首发躁狂发作后体重增加、肥胖和代谢指标：来自早期躁狂系统治疗优化计划（STOP-EM）的前瞻性 12 个月数据。

Weight gain, obesity, and metabolic indices following a first manic episode: prospective 12-month data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM).

机构信息

Mood Disorders Centre, University of British Columbia, Room 2C7 - 2255 Wesbrook Mall, Vancouver, British Columbia, Canada.

出版信息

J Affect Disord. 2010 Jul;124(1-2):108-17. doi: 10.1016/j.jad.2009.10.023. Epub 2009 Nov 14.

DOI:10.1016/j.jad.2009.10.023

PMID:19914720

Abstract

BACKGROUND

Numerous studies have demonstrated an association between bipolar disorder (BD) and obesity. However, these reports are limited by retrospective or cross-sectional designs, and the assessment of patients with lengthy illnesses. Prospective data, and data on weight gain early in the course of BD, are lacking.

METHODS

We prospectively measured weight gain and laboratory metabolic indices over 12 months in 47 patients with BD receiving maintenance treatment following their first manic episode, and in 24 age- and gender-matched healthy subjects.

RESULTS

Although approximately two-thirds of patients had experienced previous depressive or hypomanic episodes, there was no difference between patients and healthy subjects in mean body mass index or rates of overweight or obesity at recovery from the first mania. Mean weight gain over 12 months was 4.76kg in patients and 1.50kg in healthy subjects (p=0.047). Combined rates of overweight and obesity at 6 months and 12 months exceeded 50% in patients, and were almost double those of healthy subjects. Logistic regression demonstrated that weight gain in the first 6 months was significantly associated with male gender and prescription of olanzapine or risperidone. Patients who were obese at 6 months and/or 12 months had significantly greater mean serum triglyceride levels and fasting glucose levels than non-obese patients.

LIMITATIONS

This was a naturalistic study.

CONCLUSIONS

Even in patients with previous depressions and hypomanias, clinically significant weight gain in BD begins following the first manic episode, suggesting that it is primarily related to treatment with mood stabilizers and second-generation antipsychotics. However, the very small number of patients in our sample who were medication-free precludes a meaningful analysis of the degree to which weight gain might be an inherent feature of post-manic BD.

摘要

背景

大量研究表明双相障碍（BD）与肥胖之间存在关联。然而，这些报告受到回顾性或横断面设计的限制，且仅评估了病程较长的患者。目前缺乏前瞻性数据以及双相障碍早期体重增加的数据。

方法

我们前瞻性地测量了 47 例首次躁狂发作后接受维持治疗的 BD 患者和 24 例年龄和性别匹配的健康对照者在 12 个月内的体重增加和实验室代谢指标。

结果

尽管约三分之二的患者曾经历过抑郁或轻躁狂发作，但在恢复首次躁狂后，患者和健康对照者的平均体重指数或超重或肥胖的发生率并无差异。患者在 12 个月内的平均体重增加为 4.76kg，健康对照者为 1.50kg（p=0.047）。6 个月和 12 个月时，患者超重和肥胖的综合发生率超过 50%，几乎是健康对照者的两倍。逻辑回归表明，前 6 个月的体重增加与男性性别和奥氮平或利培酮的处方显著相关。6 个月和/或 12 个月时肥胖的患者的平均血清甘油三酯和空腹血糖水平明显高于非肥胖患者。