氯氮平、氯丙嗪、利培酮对肝脏纤维化指标影响的研究

目的：了解抗精神病药物氯氮平、氯丙嗪、利培酮及其联合用药后对肝脏纤维化指标Ⅲ型前胶原（PⅢNP）、Ⅳ型胶原（Col-Ⅳ）、层黏连蛋白（LN）和透明质酸（HA）的影响。方法：选择211例服用氯氮平（93例）、氯丙嗪（47例）、利培酮（31例）或联合用药（40例）治疗超过三年的精神病患者作为对象,并选择性别、年龄相匹配的75例健康人群作为对照组,抽取外周血,用酶联免疫法检测其PⅢNP、Col-Ⅳ、LN及HA。结果：①与正常对照组比较,所有服药患者血清肝纤维化指标PⅢNP及HA存在显著差异（P〈0.01）,而Col-Ⅳ和LN则无差异;②氯氮平组、氯丙嗪组、利培酮组及联合用药组之间比较,血清肝纤维化指标均无显著差异;与对照组比较,单一用药组（氯氮平组、氯丙嗪组和利培酮组）PⅢNP及HA存在显著差异（P〈0.01）,而联合用药组则PⅢNP、HA及LN均存在差异。结论：氯氮平、氯丙嗪及利培酮均对血清肝脏纤维化指标PⅢNP和HA有影响;各药物对肝纤维化指标的影响无差异,但其联合用药对肝纤维化指标的影响更大。

Effects of Clozapine, Chlorpromazine and Risperidone Treatment on the Liver Fibrosis Markers

Objective To study the effects of antipsychotics（clozapine,chlorpromazine or risperidone single or combined） treatment on the liver fibrosis markers（Ⅲ procollagen,Ⅳ collagen,laminin and hyaluronic acid）.Methods 211 patients who have received clozapine（n=93）,chlorpromazine（n=47）,risperidone（n=31） or combination treatment（40 patients） for more than three years and 75 controls were included in this study.Serum levels of Ⅲ procollagen（PⅢNP）,Ⅳ collagen（Col-Ⅳ）,layer laminin（LN） and hyaluronic acid（HA） were determined with enzyme-linked immunosorbent assay（ELISA）.Results ① The serum levels of PⅢNP and HA in patients with medication（as a whole） were significantly higher than those in controls（P0.01）,but levels of Col-Ⅳ and LN were not significantly different,② There were no differences among sreum levels of the markers in patients groups with different antipsychotics treatment.The serum levels of PⅢNP and HA in patients with single clozapine,chlorpromazine and risperidone treatment and PⅢNP,HA and LN in combination treatment group were significantly higher than those in controls（P0.01）.Conclusion These three antipsychotics can increase the serum levels of PⅢNP and HA to same degree and the effect was more pronounced in patients with combined treatment.