Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.
Can J Psychiatry. 2012 Jan;57(1):34-44. doi: 10.1177/070674371205700107.
To compare the prevalence of metabolic syndrome (MetS) and its components in second-generation antipsychotic (SGA)-treated and SGA-naive children; and to explore the utility of clinical markers, such as waist circumference (WC) and body mass index (BMI), as screening tools for MetS.
Subjects were prospectively recruited from the Psychiatry Emergency Unit at British Columbia Children's Hospital. As part of a quality-assurance project, a metabolic monitoring protocol was implemented, including collection of anthropomorphic and laboratory data.
From January 2008 to February 2010, there were 117 SGA-treated and 217 SGA-naive children recruited. The overall prevalence of MetS was 19.0% (16/84; median treatment duration = 14 months) in SGA-treated and 0.8% (1/127) in SGA-naive children (OR 29.7; 95% CI 3.85 to 228.40, P < 0.001), with an increased prevalence of all components except high-density lipoprotein cholesterol (HDL-C), respectively: elevated WC (40.7% and 10.1%; P < 0.001); hypertriglyceridemia (33.7% and 18.8%; P = 0.01); impaired fasting glucose (12.5% and 0.7%; P = 0.005); and elevated blood pressure (41.2% and 16.5%; P < 0.001). SGA treatment was the strongest predictor of MetS (OR 19.2; 95% CI 2.30 to 160.44, P = 0.006) followed by male sex (OR 5.7; 95% CI 1.08 to 30.62, P = 0.04). Presence of abdominal obesity was more sensitive (92.9%) than BMI (68.8%), while fasting glucose of 5.6 mmol/L or more and HDL-C of 1.03 mmol/L or less were most specific (94.1%) in correctly identifying MetS.
SGA treatment confers a significantly increased risk for MetS over the long term. WC measurement is a simple and sensitive screening tool for determining MetS risk in SGA-treated children. These data highlight the dangers of SGA treatment and the importance of standardized metabolic monitoring using sex- and age-adjusted tables in this population.
比较第二代抗精神病药物（SGA）治疗和未治疗的儿童代谢综合征（MetS）及其成分的患病率，并探讨腰围（WC）和体重指数（BMI）等临床标志物作为 MetS 筛查工具的效用。
研究对象从不列颠哥伦比亚省儿童医院的精神病急诊室前瞻性招募。作为质量保证项目的一部分，实施了代谢监测方案，包括收集人体测量学和实验室数据。
2008 年 1 月至 2010 年 2 月，共招募了 117 名 SGA 治疗和 217 名 SGA 未治疗的儿童。SGA 治疗组的 MetS 总体患病率为 19.0%（16/84；中位治疗时间=14 个月），而 SGA 未治疗组为 0.8%（1/127）（OR 29.7；95%CI 3.85 至 228.40，P<0.001），除高密度脂蛋白胆固醇（HDL-C）外，所有成分的患病率均升高：WC 升高（40.7%和 10.1%；P<0.001）；高三酰甘油血症（33.7%和 18.8%；P=0.01）；空腹血糖受损（12.5%和 0.7%；P=0.005）；血压升高（41.2%和 16.5%；P<0.001）。SGA 治疗是 MetS 的最强预测因素（OR 19.2；95%CI 2.30 至 160.44，P=0.006），其次是男性（OR 5.7；95%CI 1.08 至 30.62，P=0.04）。腹部肥胖的存在比 BMI（92.9%比 68.8%）更敏感，而空腹血糖≥5.6mmol/L 和 HDL-C≤1.03mmol/L 对正确识别 MetS 最特异（94.1%）。
SGA 治疗长期显著增加 MetS 的风险。WC 测量是确定 SGA 治疗儿童 MetS 风险的一种简单而敏感的筛查工具。这些数据强调了 SGA 治疗的危害，以及在该人群中使用性别和年龄调整表进行标准化代谢监测的重要性。
