广州市流浪精神分裂症患者暴力风险与血脂水平的相关性研究

作者:未知

  [摘要]目的 研究廣州市流浪精神分裂症患者暴力风险与血脂水平的相关性。方法 选取2018年4~9月白云精神病康复医院、广州市民政局精神病院收治的180例符合《美国精神疾病诊断与统计手册第五版》(DSM-V)诊断标准的急性期未用药的流浪精神分裂症患者作为研究组,另选取同期招募的180名健康志愿者作为对照组。比较两组的血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)和极低密度脂蛋白(VLDL)水平;采用阳性阴性症状量表(PANSS)、暴力风险评定量表(DASA)分析暴力风险与血脂水平的关系。结果 研究组的TC、HDL、LDL水平均低于对照组,差异有统计学意义(P<0.05);两组的TG、VLDL水平比较,差异无统计学意义(P>0.05)。TC、LDL水平与DASA评分均成负相关(r=-0.299、-0.262,P<0.05)。结论 新入院的精神分裂症急性期患者需要及时检测TC、HDL、LDL,但对降低以上三个指标的治疗方案应该谨慎使用,为暴力风险评估提供了三个生物学参考指标。
  [关键词]胆固醇;高密度脂蛋白;低密度脂蛋白;极低密度脂蛋白;暴力风险;流浪精神分裂症患者
  [中图分类号] R589.2 [文献标识码] A [文章编号] 1674-4721(2019)5(c)-0097-04
  Correlation study between violent risk and blood lipid levels in vagrant schizophrenia patients in Guangzhou
  HE Yong1 ZHANG Xiao-chun1 FANG Min1 GAO Yun2
  1. Department of Psychiatry, Baiyun Jingkang Hospital, Guangdong Province, Guangzhou 510000, China; 2. Department of Rehabilitation Science and Education, Guangzhou Civil Affairs Bureau Mental Hospital, Guangdong Province, Guangzhou 510430, China
  [Abstract] Objective To study the correlation between violent risk and blood lipid levels in vagrant schizophrenia patients in Guangzhou. Methods A total of 180 patients with acute vaginal schizophrenia patients, who were not treated with drugs and conformed to the diagnostic criteria of American Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V), admitted to the Baiyun Jingkang Hospital and Guangzhou Civil Affairs Bureau Mental Hospital from April to September 2018 were selected as the study group, and another 180 healthy volunteers during the same period were selected as the control group. The levels of serum total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) were compared between the two groups. The positive and negative symptom scale (PANSS) and the dynamic appraisal of situational aggression (DASA) were used to analyze the relationship between violent risks and blood lipid levels. Results The levels of TC, HDL and LDL in the study group were lower than those in the control group, and the differences were statistically significant (P<0.05). There were no significant differences in levels of TG and VLDL between the two groups (P>0.05). The levels of TC and LDL were negatively correlated with DASA scores (r=-0.299, -0.262, P<0.05). Conclusion Patients with schizophrenia in the acute phase need to be tested for TC, HDL, and LDL in a timely manner, but treatment options that reduce the above three indicators should be used with caution, which provide three biological reference indicators for violent risk assessment.   [Key words] Cholesterol; High density lipoprotein; Low density lipoprotein; Very low density lipoprotein; Violent risk; Vagrant schizophrenia patients
  流浪精神分裂症患者带来新的社会问题[1],具有潜在的暴力风险[2]。由于某些刺激可能突然出现情绪失控,结果往往是不寻常的悲剧性事件,精神病学专家不断提高暴力风险预测的准确性,及时进行有效干预[3]。生物因素与暴力风险有关,但几乎未被用于风险评估。近期有文献报道,暴力风险与患者外周血中高密度脂蛋白(high density lipoprotein,HDL)[4]、总胆固醇(total cholesterol,TC)[5]的浓度有关。近来有国外报导检测分析生物学指标[6]和患者潜在暴力风险的关系[7]。本研究旨在进一步探讨流浪精神分裂症患者暴力冲动风险和TC、HDL、三酰甘油(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、极低密度脂蛋白(very low density lipoprotein,VLDL)之间的关系,现报道如下。
  1资料与方法
  1.1一般资料
  采用临床顺序入组方法,选取2018年4~9月白云精神病康复医院、广州市民政局精神病院收治的250例新入院的流浪精神分裂症患者作为研究对象。纳入标准:①符合《美国精神疾病诊断与统计手册第五版》(American Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition,DSM-V)關于精神分裂症的诊断标准;②年龄18~59岁。排除标准:①合并其他重型精神病者;②严重躯体疾病者;③严重神经系统疾病等。本研究为入院常规检查,未额外进行检查,本研究通过医院医学伦理学委员会审核,研究对象本人同意进行本项研究并签署知情同意书。筛查250例新入院的流浪精神分裂症患者,根据纳入及排除标准剔除其他精神病、脑卒中、严重躯体疾病、未签署知情同意书等70例,将最终纳入研究的180例急性期未用药的流浪精神分裂症患者作为研究组。另选取同期招募的180名健康志愿者(年龄、性别等均相匹配)作为对照组。研究组中,年龄18~60岁,平均(37.52±9.12)岁;女90例[年龄20~59岁,平均(37.83±8.63)岁],男90例[年龄18~59岁,平均(35.52±8.79)岁];体重指数16~29 kg/m2,平均(20.12±2.60)kg/m2;未婚53例,已婚109例,离婚12例,丧偶6例;城市15例,农村54例,郊区111例。对照组中,年龄18~60岁,平均(36.54±8.67)岁;女90名[年龄20~59岁,平均(38.01±7.92)岁],男90名[年龄18~59岁,平均(34.73±7.41)岁];体重指数17~31 kg/m2,平均(21.33±2.50)kg/m2;未婚60例,已婚102例,离婚13例,丧偶5例;城市18例,农村54例,郊区108例。两组的年龄、性别、体重指数、婚姻状况、居住地等一般资料比较,差异无统计学意义(P>0.05),具有可比性。
  1.2方法
  禁食12 h后,在早餐前6:00~7:00时,护士分别对两组进行常规血样检查(测量TC、TG、HDL、LDL、VLDL)。研究人员填写精神病理学阳性与阴性症状量表(positive and negative symptom scale,PANSS)、暴力风险评估量表(dynamic appraisal of situational aggression,DASA)。
  1.3观察指标及评价标准
  比较两组的TC、TG、HDL、LDL和VLDL水平;采用阳性阴性症状量表(PANSS)、暴力风险评定量表(DASA)分析暴力风险与血脂水平的关系。
  1.3.1自编一般情况调查表 该调查表包括年龄、性别、体重指数、婚姻状况、居住地等一般信息。
  1.3.2 PANSS 该量表由7个条目的阳性症状量表、7个条目的阴性症状量表、16个条目的一般精神病理学症状量表组成。每个条目均有评定定义,按照7级评分,从1(无症状)到7(极重度),按照症状严重程度排序。
  1.3.3 DASA 该量表采用0~7级共8级评分对患者的冲动性、攻击性进行量化,评分0分,表示暴力风险非常低;评分>0~3分,表示暴力风险中等,应该采取适度和预防措施;评分>3~6分,表示暴力风险高,应该采取更多措施;评分>6分,表示暴力风险极高,需要采取预防措施[8-9]。
  1.4统计学方法
  采用SPSS 18.0统计学软件进行数据分析,计量资料用均数±标准差(x±s)表示,两组间比较采用t检验;计数资料采用率表示,组间比较采用χ2检验;相关性分析采用Pearson检验,以P<0.05为差异有统计学意义。
  2结果
  2.1两组TC、TG、HDL、LDL、VLDL水平的比较
  研究组的TC、HDL、LDL水平均低于对照组,差异有统计学意义(P<0.05);两组的TG、VLDL水平比较,差异无统计学意义(P>0.05)(表1)。
  2.2 TC、TG、HDL、LDL、VLDL与PANSS及DASA的相关性分析
  TC、LDL水平与DASA评分均成负相关(r=-0.299、-0.262,P<0.05)(表2)。
  3讨论
  多巴胺、5-羟色胺和其他神经递质涉及暴力行为[10],但是,低水平的TC[11]、TG、HDL[12]、LDL、VLDL与暴力之间的可能相关机制尚不明确[13],可能的生物学机制假说是中枢神经系统(central nervous system)的低TC水平[14-15]可能通过含TC的细胞膜降低多巴胺运输水平。这可能导致中枢神经系统中的5-羟色胺水平低[16],并且从前额叶皮质到脑部边缘结构的控制不足,导致暴力行为的风险增加[17]。   本研究中新收入院未服藥状态的流浪精神分裂症患者,排除抗精神病药物额外产生对生物学指标TC、TG、HDL、LDL、VLDL水平的影响。过去,大部分国内研究评估精神分裂症患者的TC、HDL、LDL水平,旨在探索代谢综合征[18],缺乏TC、HDL、LDL与暴力风险之间关系的研究。本研究结果显示,研究组的TC、HDL、LDL水平均低于对照组,差异有统计学意义(P<0.05);两组的TG、VLDL水平比较,差异无统计学意义(P>0.05);TC、LDL水平与DASA评分均成负相关(r=-0.299、-0.262,P<0.05)。提示暴力风险与TC、LDL的水平成反比,TC和LDL降低均可能导致暴力风险增加。急性期未服药状态的流浪精神分裂症患者的TC、HDL、LDL水平较低,其中TC和LDL水平与DASA暴力风险评估结果成负相关。精神分裂症患者体内的TC、HDL、LDL水平降低,可能影响5-羟色胺系统[19-20],进而提高暴力风险[21-22]。
  综上所述,广州市流浪精神分裂症患者急性期需及时检测TC、HDL、LDL水平,对采用降低TC、HDL、LDL水平治疗方案的应特别谨慎使用。本研究提出暴力风险评估量表中加入生化指标的看法,但研究也存在不足之处,数据来源于流浪精神分裂症患者入院时,横断面的分析,缺乏流浪精神分裂症患者在院外流浪未服药长时间纵轴的跟踪研究,因此研究结果有一定的局限性。笔者今后将更周密地设计实验,对本次研究得出的结果进行更深入的探讨。
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  (收稿日期:2018-10-08 本文编辑:任秀兰)
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