四种非典型抗精神病药对血清催乳素和血脂的影响

目的探讨四种非典型抗精神病药对精神分裂症患者血脂和血清催乳素（PRL）的影响，以及血清PRL水平与药物疗效的关系。方法118例精神分裂症患者分为4组，分别予以喹硫平（29例）、氯氮平（30例）、奥氮平（30例）和利培酮（29例）治疗12周。于治疗前及治疗4、8及12周末予以阳性与阴性症状量表（PANSS）评定，测定血总胆固醇（TC）、甘油三脂（TG）高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、阿朴脂蛋白A—I（ApoA-1）、阿朴脂蛋白-B（Apo—B）及血清PRL浓度。结果（1）喹硫平组TG、HDL在12周末有显著升高（P〈0．05），氯氮平组Apo—B在4、12周末有显著升高（P〈0．05）、LDL在8、12周末有显著升高（P〈0．05），利培酮组除TG外其余血脂指标在8、12周末有显著升高（P〈0．05），奥氮平组TG、HDL、LDL、ApoA-1、Apo—B在12周末有显著升高（P〈0．05），TC在8与12周有显著升高（P〈0．05）。（2）利培酮组治疗8、12周后血清PRL明显升高（P〈0．01）。（3）氯氮平组和利培酮组PANSS一般病理分的减分率分别与PRL、LDL有显著相关；氯氮平组PRL与LDL有显著相关。结论利培酮、奥氮平、喹硫平和氯氮平均影响血脂代谢；氯氮平疗效与血清催乳素及LDL有关，利培酮疗效与LDL有关。

Effect of four kinds of atypical antipsychotic drugs on the blood lipids and prolactin level in patients with schizophrenia

Objective To explore the effects of four kinds of atypical antipsychotic drugs on the levels of blood lipid and serum prolactin, and to analyze their relationship with therapeutic effect in patients with schizophrenia. Methods A to eal of 118 schizophrenic patients were rrandomly assigned to quetiapine, clozapine, olanzapine or risperidone group for the treatment of 12 weeks. The Positive and Negative Syndrome Scale （PANSS） was used to measure symptoms,levels of serum TC ,TG,HDL,LDL,ApoA - 1 ,Apo - B and PRL were tested at baseline and the 4th weeks,8th weeks and 12th weeks afeer treat menf respectively. Results （ 1 ） Serum TG and HDL in quetrapme group increased significantly after receiving 12 -week treatment （P 〈0.05 ）. Serum Apo- B increased significantly in the 4th and 12th week, and LDL increased significantly in the 8th and 12th week in clozapine group （P 〈 0.05 ）. Lipid increased significantly after receiving 8 - week and 12 - week risperidone treatment except TG （ P 〈 0.05 ）. Serum TG, HDL, EDL, ApoA - 1 and Apo- B increased significantly in the fourth 4th,8th and 12th week , and serum TC increased significantly in the 8th and 12th week in olanzapine group （P 〈0.05 ）. （2） Serum PRL in risperidonegroup increased significantly after receiving 8 - or 12 - week risperidone treatment （ P 〈 0.05 ）. （3） The decreased rates of and factor score of in clozapine group and risperidone group were significantly correlated to serum PRL and LDL. Serum PRL was significantly correlated to LDL in clozapine group. Conclusion Risperidone, olanzapine, quetiapine and clozapine had obviously effects on the metabolism of blood lipid L. The therapeutic effect of clozapine was correlated to serum PRL and LDL, and the therapeutic effect of risperidone was correlated to serum LDL.