奥氮平与齐拉西酮对精神分裂症患者血清催乳素、瘦素及糖脂代谢指标的影响

目的对比分析奥氮平与齐拉西酮对精神分裂症患者血清瘦素、催乳素及糖脂代谢指标的影响,为优化临床治疗方案提供依据。方法前瞻性选取2018年1月至2019年12月咸阳市中心医院精神科收治的60例首发精神分裂症患者作为研究对象,采用随机数字表法将患者分为奥氮平组和齐拉西酮组,每组各30例。奥氮平组患者给予口服奥氮平片治疗,齐拉西酮组患者给予口服盐酸齐拉西酮胶囊进行治疗,2组治疗疗程均不少于6周。比较和分析2组患者治疗前和治疗6周后的阳性与阴性症状量表(PANSS)评分、临床疗效总评量表(CGI-S)评分、空腹血糖(FBG)、空腹胰岛素(INS)、糖化血红蛋白(Hb A1c)、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(HDL-C)、血清催乳素、血清瘦素水平。结果治疗6周后,2组患者的PANSS评分、阳性症状评分、阴性症状评分、一般精神病理评分、CGI-S评分均较治疗前降低,差异均有统计学意义(P <0.05);治疗前及治疗6周后上述评分的组间差异均无统计学意义(P> 0.05)。治疗前,2组患者糖脂代谢指标及血清催乳素、瘦素水平的差异均无统计学意义(P> 0.05);治疗6周后,奥氮平组患者的FBG、INS、Hb A1c、TG、TC、LDL-C水平及血清催乳素、瘦素水平均较治疗前升高,齐拉西酮组患者的TG、TC、LDL-C水平及血清催乳素、瘦素水平均较治疗前升高,差异均有统计学意义(P <0.05);齐拉西酮组患者治疗6周后的FBG、INS、Hb A1c、TG、TC、LDL-C水平及血清催乳素、瘦素水平均低于奥氮平组,差异均有统计学意义(P <0.05)。结论在首发精神分裂症患者的治疗中,应用奥氮平与齐拉西酮的疗效基本相当,但齐拉西酮对患者糖脂代谢指标和血清催乳素、瘦素水平的影响较小,代谢异常不良反应较轻,应用安全性更高。

Effects of olanzapine and ziprasidone on serum prolactin,leptin,glucose and lipid metabolism in patients with schizophrenia

Objective To compare the effects of olanzapine and ziprasidone on serum leptin,prolactin,glucose and lipid metabolism in patients with schizophrenia so as to provide basis for optimizing clinical treatment.Methods The 60 patients with first-episode schizophrenia admitted to the Department of Psychiatric,Xianyang Central Hospital from January 2018 to December 2019 were selected as the research objects,30 cases were included into each group.The patients in the olanzapine group were treated with olanzapine tablet,the patients in the ziprasidone group were treated with ziprasidone hydrochloride capsules.The treatment courses of the two groups were no less than 6 weeks.The positive and negative syndrome scale(PANSS)score,the clinical global impressions-severity of illness scale(CGI-S)score,the fasting blood glucose(FBG),the fasting insulin(INS),the glycosylated hemoglobin(HbA1c),the triglyceride(TG),the total cholesterol(TC),the low-density lipoprotein cholesterol(LDL-C),the high-density lipoprotein(HDL-C),the serum prolactin,the serum leptin levels before treatment and at 6th week after treatment between the patients in the two groups were compared and analyzed.Results The PANSS score,the positive symptom score,the negative symptom score,the general psychopathology score and CGI-S score between the patients in the two groups at 6th week after treatment were significantly lower than those before treatment,the differences were statistically significant(P<0.05).There was no statistically significant difference in the above scores between the two groups before and after treatment(P<0.05).There was no statistically significant difference in glucose and lipid metabolism indexes and serum prolactin,leptin levels between the two groups before treatment(P>0.05).At 6th week after treatment,the levels of FBG,INS,HbA1c,TG,TC,LDL-C,prolactin and leptin levels of the patients in the olanzapine group were higher than those before treatment,while TG,TC,LDL-C,prolactin and leptin levels of the patients in the ziprasidone group were higher than those before treatment,the differences were statistically significant(P<0.05).The levels of FBG,INS,HbA1c,TG,TC,LDL-C,prolactin and leptin levels of the patients in the ziprasidone group were lower than those in the olanzapine group,the differences were statistically significant(P<0.05).Conclusion In the treatment of first-episode schizophrenic patients,the application of olanzapine or ziprasidone has almost the same curative effects,but ziprasidone has less influence on the indexes of glucose and lipid metabolism,serum prolactin and leptin levels.The adverse reactions of metabolic abnormalities are mild and the application has higher safety.