以體重管理計畫介入之住院中精神分裂症患者的相關代謝指標之變化—兩年分析

研究目的：本研究起意於研究者任職之中部某療養院，自2006年12月起執行之醫療品質方案，內容為以復健病房患者為樣本，自2006年12月至2008年12月，執行為期兩年的體重管理計畫。其中包含認知行為介入（衛教及督促運動），飲食管理。本研究自體重管理計畫執行前，收集相關人口統計學資料，並於體重管理執行期間持續收集兩組身體質量指數、血壓及相關代謝指標（總膽固醇、三酸甘油脂及飯前血糖值）進行分析。並收集兩組個案使用抗精神病藥物種類之資料。旨在了解在持續兩年的體重管理方案介入後，個案的相關代謝指標變化趨勢有無改善。此研究的主要結果（Primary Oucome），為住院中之慢性精神分裂症患者，於為期兩年之體重管理方案下，身體質量指數的變化。次要結果( Secondary Outcome)為其在為期兩年體重管理後，其他相關代謝指標（血壓值、總膽固醇、三酸甘油脂及飯前血糖值）之變化。研究方法及資料：本研究以該療養院共計十五個復健病房的患者為樣本，符合美國精神病診斷與統計手冊第四版（DSM-IV）精神分裂症之診斷，且十八歲以上之個案。分為介入組（執行體重管理）與對照組（原有治療模式，無體重管理介入）。在描述性統計方面，年齡及住院天數視為連續變項，以球型檢定各變項均符合常態分佈，以ANOVA檢定兩組差異。性別及使用抗精神病藥物種類視為不連續變項，以卡方檢定（Chi-square test）檢定兩組差異。研究的主要結果為身體質量指數的變化，以混合模式（mixed model）檢定兩組之差異比較。次要結果則是其他代謝指標，如血壓、飯前血糖、三酸甘油脂及總膽固醇値的變化，亦以混合模式（mixed model）檢定兩組之差異。研究結果：兩組個案於主要結果（身體質量指數）及次要結果（血壓值、總膽固醇、三酸甘油脂及飯前血糖值）於介入後之變化趨勢兩組未達顯著差異。結論與建議：精神分裂症患者為代謝症候群及相關代謝症狀之高危險群。藥物的介入成效有限且各研究結論不一。非藥物的介入方式，如認知行為治療、運動或飲食衛教被部分研究證實能預防及改善精神分裂患者的代謝症狀。然本研究發現，較長時間的介入（持續兩年的體重管理），介入組和對照組在兩年間身體質量指數及其他代謝指標並無顯著差異。未來更嚴謹的實驗設計及相關干擾因子的分析及處理，應能讓研究者清楚了解非藥物方式介入的成效分析。

關鍵字

精神分裂症；代謝症候群；身體質量指數；體重管理

並列摘要

Objective：The objective of this study is to determine the effectiveness of a 2-year weight management program that incorporated cognitive behavioral intervention, exercise and diet control in hospitalized schizophrenic patients. Methods and Materials：434 hospitalized schizophrenic patients participated in a 2-year weight management program was followed in the 2 years. The control group consisted of 288 patients with similar baseline characteristics who did not receive the clinical program. Body Mass Index (BMI) and blood pressure were assessed at 5 time-points (every 6 months) over this study. In addition, other metabolic parameters such as fasting blood sugar, triglyceride level and total cholesterol level were assessed at 3 time-points (every 12 months) over this study as the secondary outcomes. Data were analyzed also by age, gender, hospitalization days and the kinds of antipsychotics. Demographic data was analyzed by descriptive statistics, Chi-square tests and ANOVA by SPSS for windows 18.0. The primary outcome and secondary outcomes were analyzed by general linear mixed-effects models (mixed models). Results：There was no significant difference in the change of BMI between the two group( p=.28). Even in the obesity cases( BMI≧27), there was no significant difference between the two groups( p=.06). No significant difference between the two group in other metabolic parameters such as blood pressure( p=.46 in systolic blood pressure and p=.40 in diastolic blood pressure), fasting blood sugar( p=.62), triglyceride level( p=.06) and total cholesterol level( p=.16). Conclusion and Suggestion：Metabolic syndrome is more prevalent among schizophrenic patients. Some studies suggested that weight management program might be effective in short-term weight loss and improving metabolic parameters in schizophrenic patients. However, our study concluded that no significant difference in the change of BMI and other metabolic parameters between the two groups during and after a 2-year weight management program. Although it could be contributed to the limitations and bias of the study, the effectiveness of long-term weight management program needs further evaluating and examining.

並列關鍵字

Schizophrenia ； Metabolic syndrome ； Body Mass Index ； Weight Management

參考文獻

Chuang, S. Y., Chen, C. H., & Chou, P. (2004). Prevalence of metabolic syndrome in a large health check-up population in Taiwan. J Chin Med Assoc, 67(12), 611-620.

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行政院衛生署國民健康局:. (2004). 代謝症候群定義及其臨床診斷準則.

Allison, D. B., & Casey, D. E. (2001). Antipsychotic-induced weight gain: a review of the literature. J Clin Psychiatry, 62 Suppl 7, 22-31.

Allison, D. B., Fontaine, K. R., Heo, M., Mentore, J. L., Cappelleri, J. C., Chandler, L. P., et al. (1999). The distribution of body mass index among individuals with and without schizophrenia. J Clin Psychiatry, 60(4), 215-220.

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以體重管理計畫介入之住院中精神分裂症患者的相關代謝指標之變化—兩年分析

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