精神分裂症患者伴发代谢综合征与超敏C反应蛋白水平的相关研究  

Association between Metabolic Syndrome and the Level of High-sensitivity C-reactive Protein in Patients with Schizophrenia

作　　者：姚献虎 夏磊[2] 李文正 朱梅[4] 陶德刚 刘寰忠[2] YAO Xianhu;XIA Lei;LI Wenzheng;ZHU Mei;TAO Degang;LIU Huanzhong(Department of Psychiatry,Maanshan Fourth People's Hospital,Maanshan 243000,China;Department of Psychiatry,Chaohu Hospital of Anhui Medical University,Hefei 238000,China;Department of Psychiatry,Hefei Fourth People's Hospital,Hefei 230022,China;Clinical Laboratory,Chaohu Hospital of Anhui Medical University,Hefei 238000,China)

机构地区：[1]安徽省马鞍山市第四人民医院精神科,243000 [2]安徽医科大学附属巢湖医院精神科,安徽省合肥市238000 [3]安徽省合肥市第四人民医院精神科,230022 [4]安徽医科大学附属巢湖医院检验科,安徽省合肥市238000

出　　处：《中国全科医学》2020年第3期294-298,304,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81771449);安徽省重点研究和开发计划项目(1804h08020263)

摘　　要：背景机体免疫与代谢紊乱存在密切关系,炎症参与了维持多个代谢器官组织内稳态和代谢疾病的发生,目前关于精神分裂症人群中炎性反应与代谢紊乱关系的研究鲜有报道。目的探讨精神分裂症患者伴发代谢综合征(MS)与超敏C反应蛋白(hs-CRP)之间的关系。方法采用横断面研究方法,于2018年512月招募马鞍山市第四人民医院、安徽医科大学附属巢湖医院及合肥市第四人民医院精神科住院的精神分裂症患者(病程≥5年),以中华医学会糖尿病学分会(CDS)推荐的标准定义MS,比较伴发MS组和不伴发MS组患者的临床资料,并分析hs-CRP与MS及其各组成的关系。结果最终322例精神分裂症患者纳入分析,MS发生率为16.5%(53/322),男性MS发生率为13.6%(26/191),女性MS发生率为20.6%(27/131)。伴发MS组患者的年龄、hs-CRP、高C反应蛋白(CRP)血症(hs-CRP≥3 mg/L)发生率高于不伴发MS组患者,阴性症状评分低于不伴发MS组患者(P<0.05)。hs-CRP与BMI(rs=0.22,P<0.001)、收缩压(rs=0.14,P=0.014)、舒张压(rs=0.13,P=0.021)、空腹血糖(FPG)(rs=0.14,P=0.014)、三酰甘油(TG)(rs=0.15,P=0.006)呈正相关;与高密度脂蛋白胆固醇(HDL-C)呈负相关(rs=-0.17,P=0.003)。多因素Logistic回归分析结果显示,年龄大及lg(hs-CRP)高是精神分裂症患者伴发MS的危险因素(OR=1.029,P<0.05;OR=1.750,P<0.01),而阴性症状评分高是精神分裂症患者伴发MS的保护因素(OR=0.957,P<0.05)。进一步分析显示高CRP血症患者伴发MS的发生风险是非高CRP血症患者的2.305倍[OR=2.305,95%C(I 1.186,4.481),P=0.014]。结论机体微炎症状态与精神分裂症伴发肥胖、高血压及血糖、血脂等代谢紊乱存在密切关系,外周炎症指标如hs-CRP升高可以在一定程度上反应MS更高的发生风险。测定精神分裂症患者的hs-CRP水平有助于更好地评估其代谢风险状况。Background Body immunity is related closely with metabolic abnormalities.Inflammation is involved in the maintenance of homeostasis in multiple metabolic organs and the occurrence of metabolic diseases.However,there are few reports on the relationship between inflammation and metabolic abnormalities in schizophrenia.Objective To explore the association between metabolic syndrome(MS) and the level of high-sensitivity C-reactive protein(hs-CRP) in patients with schizophrenia.Methods This study was based on a cross-sectional design.Inpatients who had schizophrenia for at least 5 years were recruited from Department of Psychiatry,Maanshan Fourth People’s Hospital,Chaohu Hospital of Anhui Medical University,and Hefei Fourth People’s Hospital during May to December,2018.Among them,those with MS(MS was determined by the recommended diagnostic criteria by the Chinese Diabetes Society) and without were compared in terms of clinical data.The associations of hs-CRP with MS and its components were examined.Results Altogether,322 cases were finally included.The prevalence of MS in all the participants was 16.5%(53/322),and that in male and female participants was 13.6%(26/191),and 20.6%(27/131),respectively.The mean age,and hs-CRP level,as well as the prevalence of abnormal elevated CRP levels(hs-CRP,≥3 mg/L) were higher in those with MS,while the negative symptoms were more severe in those without MS(P<0.05).Correlation analysis showed the level of hs-CRP was positively associated with BMI(r=0.22,P<0.001),systolic blood pressure(r=0.14,P=0.014),diastolic blood pressure(r=0.13,P=0.021),fasting plasma glucose(r=0.14,P=0.014),and triglyceride(r=0.15,P=0.006),and positively associated with high-density lipoprotein cholesterol(P<0.05).Multivariate logistic regression analysis showed older age(OR=1.029,P<0.05) and elevated lg(hs-CRP) level(OR=1.750,P<0.01) were independent risk factors,and higher negative symptoms score(OR=0.957,P<0.05) was a protective factor for MS.Furthermore,the analysis showed patients with elevated CRP

关 键 词：精神分裂症 代谢综合征X C反应蛋白 超敏C反应蛋白 炎症 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R589[医药卫生—临床医学]