长期服用非典型抗精神病药对患者体重指数、血浆瘦素和胰岛素低抗的影响

 目的 探讨长期服用氯氮平、奥氮平及利培酮对精神分裂症患者体重指数、血浆瘦素和胰岛素水平及胰岛素抵抗的影响及其之间的关系。方法 74例符合中国精神障碍分类与诊断标准第三版（CCMD-3）的精神分裂症长期单一用药患者与首发精神分裂症患者分为对照组（15例）、氯氮平组（27例）、利培酮组（19例）及奥氮平组（13例），测定并比较各组患者的血浆瘦素（leptin）、空腹胰岛素（FINS）水平及胰岛素抵抗指数（HOMA-IR）。结果 ①长期经氯氮平、奥氮平及利培酮治疗可致精神分裂症患者体重指数（BMI）显著增高（P<0.05），且氯氮平与奥氮平的作用强度大于利培酮；②长期经氯氮平、奥氮平及利培酮治疗可致精神分裂症患者血浆瘦素水平显著增高（P<0.05），影响程度：氯氮平> 奥氮平> 利培酮；③长期经氯氮平、奥氮平及利培酮治疗的精神分裂症患者空腹胰岛素及胰岛素抵抗指数水平较首发精神分裂症患者高，但组间无统计学差异；④相关性分析结果显示，精神分裂症患者体重指数与其血浆瘦素、空腹胰岛素水平及胰岛素抵抗指数均呈显著正相关（P<0.05）。结论 长期单一使用氯氮平、奥氮平及利培酮治疗，会导致精神分裂症患者体重增加，血浆瘦素、空腹胰岛素水平及胰岛素抵抗指数升高，且体重指数与血浆瘦素、空腹胰岛素水平及胰岛素抵抗指数均呈显著正相关，提示长期单一应用氯氮平、奥氮平及利培酮引起血浆瘦素和胰岛素抵抗指数增高是其所致代谢紊乱的重要原因之一。

Effect of Long-Term Monotherapy of Atypical Antipsychotics on the Levels of Body Mass Index,Leptin Concentration and Insulin Resistance in Patients with Schizophrenia

OBJECTIVE To compare the effects of clozapine,olanzapine and resperidone on the levels of body mass index(BMI),leptin,fasting insulin concentration(FINS) and insulin resistance(IR) in inpatients with schizophrenia;to investigate the relationship between BMI,leptin,FINS and IR in subjects. METHODS Seventy-four Chinese inpatients with schizophrenia,treated with monotherapy of clozapine(n=27),risperidone(n=19) and olanzapine(n=13) for at least one year or unmedicated(n=15),were recruited;Levels of BMI,leptin,FINS and were measured,homeostasis model assessment of insulin resistance(HOMA-IR) were performed. RESULTS Significant difference in the mean levels of BMI was the found between four groups(P<0.05).In post hoc test,it was seen that clozapine and olanzapine-treated patients had higher levels of BMI than those in risperidone and control group;there was a significant difference in the level of leptin(P<0.05),which was the highest in clozapine-treated patients;in the comparison of the mean values of FINS and HOMA-IR levels between four groups,there was no statistically significant difference.There was a positive correlation between BMI and leptin leves,FINs,and HOMA-IR(p<0.05). CONCLUSION Treatment with clozapine,olanzapine and risperidone is associated with abnormal glucose and lipid metabolism in inpatients with schizophrenia. The positive correlation between BMI and serum leptin,fasting serum insulin levels,HOMA-IR suggests that the increase of serum leptin and fasting serum insulin levels would be an important trait of metabolic syndrome related to monotherapy of treatment with clozapine,olanzapine and risperidone in inpatients with schizophrenia.