慢性精神病患者合併非酒精性脂肪肝病之代謝性危險因子

本文主要討論慢性精神病患者合併非酒精性脂肪肝病的代謝性危險因子。研究對象以長照機構慢性精神疾病患者為主，共190 人（年齡自26-86 歲，男性130 人，女性60 人），排除飲酒過量（酒精每天20公克以上）及臥床者，其中96.3%為精神分裂症患者。測量患者血壓、身體質量指數、肝功能、空腹血糖、總膽固醇、三酸甘油酯、B 型肝炎病毒表面抗原及C 型肝炎病毒抗體，以及腹部超音波檢查。本研究有141 位病患（74.1%）罹患非酒精性脂肪肝病（平均年齡49.2 歲）。多變數分析結果發現：女性（勝算比= 4.7, p=.023）、肥胖[身體質量指數＞27kg/m2]（勝算比=3.77, p=.023）及高三酸甘油酯血症[三酸甘油酯≧150 mg/dL]（勝算比=4.47, p =.041）與非酒精性脂肪肝病有統計上顯著的相關。本研究顯示慢性精神病患者為罹患非酒精性脂肪肝病的高危險群，其危險因子為女性、肥胖及高三酸甘油酯血症。如何就本族群針對非酒精性脂肪肝病進行早期篩檢及治療，是將來精神科醫師與內科醫師在臨床照護及研究的重要課題。

The aim of our study was to assess the metabolic risk factors of nonalcoholic fatty liver disease (NAFLD) in chronic psychotic patients. A total of 190 institutionalized patients (aged 26 to 86 years, 130 males and 60 females) with chronic psychotic disorders were enrolled. Participants with excessive alcohol intake (>20 g/day) or with bedridden state were excluded. Ninety-six percent of subjects were diagnosed with schizophrenia or schizoaffective disorder. All subjects received examinations as follows: blood pressure, body mass index(BMI) , blood biochemistry study, including liver function test, fasting plasma glucose, total cholesterol and triglyceride (TG), hepatitis B virus surface antigen, hepatitis C virus antibody and abdominal ultrasonography. All of 141 subjects (74.1%) were diagnosed with NAFLD (mean age 49.2 years). Multivariate analysis revealed that female (odds ratio [OR]＝4.7, p＝.023), obesity [BMI ＞27 kg/m2](OR＝3.8, p＝.023) and hypertriglyceridemia [plasma TG ≧150mg/dL] (OR＝4.9, p＝.041) were independently associated with NAFLD. In conclusion, NAFLD was common among patients with chronic psychotic patients. The risk factors of NAFLD were female gender, obesity and hypertriglyceridemia. How to carry out early screening and treatment of NAFLD in chronic psychotic patients is an important issue for psychiatrists and internists in the future.