels of schizophrenia patients with diabetes were higher than those without[( 6. 14 ± 1. 58) vs.( 5. 20 ± 0. 57),( 6. 53 ± 1. 22) vs.( 5. 91 ± 0. 62),P < 0. 01],age of onset[( 26. 41 ± 7. 38) vs.( 24. 85 ± 6. 32),P < 0. 05]and lower LDL [( 2. 64 ± 0. 57) vs.( 2. 83 ± 0. 58),P < 0. 01] in schizophrenia with diabetes than those without. In schizophrenia with diabetes,serum Hb A1 c levels were negatively associated with the RBANS total score and 5 subscores( r =-0. 447 ^-0. 187,P < 0. 05 or 0. 01). Further multivariate regression analysis showed that serum Hb A1 c levels were associated with the RBANS total score,the attention index and the visuospatial/construction( P < 0. 01). Conclusion Cognition function is worse for schizophrenia with diabetes. Moreover,the higher levels of serum Hb A1 c can cause cognitive impairments.

关 键 词：精神分裂症 认知功能 糖化血红蛋白 糖尿病 

分 类 号：R749.3[医药卫生—神经病学与精神病学]