臺灣博碩士論文加值系統

目的
了解精神分裂症或情感性精神分裂症之病人valproic acid和代謝異常之間的相關性。同時也進一步想了解合併使用二代抗精神病藥物與valproic acid和單獨只使用二代抗精神病藥物的病人的代謝異常是否有所不同。
方法
本研究為為橫斷性研究，以嘉南療養院日間及慢性病房住院，經精神科專科醫師依據DSM-IV診斷為精神分裂症或情感性精神分裂症之病人為研究對象，收集民國99年七月時住院病人病歷資料，以AHA/NHLBI modified ATP III for Asia之標準做代謝症候群之診斷。以描述性統計方式進行人口學基本資料與血液生化檢查值（血糖、膽固醇、高密度脂蛋白、低密度脂蛋白、三酸甘油脂）統計。以卡方檢定與多項式羅吉斯迴歸分析進行分析抗精神病藥物種類、valproic acid與有無代謝症候群及是否有代謝症候群中各項異常之關係。
結果
共收案323人。該院日間病房與復健病房病人代謝症候群盛行率35.3%。相較於男性病人，女性罹患代謝症候群的勝算比是1.77(95% C.I.1.09-2.87)，腰圍異常的勝算比是3.03(95% C.I. 1.85-4.95)，HDL異常的勝算比是2.83(95% C.I. 1.71-4.69)。相較於未符valproic acid的病人，服用valproic acid罹患代謝症候群的勝算比是2.20 (95% C.I. 1.04-4.69)，腰圍異常的勝算比2.27 (95% C.I. 1.02-5.02)。相較於30歲以前，30歲之後罹患代謝症候群的勝算比為3-4。其中31-40歲為4.46 (95% C.I. 1.05-10.76)，41-50歲為3.35 (95% C.I. 1.38- 8.16)，51歲以後為4.43 (95% C.I. 1.72-11.42)。是否服用olanzapine 或clozapine 不論是在罹患代謝症候群或代謝症候群組成因子異常沒有統計上差異。
結論
在本研究中，女性病人比男性病人易罹患代謝症候群、腰圍異常與HDL異常。年紀超過30歲的病人，罹患代謝症候群的風險升高為3-4倍。服用valproic acid和代謝症候群及腰圍異常有統計上顯著相關。是否服用clozapine 或olanzapine和是否罹患代謝症候群及代謝症候群的組成因子是否異常沒有統計上顯著差異。
關鍵詞: valproic acid、精神分裂症、代謝症候群、抗精神病藥物

Objectives:
This study wants to understand the association between valproic acid and metabolic abnormality in schizophrenic or schizophrenic patients. Besides, we also try to analyse the interactional effect of valproic acid and atypical antipsychotics on metabolic abnormality.
Methods:
This is a hospital-based, cross-sectional study. The study collects the data of schizophrenic or schizoaffective inpatients in rehabilitation or day ward on July of 2010. We use AHA/NHLBI modified ATP III criteria to make the diagnosis of metabolic syndrome. The analysis method of demographic, anthropometric and metabolic parameter is descriptive analysis. Chi-square test and multiple logistic regression are used to test the association of antipsychotics, valproic acid and metabolic syndrome or its individual components.
Results:
There are 323 patients enrolled in this study. The overall prevalence of metabolic syndrome is 35.3%. Female have significant higher risk of metabolic syndrome, waist abnormality and HDL abnormality then male. The odds ratio is 1.77 (95% C.I. 1.09-2.87), 3.03 (95% C.I. 1.85-4.95) and 2.83 (95% C.I. 1.71-4.69) respectively. Patients who takes valproic acid have higher risk of metabolic syndrome and waist abnormality. The odds ratio is 2.20 (95% C.I. 1.04-4.69) and 2.27 (95% C.I. 1.02-5.02). Compared to the patient under 30 years old, the odds ratio of metabolic syndrome in 31-40, 41-50 and over 50 year-old patients are 4.46 (95% C.I. 1.05-10.76), 3.35 (95% C.I. 1.38- 8.16) and 4.43 (95% C.I. 1.72-11.42) respectively. No significant difference in metabolic syndrome and its individual components whether the patients take olanzapine or clozapine or not.
Conclusions:
Female have significant higher risk of metabolic syndrome, waist abnormality and HDL abnormality then male. Valproic acid is associated with metabolic syndrome and waist abnormality. Older patients may have higher risk of metabolic syndrome.
Key words: valproic acid, schizophrenia, metabolic syndrome, antipsychotics

論文審定同意書
誌謝
中文摘要 i
Abstract iii
目 錄 v
表 目 錄 vii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 精神分裂症與代謝症候群 3
第二節 Valproic acid與代謝異常 15
第三章 研究方法 18
第一節 研究架構 18
第二節 研究問題 19
第三節 名詞界定 19
第四節 研究設計 22
第五節 研究對象 22
第六節 研究資料收集過程 22
第七節 統計分析 22
第四章 研究結果 24
第一節 精神分裂症或情感性精神分裂症病人代謝異常之盛行情形 24
第二節 精神分裂症或情感性精神分裂症病人抗精神病藥物與valproic acid使用情形 26
第三節 精神分裂症或情感性精神分裂症病人代謝異常相關危險因子 31
第五章 討論 48
第六章 結論與建議 50
第一節 結論 50
第二節 建議 50
第三節 研究限制 50
參考文獻 52

Table 1. ATP III、IDF、Modified ATP III及國民健康局代謝症候群定義 7
Table 2. Demographic and clinical characteristics data of enrolled patients 25
Table 3. Prevalence of metabolic syndrome and individual components of metabolic syndrome 25
Table 4. Demographic data of enrolled patients taking valproic acid (VPA) or not 26
Table 5. Demographic data of enrolled patients taking clozapine or olanzapine 27
Table 6. Anthropometric measurements and biochemical data by olanzapine or clozapine combined with valproic acid or not 28
Table 7. Waist abnormality by olanzapine or clozapine and valproic acid 29
Table 8. Individual criteria of MetS and MetS by olanzapine or clozapine and vlaproic acid 30
Table 9. Difference of age, onset of age, ill duration by metabolic syndrome 31
Table 10. Enrolled subjects characteristics by metabolic syndrome 32
Table 11. Difference of age, onset of age, ill duration by waist criteria 33
Table 12. Enrolled subjects characteristics by waist criteria 34
Table 13. Difference of age, onset of age, ill duration by BP criteria 35
Table 14 Enrolled subjects characteristics by BP criteria 36
Table 15. Difference of age, onset of age, ill duration by Glucose criteria 37
Table 16. Enrolled subjects characteristics by Glucose criteria 38
Table 17. Difference of age, onset of age, ill duration by HDL criteria 39
Table 18. Enrolled subjects characteristics by HDL criteria 40
Table 19. Difference of age, onset of age, ill duration by TG criteria 41
Table 20. Enrolled subjects characteristics by TG criteria 42

Table 21. Mean difference of age, onset of age, ill duration in individual criteria of MetS and MetS 43
Table 22 . Categorical difference in met individual criteria of MetS and MetS 44
Table 23. Logistic regression model of metabolic syndrome 45
Table 24. Logistic regression model of component criteria of metabolic syndrome 47

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