二甲双胍合并行为干预疗法对氯氮平治疗精神分裂症患者体重、血糖、血脂的影响

目的探讨二甲双胍合并行为干预疗法对氯氮平治疗精神分裂症患者体重、血糖、血脂的影响。方法将60例开始单独服用氯氮平治疗的精神分裂症患者随机分为两组,研究组采用氯氮平（250～400mg/d）联合二甲双胍（750mg/d）及实施行为干预治疗,对照组则单用氯氮平（250～400mg/d）,未实施任何干预措施,治疗12周。两组患者分别于入组时和治疗后第4、8及12周末测定空腹血糖（FBG）、血脂（TC、TG、HDL、LDL）、身高、体重、腰围,计算体重指数（BMI）以及治疗12周末体重增加大于7%的人数比率。用阴性与阳性症状量表（PANSS）于治疗前和治疗12周末评定疗效。结果治疗12周末,研究组与对照组体重较治疗前分别增加为（2.03±1.26）kg、（4.98±3.09）kg;BMI较治疗前分别增加为（0.54±0.62）kg/m2、（2.03±1.02）kg/m2,体重、BMI的升高程度对照组高于研究组（P〈0.05）,体重增加大于7%的患者研究组为6例（20%）、对照组为16例（53%）,对照组明显高于研究组（P〈0.05）。两组患者治疗后空腹血糖、血脂各项的升高程度对照组明显高于研究组（P〈0.05）。结论二甲双胍合并行为干预疗法能有效减轻氯氮平治疗精神分裂症患者所致的体重增加及血糖、血脂升高。

The efficacy of metformin in combination with life style intervention on body weight,blood lipid and blood glucose in schizophrenia during clozapine treatment

Objective To test the efficacy of metformin in combination with life style intervention on body weight,blood lipid and blood glucose in during clozapine treatment.Methods 60 schizophrenic patients who were treated with clozapine 250~400mg/day were divided into 2 groups：study group received 12-week individual treatments （metformine 750mg/day in combination with life style intervention）,control group received no intervention.Before and after four-week,eight-week and twelve-week treatment,the height,body weight,waist circumference,and the fasting blood glucose and blood lipid were measured.In addition,the body mass index（BMI）and the proportion of patients gained more than 7% at the end of the 12-week treatment were caleulated.The Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms（PANSS）were used to assess the treatment.Results There was a significant increase in body weight and BMI within 2 groups from baseline to week 12：study group（2.03±1.26）kg and （0.54±0.62）kg/m2;control group（4.98±3.09）kg and（2.03±1.02）kg/m2.The increase in weight,BMI of control group was more than that of study group（P0.05）.Significantly fewer patients in study6（20%）]than patients in control group16（53%）]increased their baseline weight by more than 7%（P0.05）.The increase in fasting bloog glucose and blood lipid of control group was more than that of study group （P0.05）.Conclusion Metformin in combination with life style intervention was effective in attenuating clozapine-induced weight gain and increase of blood glucose and blood lipid in schizophrenic patients.