阿立哌唑与奥氮平对首发年轻成人精神分裂症患者短期内代谢风险的比较

 【目的】比较阿立哌唑与奥氮平对首发年轻成人精神分裂症患者短期内的代谢风险。【方法】 采用开放对照的临床观察方法,对符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)精神分裂症诊断标准的首发住院精神分裂症患者,分别使用阿立哌唑(21例)和奥氮平(42例)治疗,自然观察时间不低于2周,不大于4周,于治疗前后各检测一次体质量、腰围、空腹血脂血糖及胰岛素、C肽。【结果】 观察结束时:阿立哌唑组的体质量、体质量指数(BMI)、腰围、腰臀比均有增高(P < 0.05),糖脂改变无统计学差异,男女患者间各项代谢指标的变化无统计学差异(P > 0.05);奥氮平组的体质量、体质量指数(BMI)、腰围、腰臀比、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白AI和B100及脂蛋白LPa较治疗前增高(P < 0.01),且胰岛素(INS)水平和胰岛素抵抗指数(IR)增高(P < 0.05),多元逐步回归分析显示胰岛素抵抗与甘油三脂的增高有关(R2 = 0.107,P = 0.007);奥氮平组男性患者的空腹胰岛素和C肽、胰岛素抵抗指数均增高(P < 0.05),女性患者则没有。【结论】阿立哌唑和奥氮平对首发年轻成人精神分裂症患者短期内的代谢风险即有差异,性别差异可能影响着非典型抗精神病药物的代谢风险。

Comparison of Short-term Metabolic Risk in First-episode Young-adult Schizophrenia Treated with Aripiprazole and Olanzapine

【Objective】 To compare the short-term metabolic risk in the first-episode young-adult schizophrenia treated with Aripiprazole and Olanzapine. 【Methods】 The open-lable, natural observed, compared method was designed for this study. All of these cases were diagnosed as first-episode schizophrenia in accordance with the DSM-Ⅳ diagnosis criteria and respectively allocated into two groups for either Aripiprazole or Olanzapine treatment. The natural observed period was from two weeks to four weeks. Weight, waist circumference, fasting glucose, and lipid concentration, fasting insulin and C peptide concentration, and insulin resistance index were tested or checked at baseline and endpoint, respectively. 【Results】 Sixty-three young adult first-episode schizophrenia patients were recruited in this study, 21 for Aripiprazole (F/M, 10/11) and 42 for Olanzapine (F/M, 21/21). Weight, BMI, waist circumference and waist/hip increased in Aripiprazole group at endpoint(P < 0.05), there existed no statistical metabolic index difference between two sex groups (P > 0.05). Weight, BMI, waist circumference and waist/hip, lipid level increased in Olanzapine group at endpoint (P < 0.01). Meanwhile, fasting insulin and IR increased (P < 0.05), stepwise multiple regression analysis indicated mild positive correlation between IR and TG level(R2 = 0.107,P = 0.007). Fasting insulin, C peptide and IR increased among male patients in Olanzapine group at endpoint(P < 0.05), although female patients were normal. 【Conclusion】 The results suggested that there existed short-term metabolic risk difference between first-episode young-adult schizophrenia treated with Aripiprazole and Olanzapine, sex difference could play a role in the metabolic risk of SGA.