精神分裂症复发与不同药物维持治疗的相关性

目的:探讨采用不同药物维持治疗的精神分裂症患者复发率是否存在显著差异。方法:对首次发病住院的精神分裂症患者出院时采用氯丙嗪、奋乃静、舒必利、氯氮平、利培酮、奥氮平、喹硫平、阿立哌唑等8种抗精神病药物维持治疗,以自制的调查表及PANSS量表观察其2年内复发率、服药依从性,并进行统计分析。结果:425例患者2年内的总复发率为64.06%;选用氯丙嗪、奋乃静、舒必利、氯氮平、利培酮、奥氮平、喹硫平、阿立哌唑药物维持的精神分裂症患者复发率分别为73.7%、73.2%、71.2%、54.3%、60.3%、51.7%、61.4%、66.7%;奥氮平组显著低于氯丙嗪、奋乃静、舒必利组(P<0.05);氯氮平组显著低于氯丙嗪、奋乃静组(P<0.05),其余各组间差异无显著性(P>0.05),上述8种药物的服药依从性差异无显著性(P>0.05)。结论:采用奥氮平、氯氮平维持治疗的精神分裂症患者的复发率最低,与服用其他药物维持治疗的相比或有显著性差异(P<0.05)。     

3种抗精神病药物短期治疗对首发精神分裂症患者体重和血糖的影响

目的研究3种抗精神病药物短期治疗对首发精神分裂症患者体重和血糖的不良影响。方法46例首发精神分裂症患者根据临床需要分为氯氮平组、利培酮组和奋乃静组,每组患者于治疗前及治疗后第4周、8周、12周分别测体重、BPRS评分,于治疗前、治疗后12周测空腹血糖。结果3组患者短期体重均有所增长,但与治疗前无显著差异;治疗前后空服血糖无显著变化。结论该3种药物短期使用对患者血糖几乎无不良影响,对体重影响在可接收程度之内。     

阿立哌唑对精神病患者血糖、血脂水平的影响

目的探讨阿立哌唑对精神病患者血糖、血脂水平的影响。方法对28例首次使用抗精神病药物阿立哌唑治疗的患者在入组时和治疗第16周时进行血糖、血脂等检查,并选择29例使用传统抗精神病药物奋乃静的患者进行对照分析。结果阿立哌唑治疗患者治疗前后血糖（GLU）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）水平均无明显变化（P〉0．05）,而奋乃静治疗患者治疗后血糖、血脂水平明显高于治疗前（P〈0．05）。结论阿立哌唑对精神病患者血糖、血脂的影响不明显,其适应证更广泛。     

国产奥氮平与奋乃静治疗老年期精神分裂症疗效比较

目的 比较国产奥氮平与奋乃静治疗老年期精神分裂症的疗效与安全性.方法 将62例老年期精神分裂症患者随机分为两组,分别用国产奥氮平或奋乃静治疗12周;采用阳性和阴性症状量表(PANSS)、副反应量表(TESS)评价临床疗效和不良反应.结果 12周治疗结束后,国产奥氮平组有效率为81.25%,显效率为50.00%;奋乃静组有效率为73.33%,显效率为43.33%.两组间疗效差异无统计学意义(P>0.05).国产奥氮平组药物副反应较少且轻,两组副反应量表总分差异有统计学意义(P<0.01).结论 国产奥氮平与奋乃静治疗老年期精神分裂症疗效相当,但国产奥氮平副反应更少且轻,安全性更高.     

住院老年精神分裂症患者抗精神病药物用药情况调查分析

目的:了解我院老年精神分裂症患者抗精神病药物使用情况.方法:对住我院84例住院老年精神分裂症患者使用抗精神病药物治疗情况进行调查.结果:单一用药76例,占90.48%,两种药物联用7例,占8.33%.按照单一药物应用频度排列前5位的是利培酮、氯氮平、奋乃静、喹硫平、氯丙嗪.结论:抗精神病药物使用多样化,剂量个体化.     

精神分裂症患者长期服用氯氮平所致药源性脂肪肝分析

<正>精神分裂症近年发病率逐年升高,可能和人们生活、工作压力增加,生活环境改变以及遗传因素分不开。精神分裂症具有治疗难度大,疗效差异化,病程迁延及反复发作等特点,需要长期服用抗精神病药物(APS)治疗。目前临床常用APS主要有氯氮平、奋乃静、利培酮、奥氮平、舒必利等。长期服用抗精神病药物有较多不良反应,尤其对人体肝脏影响较大,易引起脂肪肝。本研究对487例精神分裂症患者长期服     

457例老年精神病患者抗精神病药使用调查

目的:了解我院老年精神病患者抗精神病药使用情况。方法:对我院2011年4月26日60岁以上老年住院精神病患者情况及用药记录进行调查分析。结果:使用抗精神病药的431例患者中,单一用药355例,联合用药76例,药物使用频率前5位的是利培酮、奥氮平、氯氮平、喹硫平、奋乃静。结论:我院老年精神病患者抗精神病治疗以单一用药为主,且药物剂量相对较低,其中非典型抗精神病药使用频率较高。     

奥氮平治疗老年期精神分裂症对照研究

目的：对比奥氮平与奋乃静治疗老年期精神分裂症的疗效和安全性。方法：将60例老年期精神分裂症住院患者随机分为两组，分别给予奥氮平和奋乃静治疗，疗程8周。以阳性和阴性症状量表（PANSS）评定临床疗效，以副反应量表（TESS）评定不良反应。结果：奥氮平与奋乃静临床疗效差异无显著性。奥氮平组不良反应发生率低于奋乃静组。结论：奥氮平治疗老年期精神分裂症的疗效较好，安全性高，有利于长期巩固维持治疗。     

非典型抗精神病药的体内代谢与药物相互作用

典型抗精神病药物,又称第1代抗精神病药,代表药物有氯丙嗪、奋乃静、氟奋乃静、三氟拉嗪、氟哌啶醇、硫利达嗪等,由于它们不良反应多[1],如代谢综合征、高泌乳素血症、QTc延长、锥体外系不良反应大及体重增加等,现已逐渐被非典型抗精神病药物(即第2代抗精神病药物)取代.Leucht S等[2]对第1代抗精神病药和第2代抗精神病药进行了meta分析,认为从整体作用上讲,氯氮平、利培酮、奥氮平、氨磺必利4种药物要优于第1代抗精神病药和其他第2代抗精神病药物.本文在回顾大样本文献的基础上,从药物代谢酶和P-gp两方面对氯氮平、利培酮、奥氮平、氨磺必利的药物相互作用进行综述.     

神经-精神科疾病合理用药专家圆桌会议纪要

1精神病药及其合理应用原则1·1抗精神病药的发展历史回顾回顾自上世纪30年代以来,抗精神病药(AntipsychoticsDrugs)取得重大的发展,其研制和上市的品种层出不穷。表现在50年代的氯丙嗪;60年代的氟哌啶醇、氟奋乃静、硫利达嗪、奋乃静;上世纪70年代~90年代的氯氮平;90年代的利培酮、奥氮平、奎硫平;21世纪初,阿立哌唑抗精神病药带来了全新的治疗模式。抗精神病药按作用靶位、化学结构分为经典(1代)和非经典(2代)药。其中第1代抗精神病药(氯丙嗪、氟奋乃静、氟哌啶醇、氟哌噻吨、奋乃静和甲硫哒嗪等)被称为经典抗精神病药(Classics Antipsy…     

A randomized, 12-week study of the effects of extended-release paliperidone (paliperidone ER) and olanzapine on metabolic profile, weight, insulin resistance, and β-cell function in schizophrenic patients

Objective

To compare matched paliperidone-ER- and olanzapine-treated schizophrenic patients on measures of glucose and lipid metabolism.

Methods

Eighty hospitalized patients with schizophrenia (DSM-IV) were randomly assigned to treatment with paliperidone ER or olanzapine for a period of 12 weeks. At baseline and every 4 weeks, we assessed weight, subcutaneous fat, waist and hip circumferences, fasting glucose, insulin, glycohemoglobin A1, cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, and prolactin. We also assessed at every time point body mass index (BMI), homeostasis insulin resistance (HOMA-IR), and homeostasis β-cell function (HOMA-B).

Results

Thirty-three patients randomly assigned to paliperidone ER and 23 patients randomly assigned to olanzapine groups completed the entire 12-week treatment. Within-group analyses showed that fasting measures in both groups increased for weight, BMI, waist circumferences, hip circumference, subcutaneous fat, cholesterol, triglycerides, and prolactin. In contrast, fasting glucose, LDL, and HOMA-B increased during treatment only in the olanzapine group. We also detected significantly different serum prolactin levels at all time point between the paliperidone ER- and olanzapine-treated groups, as well as a statistical trend for HOMA-B to increase more in the olanzapine compared to paliperidone-ER group over the 12 weeks of the trial. We did not detect, however, differential drug effects over the 12 weeks of the trial on fasting measures of BMI, glucose, glycohemoglobin A1, insulin, HDL, LDL, cholesterol, triglyceride, or HOMA-IR.

Conclusion

This study reinforces the necessity of regularly monitoring metabolic parameters in patients with schizophrenia taking atypical antipsychotics, including paliperidone ER.     

阿立哌唑对女性精神分裂症患者服用奥氮平引起的代谢综合征的影响分析

目的:探析阿立哌唑对女性精神分裂症患者服用奥氮平引起的代谢综合征的影响。方法:选取广东省惠州市第二人民医院于2017年5月~2018年5月收治的64例服用奥氮平引起代谢综合征的女性精神分裂症患者作为主要对象,采用数字随机表达法分为观察组和对照组,各32例。观察组采用阿立哌唑治疗,对照组采用利培酮治疗,比较两组代谢综合征及精神症状的治疗效果。结果:治疗前观察组与对照组的腰围、BMI指数、空腹血糖、甘油三酯、高密度脂蛋白等代谢指标无明显差异(P>0.05);治疗后观察组的腰围、BMI指数、空腹血糖、甘油三酯等代谢指标均明显低于对照组(P<0.05);治疗前观察组与对照组的PANSS评分无明显差异(P>0.05),治疗后观察组的PANSS评分明显低于对照组(P<0.05)。结论:阿立哌唑可改善女性精神分裂症患者服用奥氮平引起的代谢综合征,且对精神分裂症的治疗效果佳。     

间歇性禁食对肥胖患者的血糖血脂代谢的影响

目的观察间歇性禁食(IF)对肥胖患者的测量学指标及血糖血脂代谢的影响。方法23例肥胖患者,根据每例患者的体重、体力活动程度计算每日能量需要量,并估算间歇性禁食日的能量摄入量,根据禁食日的能量摄入量设计三餐食谱,每周不连续的2 d为禁食日并依照食谱进食,其余5 d不限制能量摄入,患者均经过8周的间歇性禁食干预。观察患者禁食干预前后体格检查指标、血糖和血脂变化情况。结果禁食干预8周后,男、女患者体重、体质量指数(BMI)、体脂率、内脏脂肪等级、腰围、臀围、腰臀比、收缩压、舒张压与同性别基线值比较差异无统计学意义(P>0.05),但均有较明显的下降趋势。男性患者体重减少3.8 kg,女性患者体重减少2.8 kg;体脂率分别下降了1.3%和1.9%。收缩压和舒张压均有下降,收缩压降低更明显。禁食干预8周后,患者空腹血糖、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白-B(Apo-B)、载脂蛋白-A1(Apo-A1)与基线值比较差异无统计学意义(P>0.05),但空腹血糖、TG、Apo-B有下降趋势,TC、LDL-C、HDL-C、Apo-A1无明显趋势。结论间歇性禁食对肥胖患者具有减体重、体脂,促进血脂代谢改善的作用。通过进一步在超重、肥胖、高血压、高血脂患者中推广间歇性禁食干预,可以向广大居民传递正确、科学的营养常识和减重指导,具有深远的疾病预防关口前移的意义。     

Metabolic control in patients with schizophrenia treated with amisulpride or olanzapine

The use of certain atypical antipsychotics has been associated with metabolic disturbances. We have assessed the evolution of body weight and glycaemia during a 6-month randomized comparative trial of amisulpride and olanzapine. Three hundred and seventy-seven adult patients with schizophrenia were randomized to either amisulpride (200-800 mg/day) or olanzapine (5-20 mg/day) for 6 months. Body weight and fasting blood glucose were measured. Both treatments showed comparable antipsychotic activity. Weight gain over the study was significantly greater (P=0.0004) in the olanzapine group (3.9+/-5.3 kg) than in the amisulpride group (1.6+/-4.9 kg). Mean fasting blood glucose increased in the olanzapine group by 4.42 mg/dl to a mean maximum value (118+/-38 mg/dl). In the amisulpride group, mean glucose levels fell by 2.82 mg/dl. The difference between groups was significant at 2 (P=0.0066) and 6 months (P=0.017). One olanzapine-treated patient was diagnosed with diabetes. Metabolic changes in the amisulpride group were restricted to patients with high body mass index at inclusion. At doses that provide comparable control of psychosis, treatment with olanzapine was associated with greater increase in weight and blood glucose compared with amisulpride. This should be taken into account in assessing risk-benefit of treatment options in schizophrenia.     

利拉鲁肽治疗腹型肥胖2型糖尿病患者的临床观察

目的：观察腹型肥胖的2型糖尿病患者应用利拉鲁肽治疗的疗效及其安全性。方法筛选20例符合入选标准的腹型肥胖2型糖尿病患者,在原有降糖药物基础上,加用利拉鲁肽0.6~1.8 mg皮下注射,1次/d。治疗随访观察12周,比较治疗前后空腹血糖（FPG）、餐后2 h血糖（2 hPG）、空腹及餐后2 h胰岛素及C肽、糖化血红蛋白（HbA1c）、体重指数（BMI）、腰围、血压、血脂的变化情况。观察并记录其不良反应。结果对采用利拉鲁肽治疗患者前后的空腹血糖、餐后2h血糖、糖化血红蛋白、体重、BMI、腰围、HOMA-β及HOMA-IR指数相互比较,其差异有统计学意义（ P〈0.05）。观察到有少数患者出现不良反应,但均能耐受治疗。结论在原有口服降糖药物基础上加用利拉鲁肽能有效降低血糖,显著降低患者体重,并能改善胰岛β细胞功能,降低血脂、血压,且发生低血糖的风险低,是2型糖尿病患者治疗的新选择。     

Plasma orexin A, ghrelin, cholecystokinin, visfatin, leptin and agouti-related protein levels during 6-week olanzapine treatment in first-episode male patients with psychosis

The objective of the study was to investigate the change of body mass index (BMI), waist circumference, lipid profile, leptin, ghrelin, orexin, visfatin, agouti-related protein, and cholecystokinin levels during 6 weeks of olanzapine treatment in newly diagnosed first-episode drug naive, young adult, nonobese male patients with psychosis. Twenty male participants who were all first-episode drug naive psychotic patients without prominent affective signs and symptoms and 22 healthy male controls of similar age were included. BMI, waist circumference, fasting glucose, and lipid profiles were measured, and Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores were obtained at baseline, during the second and sixth week of treatment, and the aforementioned neuropeptide levels were measured at baseline and during the sixth week of treatment. Treatment was associated with significant increases in BMI, waist circumference, serum triglyceride, and low-density lipoprotein levels. BMI levels increased more than 7% in over 75% of the patients. Leptin increased, and ghrelin and orexin decreased significantly with olanzapine treatment, whereas cholecystokinin, visfatin, and agouti-related protein levels did not change significantly. In conclusion, consistent with previous studies, we found increased BMI, leptin and lipids during olanzapine treatment. Association of neuropeptide level changes with symptom improvement might be mediated by the dopaminergic and serotonergic systems.     

Metabolic syndrome in female patients with schizophrenia treated with second generation antipsychotics: a 3-month follow-up

The objective of this study was to determine the occurrence of metabolic abnormalities among previously unmedicated female patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition schizophrenia spectrum disorders and their associations with olanzapine and risperidone treatment. We analysed 94 female patients who were treated with olanzapine or risperidone in the period of 3 months. Analysed variables included fasting glucose, total cholesterol, low-density lipoprotein (LDL), high-density lipoproteins and triglycerides in blood, blood pressure (BP), waist and hip circumferences and body mass index (BMI). At baseline, 14 patients (15%) fulfilled criteria for metabolic syndrome. After 3 months of treatment, 25 patients (27%) fulfilled criteria for metabolic syndrome, and their baseline BMI was the only predictor for its development. Treatment with both antipsychotics was associated with significant increase in waist circumference. Positive family history of diabetes mellitus contributed to a significant greater increase in abdominal obesity, significant higher baseline levels and a borderline significant increase in fasting glucose among olanzapine-treated patients. Olanzapine admission was associated with a significant increase in LDL and risperidone with a significant increase in triglycerides. Metabolic abnormalities seem to be more prevalent in unmedicated female patients with schizophrenia spectrum disorders than expected based on results in general population (adjusted for age and sex). Olanzapine treatment might induce significant alterations in metabolic profiles, especially among patients with positive family history of diabetes, mostly by inducing abdominal obesity. The association of risperidone application and increase in triglyceride level still needs to be determined.     

社区糖尿病患者糖化血红蛋白影响因素分析

目的：了解上海五角场镇社区2型糖尿病患者血糖控制水平,探讨影响糖尿病患者糖化血红蛋白（HbA1c）水平的因素,为糖尿病患者的社区管理提供依据。方法：随机选择确诊的2型糖尿病患者676名,测量身高、体重、血压、腰围、臀围,检测血糖、血脂、HbA1c等。依据HbA1c控制是否达到7.0%为标准,分为A组（〈7.0%）和B组（≥7.0%）,回顾分析可能影响糖尿病患者糖化血红蛋白水平的因素,采用SAS9.1.3进行统计学分析。结果：A组中糖化血红蛋白水平受体重指数（BMI）、腰臀比、空腹血糖、葡萄糖耐量试验（OGTT）、高密度脂蛋白（HDL-C）的影响,差异有统计学意义（P〈0.05）;B组中糖化血红蛋白水平受到空腹血糖和OGTT的影响,差异有统计学意义（P〈0.05）。结论：糖化血红蛋白可能受到体重指数、腰臀比、空腹血糖、OGTT、和HDL-C的影响。控制饮食、减轻体重、减小腰围及定期检测糖化血红蛋白对监测糖尿病的发生、发展有着重要意义。     

初发2型糖尿病合并高血压患者血清内脂素、网膜素和TNF-α水平的变化*

【摘要】 目的 探讨初发2型糖尿病（T2DM）合并高血压患者血清内脂素、网膜素和肿瘤坏死因子（TNF）-α水平的变化及意义。方法 初次诊断为T2DM的患者106例,分为T2DM组54例和T2DM合并高血压组（DM+H组）52例。所有受试者测定血压、身高、体质量、血脂、尿酸,并行口服葡萄糖耐量试验与胰岛素激发试验,同时取血测定空腹与服糖120 min 血糖、胰岛素、内脂素、网膜素和TNF-α水平。计算体质指数（BMI）和稳态模型胰岛素抵抗指数（HOMA-IR）。结果 （1）与T2DM组相比,DM+H组空腹及服糖120 min血清内脂素和TNF-α水平明显升高,网膜素水平明显降低（P < 0.05）。（2）内脂素和TNF-α均与收缩压、腰围、空腹胰岛素和HOMA-IR呈正相关,而网膜素与舒张压、腰围、空腹胰岛素和HOMA-IR呈负相关。（3）多元线性回归分析显示,空腹胰岛素水平是空腹与高糖刺激下内脂素的影响因素,而收缩压则主要影响空腹内脂素水平;空腹网膜素主要受HOMA-IR 和舒张压影响,而腰围、HOMA-IR、血尿酸是高糖刺激下血清网膜素的影响因素;空腹与120 min TNF-α 的影响因素分别为BMI和空腹胰岛素。结论 初发T2DM合并高血压患者血清内脂素、网膜素和TNF-α水平明显改变,其可能通过多种途径参与了糖尿病并发高血压的病理过程。      

二甲双胍对首发精神分裂症白族患者代谢影响的对照研究

目的：探讨二甲双胍对利培酮治疗首发精神分裂症白族患者代谢的影响及效果。方法：将170例首发精神分裂症白族患者随机分为研究组（86例）和对照组（84例）,在利培酮和心理治疗的基础上,研究组合并二甲双胍,对照组合并安慰剂,疗程5月,于治疗前及治疗后1、2、3、4、5月测定体重、体质量指数（BMI）、腰围、腰臀比等体重指标;治疗前及治疗5月后测定血压、空腹血糖、胰岛素敏感性、血脂、催乳素及肝功能变化等指标,并评定阳性和阴性症状量表（PANSS）及副反应量表（TESS）。结果：两组治疗5月后INS、IRI、TG、ALT、GGT、BMI、腰围、腰臀比、体质量变化有高度差异（P〈0．01）,FBG、TC有差异（P〈0．05）;研究组治疗3～4月及4～5月期间体重变化量明显低于对照组（P〈0．01）,研究组治疗前与治疗后5月SBP、FBG、INS、IRI、TC、TG、LDL-C、ALT、GGT有高度差异（P〈0．01）;而对照组仅有SBP、INS、ALT、GGT有高度差异（P〈0．01）,FBG、IRI有差异（P〈0．05）。两组PANSS减分率、TESS评分差异无统计学意义（P〈0．05）。结论：联用二甲双胍有益于利培酮治疗首发精神分裂症白族患者的糖脂等代谢,且不影响抗精神病药物治疗的疗效及耐受性。