Beta-cell Function and Metabolic Clearance Rate of Glucose in Patients with Major Mental Health Disorders on Antipsychotic Drug Treatment
Beta-cell Function and Metabolic Clearance Rate of Glucose in Patients with Major Mental Health Disorders on Antipsychotic Drug Treatment
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DOI：
10.1016/j.jnma.2018.01.003
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发表时间：
2018-10-01
影响因子：
3.3
通讯作者：
Lasebikan, Victor Olufolahan
中科院分区：
文献类型：
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作者：
Akinlade, Kehinde Sola;Rahamon, Sheu Kadiri;Lasebikan, Victor Olufolahan
背景：胰岛素抵抗和代谢改变仍然是主要精神健康障碍(MMHD)的基本特征，但其机制尚不清楚和多方面。本研究旨在提供有关主要精神疾病患者的胰岛素抵抗、β细胞功能、葡萄糖代谢清除率及其与抗精神病药物使用时间的可能相互作用的信息。方法：对124例MMHD患者在隔夜禁食、30分钟和120分钟标准口服葡萄糖耐量试验后测定血糖和胰岛素水平。然后，适当计算胰岛素抵抗指数、β细胞功能和估计的葡萄糖代谢清除率(EMCR)。以单因素方差分析、Kruskal Wallis检验、独立学生t检验和Mann-Whitney U检验进行统计学处理。结果：精神分裂症、双相情感障碍和抑郁症患者之间的代谢因素(空腹和餐后血糖、胰岛素)、胰岛素敏感性指数和β细胞功能比较，差异无统计学意义。非典型抗精神病药物组餐后30min胰岛素水平[18.15mU/ml(320.06-911.31)pmol/L，180.30(114.82-249.39)pmol/L]显著低于典型抗精神病药物组[27.48mU/ml(13.33-47.68mU/ml，767.69(530.58-1198.35)pmol/L]。209.89(154.01-310.97)pmoL/L]。此外，服用抗精神病药物10年以上的患者的平均腰围和体重指数显著高于服用抗精神病药物不足5年的患者。随着抗精神病药物使用年限的增加，血糖的EMCR呈进行性下降，服用抗精神病药物10年以上的患者血糖EMCR显著降低[8.09(5.90-9.44)mL.kg(1)]。Min(1)]与服药5年以下的患者比较[9.03(7.47-10.04)mL.kg(1)]。Min(1)]结论：服用非典型抗精神病药物的患者似乎有与b细胞功能障碍相一致的胰岛素分泌期。此外，抗精神病药物治疗的长期性使患有严重精神健康障碍的患者容易发生中心性肥胖和葡萄糖代谢清除率低，这是葡萄糖不耐受的先兆。
Background: Insulin resistance and metabolic alteration continue to be essential features of major mental health disorders (MMHD) with poorly understood and multifaceted mechanisms. This study was carried out to provide information on insulin resistance, beta-cell function, metabolic clearance rate of glucose and their possible interplay with duration of antipsychotic use in patients with major mental health disorders.Methodology: Plasma levels of glucose and insulin were determined in 124 patients with MMHD after an overnight fast and at 30 and 120 min of standard Oral Glucose Tolerance Test. Thereafter, indices of insulin resistance, beta-cell function and estimated metabolic clearance rate of glucose (eMCR) were calculated appropriately. Statistical analysis was done using ANOVA, Kruskal Wallis, independent Student's t-test and Mann-Whitney U. P-values less than 0.05 were considered as statistically significant.Results: Metabolic factors (fasting and postprandial glucose and insulin), indices of insulin sensitivity and beta-cell function were not significantly different when patients with schizophrenia, bipolar and depression were compared with one another. Postprandial insulin level at 30 min (30 min PPI), estimated First and Second Phases of Insulin Release (eFPIR, eSPIR) were significantly lower in patients on atypical antipsychotic drugs [18.15 (3.57-40.35) mu IU/ml), 617.63 (320.06-911.31) pmol/l, 180.30 (114.82-249.39) pmol/l] compared with patients on typical antipsychotic drugs [27.48 (13.33-47.68) mu IU/ml, 767.69 (530.58-1198.35) pmol/l, 209.89 (154.01-310.97) pmol/l]. Furthermore, the mean waist circumference and body mass index were significantly higher in patients who have been on anti-psychotic drug for more than 10 years compared with patients with less than 5 years history of anti-psychotic use. eMCR of glucose progressively declined with increasing duration of antipsychotic use and it was significantly lower in patients who have been on antipsychotic drugs for more than 10 years [8.09 (5.90-9.44) ml.kg (1). min (1)] compared with patients who have been on the drugs for less than 5 years [9.03 (7.47-10.04) ml.kg (1). min (1)].Conclusion: Patients on atypical antipsychotics seem to have insulin secretion phases consistent with b-cell dysfunction. Also, chronicity of antipsychotic treatment predisposes patients with major mental health disorders to central adiposity and low metabolic clearance rate of glucose, a forerunner of glucose intolerance.