氯氮平、氟哌啶醇和氯丙嗪对慢性精神分裂症患者糖、脂代谢及体质量的影响

目的 探讨氯氮平、氟哌啶醇和氯丙嗪对慢性精神分裂症患者的糖、脂代谢和体质量的影响。方法 对服用氯氮平（89例，氯氮平组），服用氟哌啶醇（87例，氟哌啶醇组）及服用氯丙嗪（83例，氯丙嗪组）治疗的慢性精神分裂症患者于治疗前后的不同时间进行血糖、胰岛素、血脂及体质量测定，并做相关因素分析。结果 氯氮平组治疗第90天和第180天空腹血糖异常（空腹血浆血糖〉7.0mmo/L）的发生率分别为8％及24％，氟哌啶醇组分别为1％和2％，氯丙嗪组分别为1％及4％。治疗第90天氯氮平组和氯丙嗪组的空腹及餐后2h血糖浓度均较治疗前升高，治疗第180天的血糖浓度高于第90天，氟哌啶醇组各时点的变化则不明显；差异均有统计学意义（P均〈0．01）。治疗第90天，氯氮平组的体质量平均高于治疗前5．5％，氯丙嗪组高于治疗前4．8％；治疗第180天两组分别高于治疗前9．1％和7．4％；氟哌啶醇组则无明显变化；三组间的差异有统计学意义（P〈0．01）。三组患者治疗第180天的胰岛素浓度均高于治疗前，差异均有统计学意义（P均〈0．01），但三组间的差异无统计学意义（P〉0．05）。氯氮平组和氯丙嗪组的胆固醇和甘油三酯浓度均高于治疗前，差异均有统计学意义（P均〈0．01），氟哌啶醇组则无明显变化。治疗第180天氯氮平组和氯丙嗪组患者血糖、胰岛素、血脂浓度与体质量均有一定相关性（r=0．23-0．39）；氯氮平组的血糖、体质量、血脂代谢还与血药浓度呈显著性相关（r=0．28-0．62），差异均有统计学意义（P〈0．05或〈0．01）。结论 氯氮平和氯丙嗪治疗影响慢性精神分裂症患者的糖、脂代谢及体质量。

Body weight and metabolism of glucose and lipid in chronic schizophrenia patients with clozapine,haloperidol and chlorpromazine treatment

Objective To explore the impact of clozapine,haloperidol and chlorpromazine treatment on the body weight and metabolism of glucose and lipid in chronic schizophrenia patients.Methods Eight-nine patients treated with clozapine,87 with haloperidol,and 83 with chlorpromazine were recruited.Weight,blood glucose,insulin,cholesterol and triglyceride were determined at baseline,90-and 180-day treatment.Results The incidences of abnormal the fasting blood glucose level(>7.0 mmol/L) after 90-and 180-day treatment were 8% and 24% in clozapine,1% and 2% in haloperidol,and 1% and 4% in chlorpromazine group,respectively.Compared to baseline,the fasting blood glucose level and 2-hour-after-meal level in clozapine and chlorpromazine were elevated after 90-day treatment and even higher after 180-day treatment.The glucose level in clozapine group was higher than other two groups.After 90-day treatment,the weight increased 5.5% in clozapine,and 4.8% in chlorpromazine group.After 180 days,the weight increased (9.1%) in clozapine,and 7.4% in chlorpromazine group.The insulin level increased in three groups after treatment(P<0.05),but there was no significant difference on the increase between the three groups(P>0.05).The blood cholesterol and triglyceride level increased in clozapine and chlorpromazine group after treatment(P<0.01),but not in haloperidol group.There were correlations between the change of blood glucose,insulin,cholesterol,triglyceride and body weight.In clozapine group,the blood glucose,body weight,cholesterol and triglyceride increases were correlated to the blood clozapine(r=0.28-0.62, P<0.05 or(P<0.01).)Conclusion Clozapine and chlorpromazine have an impact on the metabolism of glucose and fat,as well as body weight in patients with chronic schizophrenia,therefore proper monitoring is required during treatment.