Prevalence of Metabolic Syndrome and Metabolic Abnormalities in Schizophrenia and Related Disorders-A Systematic Review and Meta-Analysis
Prevalence of Metabolic Syndrome and Metabolic Abnormalities in Schizophrenia and Related Disorders-A Systematic Review and Meta-Analysis
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DOI：
10.1093/schbul/sbr148
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发表时间：
2013-03-01
影响因子：
6.6
通讯作者：
De Hert, Marc
中科院分区：
文献类型：
--
作者：
Mitchell, Alex J.;Vancampfort, Davy;De Hert, Marc
精神分裂症患者具有高水平的医学合并症和心血管危险因素。存在3个或3个以上特定因素表明代谢综合征，这对未来的发病率和死亡率有重要影响。我们的目的是阐明代谢综合征（MetS）在精神分裂症和相关疾病成人中的患病率和预测因素，并解释亚组差异。对77篇出版物（n = 25 692）中的126项分析进行了PRISMA系统检索、评价和荟萃分析。MetS的总体发生率为32.5%（95% CI = 30.1%-35.0%），根据MetS的不同定义、治疗环境（住院与门诊）、原籍国，仅存在微小差异，男性和女性之间无明显差异。年龄较大对代谢综合征的发生率有一定的影响（校正后的R-2 = 0.20; P <0.0001），但最大的影响是疾病持续时间（校正后的R-2 = 0.35; P <0.0001）。在研究水平上，腰围是预测代谢综合征高发生率最有用的指标，敏感性为79.4%，特异性为78.8%。高血压、高甘油三酯、高葡萄糖和低高密度脂蛋白以及年龄（>38岁）的敏感性和特异性见在线补充附录2。关于处方抗精神病药物，最高比率见于处方氯氮平（51.9%），最低比率见于未用药者（20.2%）。目前的研究结果有力地支持了精神分裂症患者应被视为高危人群的观点。精神分裂症患者应接受定期监测和充分治疗的心脏代谢危险因素。
Individuals with schizophrenia have high levels of medical comorbidity and cardiovascular risk factors. The presence of 3 or more specific factors is indicative of metabolic syndrome, which is a significant influence upon future morbidity and mortality. We aimed to clarify the prevalence and predictors of metabolic syndrome (MetS) in adults with schizophrenia and related disorders, accounting for subgroup differences. A PRISMA systematic search, appraisal, and meta-analysis were conducted of 126 analyses in 77 publications (n = 25 692). The overall rate of MetS was 32.5% (95% CI = 30.1%-35.0%), and there were only minor differences according to the different definitions of MetS, treatment setting (inpatient vs outpatient), by country of origin and no appreciable difference between males and females. Older age had a modest influence on the rate of MetS (adjusted R-2 = .20; P < .0001), but the strongest influence was of illness duration (adjusted R-2 = .35; P < .0001). At a study level, waist size was most useful in predicting high rate of MetS with a sensitivity of 79.4% and a specificity of 78.8%. Sensitivity and specificity of high blood pressure, high triglycerides, high glucose and low high-density lipoprotein, and age (>38 y) are shown in supplementary appendix 2 online. Regarding prescribed antipsychotic medication, highest rates were seen in those prescribed clozapine (51.9%) and lowest rates of MetS in those who were unmedicated (20.2%). Present findings strongly support the notion that patients with schizophrenia should be considered a high-risk group. Patients with schizophrenia should receive regular monitoring and adequate treatment of cardio-metabolic risk factors.