臺灣博碩士論文加值系統

目的：近幾年來關於非典型抗精神病藥物使用後產生代謝性症候群的研究愈來愈多，及有關於基因如Apo E polymorphism與脂質相關在代謝性疾患扮演重要的角色。精神分裂症患者在使用傳統及非典型抗精神病藥物治療卻並不一定會罹患代謝性疾患。因此希望能藉由這個研究來確實了解抗精神病藥物與代謝性症候群在精神分裂症者的關係，以評估非典型抗精神病藥物長期治療的患者罹患代謝性症候群的可能性，進一步探討精神分裂症的Apo E allele 基因型在代謝性症候群與使用抗精神病藥物之間的關連。
方法：本研究採單中心，無對照組，回溯性病歷回顧之臨床研究模式。本研究將收集約111個南部某區域教學醫院精神科病患，納入本研究的標準為診斷符合DSM-III-R 精神分裂症及情感性精神分裂症。病患基本資料透過病歷回顧與臨床評估收集，包括年齡、發病年齡、性別、身高、體重，血壓、空腹血糖、膽固醇，三酸甘油脂、同時萃取DNA進行Apo E基因多型性鑑定，收集使用的抗精神病藥物種類。統計以多變量迴歸分析方法及結構方程模式 (AMOS) 來分析做比較因果關係。
結果：多變量迴歸分析方法及結構方程模式 (AMOS) 顯示，在非典型抗精神病藥物與得高血壓有負向直接影響 (β=-.18, p =0.049)，同時與三酸甘油脂 (β=-.31, p<0.001) 及膽固醇 (β=-.21, p =0.026) 有負向直接影響，顯示非典型抗精神病藥物比較於傳統抗精神病藥物反而得高血壓及高血脂的情形較少。同時顯示非典型抗精神病藥物對身體質量指數 (BMI) 無直接影響而是間接的影響。
討論：本研究發現非典型抗精神病藥物比較於傳統抗精神病藥物反而得高血壓及高血脂的情形較少，尤其在三酸甘油脂的部份最明顯。另外非典型抗精神病藥物與身體質量指數並無直接的影響，而是經由三酸甘油脂及高血壓間接來影響身體質量指數。

Objective: The metabolic syndrome has been recognized as a side effect of antipsychotic treatment. ApoE polymorphism was associated with lipid metabolism in the metabolic syndrome. The study explored the relationship of schizophrenia and metabolic syndrome and predicted the prevalence about the risk of metabolic syndrome in the atypical antipsychotic treatment. Further, we explored the relationship between the ApoE genotypes and metabolic syndrome in schizophrenic patients.
Method: This is a retrospective and chart review study. Total of 111 Taiwanese patients met the DSM III-R criteria for schizophrenia and schizoaffective disorder. All individuals were collected the data of age, onset age, gender, height, weight, blood pressure, fasting glucose, triglyceride, cholesterol level, ApoE genotype and the type of antipsychotics. Logistic regression and structural equation modeling were used to identify the relationship of cause and effect.
Results: The logistic regression and structural equation modeling revealed that atypical antipsychotics negative directly influenced hypertension (β=-.18, p =0.049), triglyceride (β=-.31, p<0.001) and cholesterol (β=-.21, p =0.026) of plasma. The atypical antipsychotics compared with conventional antipsychotics individuals less hypertension and hyperlipidemia. In the study, the atypical antipsychotics showed indirect influence with the variable of body mass index.
Conclusion: Our findings showed atypical antipsychotics compared with conventional antipsychotics individuals decreases risk of hypertension and hyperlipidemia, especially predominant on triglyceride plasma level.
The atypical antipsychotic did not directly influenced body mass index (BMI), but indirectly influenced BMI by the variables of hypertension and triglyceride.

致謝 •••••••••••••••••••••••I
摘要 •••••••••••••••••••••••II
Abstract •••••••••••••••••••••••IV
目錄 •••••••••••••••••••••••VI
圖表目錄 •••••••••••••••••••••••VIII
第壹章 緒論 •••••••••••••••••••• 1
第壹節 研究動機及重要性 ••••••••• 1
第貳節 研究目的•••••••••••••• 2
第參節 名辭定義••••••••••••• 3
第貳章 文獻回顧•••••••••••••••••••8
第壹節 精神分裂症與代謝性症候群的關係 •••8
第貳節 Apolipoprotein E genotype的研究 ••11
第参節 抗精神病藥物與代謝性症候群關係的研究•13
第肆節 抗精神病藥物與體重增加、高血壓、糖尿病及
異常血脂的關係 •••••••••••15
第参章 研究方法 •••••••••••••••••• 22
第壹節 研究架構與假設 •••••••••••22
第貳節 研究對象 ••••••••••••••24
第参節 研究工具 ••••••••••••••25
第肆節 研究設計 ••••••••••••••30
第伍節 統計方法 ••••••••••••••31
第肆章 研究結果 •••••••••••••••••• 32
第壹節 研究對象之基本資料 •••••••••32
第貳節 邏輯對數迴歸(logistic regression)分析結
果••••••••••••••••• 40
第参節 結構方程模式分析結果 ••••••••42
第伍章 討論 •••••••••••••••••••• 44
第壹節 抗精神病藥物與高血壓的關係 •••••44
第貳節 抗精神病藥物與身體質量指數的關係 ••46
第参節 抗精神病藥物與血脂肪的關係 •••••48
第肆節 Apo E gene與抗精神病藥物及代謝性症候群的
關連 ••••••••••••••••50
第伍節 本研究之限制 ••••••••••••50
第陸章 結論與建議 ••••••••••••••••• 51
参考文獻 •••••••••••••••••••••••53
附錄一 人體試驗委員會會議紀錄••••••••••••64

中文資料
顏永杰 ( 民89 ) 阿滋海默病與Apo E4 基因之相關性。高雄醫學大學行為科學研究所碩士論文。

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