非典型抗精神病药对体质量、血胃饥饿素、瘦素水平的影响及相关研究

目的 观测非典型抗精神病药物治疗前后体质量、血糖、血脂、血胃饥饿素及瘦素的水平变化,以探讨胃饥饿素和瘦素在非典型抗精神病药物引起体质量增加中的作用.方法 收集精神分裂症患者76例和正常对照组30例,患者组分为奥氮平组,奎硫平组,利培酮组,分别给予上述药物单独治疗达6周,检测治疗前后上述各指标的水平.结果 (1)治疗后总患者组体质量由(56.64±8.76)kg增加至(60.80±9.18)kg(t=0.944,P=0.000)、胆固醇由(4.49±0.91)mmol/L增加至(5.34±1.43)mmol/L(t=0.697,P=0.000)、甘油三脂由(1.39±1.21)mmol/L增加至(2.06±1.26)mmol/L(t=0.378,P=0.012)、瘦素由(3.01±4.36)μg/L增加至(7.50±10.84)μg/L(t=3.894,P=0.000);但胃饥饿素水平未见明显变化;治疗后三组患者体质量、胆固醇及瘦素均明显升高(P>0.05);(2)治疗后体质量增加>7%和<7%的2组患者间,治疗前甘油三酯(t=2.119,P=0.030)、胃饥饿素(t=2.333,P=0.029)水平有显著性差异;(3)Spearman相关分析表明治疗后体质量与瘦素水平成显著正相关(r=0.440,P=0.008).结论 在非典型抗精神病药物治疗的早期,出现体质量增加和脂代谢紊乱,但血糖未出现明显变化;瘦素水平升高,提示机体对抗精神病药物源性肥胖和脂代谢异常有一定控制能力,但已处于失代偿状态;奥氮平可能对胃饥饿素的分泌有促进作用,从而更大程度的引起食欲和体质量的增加.

The relationship between, weight serum ghrelin, leptin levels and atypical antipsychotics

Objective To explore the role of ghrelin and leptin on the pathphysiology of antipsychotics induced weight gain by investigating the early changes of weight gain, serum glucose, lipids, ghrelin and leptin levels during treatment of atypical antipsychotics. Methods Seventy six schizophrenic patients and thirty healthy controls were recruited into our study. They were initiated with single olanzapine ( n = 20), risperidone ( n = 31 ) or quetiapine( n = 25 ) treatment for 6 weeks. Serum levels of ghrelin,leptin as well as weight and fasting glucose ,lipids were investigated at the baseline and at 6 weeks. Results ( 1 ) The weight from (56.64±8.76 ) kg to (60.80 ± 9.18 )kg ( t =0.944, P=0.000) ,cholesterol from (4.49 ±0.91)mmol/L to (5.34 ± 1.43)mmol/L ( t =0.697, P=0.000) ,blood triglyceride from (1.39 ± 1.21)mmol/L to (2.06 ± 1.26) mmol/L ( t=0. 378, P=0.012) andleptin from ( 3.01 ± 4.36 ) μg/L to (7.50 ± 10.84 ) μg/L ( t = 3. 894, P = 0.000 ) levels increased significantly after six weeks' antipsyehotie treatment. In addition, the weight, blood cholesterol as well as leptin levels were also increased in olanzapine, quetiatine and risperidone group ( P > 0.05 ). ( 2 ) Between the treatment subjects whose weight gain is higher than 7% and those less than 7% ,significant differences were found in serum triglyceride levels at baseline( t =2. 119, P=0. 030) as well as ghrelin level( t =2. 333, P=0.029) at 6 weeks. (3) Spearman Correlation analysis indicated that leptin was positively correlated with weight after six weeks ( r = 0. 440, P =0.008). Conclusions Weight gain and lipid metabolism disorder were considered to be an early change of treatment of atypical antipsychoties, while serum glucose level did not change significantly; the increasing of leptin levels suggested that there exists certain protecting mechanism against APS associated-weight gain and lipid metabolism disorder, but it may be decompensated. Olanzapine might directly accelerate the secretion of ghrelin, and therefore caused increasing appetite and weight gain more.