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研究生:孔繁錦
研究生(外文):Fan-chin Kung
論文名稱:精神分裂症患者戒菸過程對其心臟神經功能調控之影響
論文名稱(外文):The Effects of Smoking Cessation on Cardiac Neural Regulation in Patients with Schizophrenia
指導教授:郭博昭郭博昭引用關係
學位類別:碩士
校院名稱:慈濟大學
系所名稱:神經科學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:53
中文關鍵詞:頻譜分析心率變異性精神分裂症戒菸心臟病猝死心臟神經弁鉠梇�尼古丁依賴
外文關鍵詞:spectral analysisschizophreniasmoking cessationcardiogenic sudden deathcardiac neural regulationnicotine dependenceheart rate variability
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精神分裂症被形容為一種「短命疾病」。患者的平均預期壽命比
一般民眾短少約十至十五年。除較高之自殺率以及意外事件發生率
外,精神分裂症患者有著較不足的心臟神經功能調控以及較高的心臟
病猝死率,其原因可能包括疾病本身的病理機轉,藥物的副作用,或
是共病疾患如焦慮症、憂鬱症、代謝異常症候群、尼古丁依賴等所引
致。大部分的精神分裂症患者都有吸菸的習慣,比率高達百分之七十
至八十,一般大眾吸菸比率則約為百分之二十五。精神分裂症患者猝
死率比一般大眾高三倍,因心臟血管疾病死亡的比率比一般大眾高二
倍,由於吸菸者有著更高心臟病猝死的風險,因此首先探究精神分裂
症患者吸菸因子是否對心臟神經功能調控有明顯影響,將是一合理的
做法。
心臟神經功能失調極可能是引發心臟病猝死之主要共同路徑,它
可以藉由心率變異性之頻譜分析方便地篩檢出來,並且持續監測。本
研究之目的,即為藉由心率變異性之頻譜分析,探討一群成年男性精
神分裂症患者吸菸以及戒菸過程對其心臟神經功能調控之影響。我們
徵集了35 位成年精神分裂症患者(全為男性,17 位習慣吸菸,18
位不吸菸),均不具有糖尿病神經病變、心律不整或其他心臟血管疾
II
病的病史,不具有焦慮症、憂鬱症、代謝異常症候群等共病疾患,不
曾服用clozapine、olanzapine、ziprasidone 等抗精神病藥物或其
他心臟內科藥物,且表現出彼此相當之精神病症狀嚴重度。實驗過程
中,分別以實驗前、實驗第一天、第三天、第七天、第十四天、第二
十一天、第二十八天為測試日。在測試日當天白天某時刻,每位受試
者平躺休息至少五分鐘,張開雙眼,正常呼吸,然後接受五分鐘第一
導程心電圖測量,隨後心率變異性頻譜分析即以一自動化「心率變異
性分析儀」完成。
結果顯示,習慣吸菸的精神分裂症患者,相對於不吸菸的患者而
言,呈現更嚴重的心臟神經功能失調,包括整體自主神經功能活性降
低,交感神經功能活性小幅增加以及副交感神經功能活性減弱等,且
此異常將可於戒菸後獲得部分恢復。本研究之結果所支持之假說為:
「心臟神經功能失調是習慣吸菸之精神分裂症患者的一個特徵,而戒
菸可矯正其部份心臟電生理功能上之毒性作用。」由此假說可知,更
強烈地勸告精神分裂症患者戒菸將是臨床上合宜的做法。
Schizophrenia has been described as a “life shortening
illness”, which reduces patients’ life expectancy by ten to fifteen
years. Besides having the higher suicide rate and accident rate,
patients with schizophrenia are with attenuated function of
cardiac neural regulation and higher sudden cardiogenic death
rate. The reason could be the pathological mechanism of the
illness itself, the side effects of the medications, or the other
comorbid conditions such as anxiety disorder, depressive
disorder, metabolic syndrome, or nicotine dependence. Most of
the schizophrenic patients are habitual cigarette smokers, and
the smoking rate of schizophrenic patients is as high as seventy
to eighty percents, comparing the rate twenty-five percents in
general population. Sudden death rate of schizophrenic patients
is three times higher and cardiovascular death rate is two-times
higher than general population. Since the smokers are at even
higher risk for sudden cardiogenic death, it is reasonable to firstly
investigate the effects of the factor of cigarette smoking on
cardiac neural regulation in patients with schizophrenia.
The mainly common pathway of sudden cardiogenic death is
cardiac neural dysregulation, which could be conveniently
screened and monitored by heart rate variability spectral analysis.
The objective of this study was to examine the effects of cigarette
smoking and smoking cessation on cardiac neural regulation in a
group of male adult schizophrenic patients. We recruited 35 adult
schizophrenic patients (all are male, 17 habitual cigarette
smokers and 18 non-smokers) who were clinically diagnosed
without history of diabetic neuropathy, cardiac arrhythmia, or
other cardiovascular diseases, without anxiety disorder,
depressive disorder, or metabolic syndrome, without prescription
of antipsychotics such as clozapine, olanzapine, or ziprasidone or
other cardiovascular drugs, and showed equivalent symptom
severity. The experiments were performed on Day 0 (before
smoking cessation, as the baseline), Day 1 (the first day of
smoking cessation), Day 3, Day 7, Day 14, Day 21, and Day 28.
In the daytime of the experimental day, after lying for at least five
minutes, each patient received a 5-minute lead I ECG recording
in the quiet supine position, with his eyes open and breathes
normal. The heart rate variability (HRV) power spectrum analyses
were performed using an automatic HRV analyzer (SSIC, Enjoy
Research Inc., Taiwan).
The results suggested that the habitually-smoking
schizophrenic patients, as compared to the nonsmoking patients,
manifested further cardiac neural dysregulation, including
decreased total autonomic function activity, slightly increased
sympathetic outflow and impaired parasympathetic function
activity which could be somewhat reversed by smoking cessation.
The results supported the hypothesis that cardiac neural
patients, and smoking cessation could reverse part of the noxious
effects. Derived from this hypothesis is that an even stronger
advise for schizophrenic patients to quit smoking may be clinically
appropriate.
中文摘要................................................. I
英文摘要............................................... III
研究背景................................................. 1
一、 精神分裂症之生理議題
1. 精神分裂症患者之預期壽命.............................. 1
2. 精神分裂症患者之心臟疾病致病因子...................... 1
3. 精神分裂症患者之吸菸問題.............................. 2
二、 吸菸之生理議題
1. 吸菸之生理與病理作用.................................. 3
2. 吸菸對人體心臟功能之影響.............................. 4
3. 吸菸與心率變異性...................................... 4
三、 心率變異性之生理議題
1. 心率變異性與自主神經功能活性.......................... 5
2. 心率變異性頻譜分析測量值之相對生理意義................ 9
3. 心率變異性頻譜分析與心臟疾病之關係................... 10
VII
研究動機與目的
一、研究動機
1. 精神分裂症患者應享有同等之醫療照護與衛教新知......... 12
2. 打破「對精神病患無法推展菸害防制」的迷思............. 12
二、研究目的............................................... 13
三、本研究之重要性
1.「菸草戰爭」永無止息.................................. 14
2. 本實驗所能提供的重大訊息............................. 15
研究材料與方法
一、研究對象............................................... 15
二、實驗儀器............................................... 15
三、實驗步驟............................................... 17
四、心電圖記錄............................................. 18
五、頻譜分析
1.心電圖訊號之處理..................................... 19
2.心率變異性頻譜分析................................... 20
六、統計分析............................................... 20
VIII
研究結果
一、各組基本資料分析....................................... 21
二、原始實驗資料........................................... 22
三、統計結果............................................... 23
討論
一、吸菸與不吸菸之精神分裂症成年男性患者自主神經功能調控之差
異..................................................... 25
二、戒菸前後對於習慣吸菸之精神分裂症成年男性患者自主神經功能
調控之影響............................................. 26
三、本論文之限制與檢討..................................... 27
結論......................................................... 30
建議......................................................... 30
附表......................................................... 31
附圖......................................................... 33
參考文獻..................................................... 35
附錄......................................................... 39
附件......................................................... 45
Akselrod, S., Gordon, D., Ubel, F. A., Shannon, D. C., Berger, A. C.
and Cohen, R. J., 1981. Power spectrum analysis of heart rate
fluctuation: a quantitative probe of beat-to-beat cardiovascular
control. Science. 213, 220-222.
Allebeck, P., 1989. Schizophrenia: a life-shortening disease.
Schizophr Bull. 15, 81-89.
Bar, K. J., Letzsch, A., Jochum, T., Wagner, G., Greiner, W. and Sauer,
H., 2005. Loss of efferent vagal activity in acute schizophrenia. J
Psychiatr Res. 39, 519-527.
Barutcu, I., Esen, A. M., Kaya, D., Turkmen, M., Karakaya, O., Melek,
M., Esen, O. B. and Basaran, Y., 2005. Cigarette smoking and
heart rate variability: dynamic influence of parasympathetic and
sympathetic maneuvers. Ann Noninvasive Electrocardiol. 10,
324-329.
Bayer, R. and Stuber, J., 2006. Tobacco control, stigma, and public
health: rethinking the relations. Am J Public Health. 96, 47-50.
Binkley, P. F., Nunziata, E., Haas, G. J., Nelson, S. D. and Cody, R. J.,
1991. Parasympathetic withdrawal is an integral component of
autonomic imbalance in congestive heart failure: demonstration
in human subjects and verification in a paced canine model of
ventricular failure. J Am Coll Cardiol. 18, 464-472.
Bromet, E. J. and Fennig, S., 1999. Epidemiology and natural history
of schizophrenia. Biol Psychiatry. 46, 871-881.
Chute, D., Grove, C., Rajasekhara, B. and Smialek, J. E., 1999.
Schizophrenia and sudden death: a medical examiner case
study. Am J Forensic Med Pathol. 20, 131-135.
Collishaw, N. E., 2004. Global tobacco control must become a top
public health priority. Int J Tuberc Lung Dis. 8, p1159.
Davidson, M., 2002. Risk of cardiovascular disease and sudden death
in schizophrenia. J Clin Psychiatry. 63 Suppl 9, 5-11.
De Hert, M., van Winkel, R., Van Eyck, D., Hanssens, L., Wampers,
M., Scheen, A. and Peuskens, J., 2006. Prevalence of the
diabetes, metabolic syndrome and metabolic abnormalities in
schizophrenia over the course of the illness: a cross-sectional
study. Clin Pract Epidemol Ment Health. 2, 14.
36
Dixon, L., Weiden, P., Delahanty, J., Goldberg, R., Postrado, L.,
Lucksted, A. and Lehman, A., 2000. Prevalence and correlates
of diabetes in national schizophrenia samples. Schizophr Bull.
26, 903-912.
Eryonucu, B., Bilge, M., Guler, N., Uzun, K. and Gencer, M., 2000.
Effects of cigarette smoking on the circadian rhythm of heart
rate variability. Acta Cardiol. 55, 301-305.
Ewing, D. J., Martyn, C. N., Young, R. J. and Clarke, B. F., 1985. The
value of cardiovascular autonomic function tests: 10 years
experience in diabetes. Diabetes Care. 8, 491-498.
Goff, D. C., Cather, C., Evins, A. E., Henderson, D. C., Freudenreich,
O., Copeland, P. M., Bierer, M., Duckworth, K. and Sacks, F. M.,
2005. Medical morbidity and mortality in schizophrenia:
guidelines for psychiatrists. J Clin Psychiatry. 66, 183-194
Hautecouverture, S., Limosin, F. and Rouillon, F., 2006. [Epidemiology
of schizophrenic disorders]. Presse Med. 35, 461-468.
Hayano, J., Yamada, M., Sakakibara, Y., Fujinami, T., Yokoyama, K.,
Watanabe, Y. and Takata, K., 1990. Short- and long-term effects
of cigarette smoking on heart rate variability. Am J Cardiol. 65,
84-88.
Holt, R. I., Peveler, R. C. and Byrne, C. D., 2004. Schizophrenia, the
metabolic syndrome and diabetes. Diabet Med. 21, 515-523.
Hon, E. H. and Lee, S. T., 1963. Electronic Evaluation Of The Fetal
Heart Rate. Viii. Patterns Preceding Fetal Death, Further
Observations. Am J Obstet Gynecol. 87, 814-826.
Jablensky, A., 2000. Epidemiology of schizophrenia: the global burden
of disease and disability. Eur Arch Psychiatry Clin Neurosci. 250,
274-285.
Kuo, T. B. J., Lin, T., Yang, C. C. H., Li, C. L., Chen, C. F. and Chou, P.,
1999. Effect of aging on gender differences in neural control of
heart rate. Am J Physiol. 277, H2233-H2239.
Kuo, T. B. J., Yang, C. C. H., 2004. Scatterplot analysis of EEG
slow-wave magnitude and heart rate variability: an integrative
exploration of cerebral cortical and autonomic functions. Sleep.
15;27(4), 648-656.
Lambert, T. J., Velakoulis, D. and Pantelis, C., 2003. Medical
comorbidity in schizophrenia. Med J Aust. 178 Suppl, S67-70.
37
Langewitz, W., Ruddel, H. and Schachinger, H., 1994. Reduced
parasympathetic cardiac control in patients with hypertension at
rest and under mental stress. Am Heart J. 127, 122-128.
Marder, S. R., Essock, S. M., Miller, A. L., Buchanan, R. W., Casey, D.
E., Davis, J. M., Kane, J. M., Lieberman, J. A., Schooler, N. R.,
Covell, N., Stroup, S., Weissman, E. M., Wirshing, D. A., Hall, C.
S., Pogach, L., Pi-Sunyer, X., Bigger, J. T., Jr., Friedman, A.,
Kleinberg, D., Yevich, S. J., Davis, B. and Shon, S., 2004.
Physical health monitoring of patients with schizophrenia. Am J
Psychiatry. 161, 1334-1349.
McDonald, C., 2000. Cigarette smoking in patients with schizophrenia.
Br J Psychiatry. 176, 596-597.
MMWR. 2005. Annual smoking-attributable mortality, years of
potential life lost, and productivity losses--United States,
1997-2001. Morb Mortal Wkly Rep. 54, 625-628.
Myers, G. A., Martin, G. J., Magid, N. M., Barnett, P. S., Schaad, J. W.,
Weiss, J. S., Lesch, M. and Singer, D. H., 1986. Power spectral
analysis of heart rate variability in sudden cardiac death:
comparison to other methods. IEEE Trans Biomed Eng. 33,
1149-1156.
Newman, S. C. and Bland, R. C., 1991. Mortality in a cohort of
patients with schizophrenia: a record linkage study. Can J
Psychiatry. 36, 239-245.
Osby, U., Correia, N., Brandt, L., Ekbom, A. and Sparen, P., 2000.
Mortality and causes of death in schizophrenia in Stockholm
county, Sweden. Schizophr Res. 45, 21-28.
Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J.,
Judd, L. L. and Goodwin, F. K., 1990. Comorbidity of mental
disorders with alcohol and other drug abuse. Results from the
Epidemiologic Catchment Area (ECA) Study. Jama. 264,
2511-2518.
Rossler, W., Salize, H. J., van Os, J. and Riecher-Rossler, A., 2005.
Size of burden of schizophrenia and psychotic disorders. Eur
Neuropsychopharmacol. 15, 399-409.
Sayers, B. M., 1973. Analysis of heart rate variability. Ergonomics. 16,
17-32.
Singh, J. P., Larson, M. G., Tsuji, H., Evans, J. C., O'Donnell, C. J. and
38
Levy, D., 1998. Reduced heart rate variability and new-onset
hypertension: insights into pathogenesis of hypertension: the
Framingham Heart Study. Hypertension. 32, 293-297.
Task Force of the European Society of Cardiology and the North
American Society of Pacing and Electrophysiology, 1996. Heart
rate variability: standards of measurement, physiological
interpretation and clinical use. Circulation. 93, 1043-1065.
WHO. 2004. WHO tobacco treaty set to become law, making global
public health history. Indian J Med Sci. 58, 546-547.
Wilson, P. W., D'Agostino, R. B., Levy, D., Belanger, A. M., Silbershatz,
H. and Kannel, W. B., 1998. Prediction of coronary heart
disease using risk factor categories. Circulation. 97, 1837-1847.
Wolf, M. M., Varigos, G. A., Hunt, D. and Sloman, J. G., 1978. Sinus
arrhythmia in acute myocardial infarction. Med J Aust. 2, 52-53.
Yang, M. C., Fann, C. Y., Wen, C. P. and Cheng, T. Y., 2005. Smoking
attributable medical expenditures, years of potential life lost, and
the cost of premature death in Taiwan. Tob Control. 14 Suppl 1,
62-70.
Yotsukura, M., Koide, Y., Fujii, K., Tomono, Y., Katayama, A., Ando, H.,
Suzuki, J. and Ishikawa, K., 1998. Heart rate variability during
the first month of smoking cessation. Am Heart J. 135,
1004-1009.
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