Ventriglio Antonio, Baldessarini Ross J, Vitrani Giovanna, Bonfitto Iris, Cecere Angela Chiara, Rinaldi Angelo, Petito Annamaria, Bellomo Antonello
Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
International Consortium for Psychotic & Mood Disorder Research, McLean Hospital, Belmont, MA, United States.
Front Psychiatry. 2019 Jan 16;9:744. doi: 10.3389/fpsyt.2018.00744. eCollection 2018.
Severe mental illnesses are associated with increased risks for metabolic syndrome (MetS) and other medical disorders, often with unfavorable outcomes. MetS may be more likely with schizoaffective disorder (SzAff) than schizophrenia (Sz). MetS is associated with long-term antipsychotic drug treatment, but relative risk with orally administered vs. long-acting injected (LAI) antipsychotics is uncertain. Subjects ( = 151 with a DSM-IV-TR chronic psychotic disorder: 89 Sz, 62 SzAff), treated with oral or LAI antipsychotics were compared for risk of MetS, initially with bivariate comparisons and then by multivariate regression modeling. Aside from measures on which diagnosis of MetS is based, factors preliminarily associated with MetS included antipsychotic drug dose, "high-risk" antipsychotics associated with weight-gain, older age and female sex. Defining factors associated with diagnosis of MetS ranked in multivariate regression as: higher fasting glucose, lower LDL cholesterol, higher diastolic blood pressure, and higher BMI. Risk of MetS with antipsychotics ranked: quetiapine ≥ clozapine ≥ paliperidone ≥ olanzapine ≥ risperidone ≥ haloperidol ≥ aripiprazole. Other associated risk factors in multivariate modeling ranked: higher antipsychotic dose, older age, and SzAff diagnosis, but not oral vs. LAI antipsychotics SzAff diagnosis and higher antipsychotic doses were associated with MetS, whereas orally vs. injected antipsychotics did not differ in risk of MetS.
严重精神疾病与代谢综合征（MetS）及其他医学病症的风险增加相关，且往往预后不佳。相较于精神分裂症（Sz），精神分裂症伴情感障碍（SzAff）可能更易出现MetS。MetS与长期抗精神病药物治疗有关，但口服抗精神病药物与长效注射（LAI）抗精神病药物相比的相对风险尚不确定。对151名患有DSM-IV-TR慢性精神障碍的受试者（89例Sz，62例SzAff）进行了比较，这些受试者接受了口服或LAI抗精神病药物治疗，比较其患MetS的风险，最初进行双变量比较，然后通过多变量回归建模进行分析。除了MetS诊断所依据的指标外，与MetS初步相关的因素包括抗精神病药物剂量、与体重增加相关的“高风险”抗精神病药物、年龄较大和女性。在多变量回归中，与MetS诊断相关的因素排序为：空腹血糖较高、低密度脂蛋白胆固醇较低、舒张压较高和体重指数（BMI）较高。抗精神病药物导致MetS的风险排序为：喹硫平≥氯氮平≥帕利哌酮≥奥氮平≥利培酮≥氟哌啶醇≥阿立哌唑。多变量建模中的其他相关风险因素排序为：抗精神病药物剂量较高、年龄较大和SzAff诊断，但口服与LAI抗精神病药物无关。SzAff诊断和较高的抗精神病药物剂量与MetS相关，而口服与注射抗精神病药物在患MetS的风险上没有差异。
