二甲双胍对奥氮平治疗的精神分裂症患者血脂的影响及与胰岛素抵抗的关系

目的探讨二甲双胍对奥氮平治疗的精神分裂症患者血脂的影响及其与胰岛素抵抗的关系。方法接受奥氮平单药治疗的精神分裂症患者(n=48),加用二甲双胍750 mg/d治疗,疗程8周。分别于治疗前、治疗后4、8周末,测定甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及稳态模型评估的胰岛素抵抗指数(HOMA-IR)。结果①治疗后4、8周时,TG、TC、LDL-C均较治疗前下降,差异有统计学意义(t=2.084~2.674,P=0.042~0.018);HOMA-IR也较治疗前显著下降,差异有统计学意义(t=2.870、2.904,P=0.009、0.007);②治疗后4、8周时的TG变化值与HOMA-IR变化值正性相关(r=0.354、0.386,P=0.016、0.008)。结论二甲双胍可降低奥氮平治疗的精神分裂症患者血脂水平,并可能与二甲双胍对患者胰岛素抵抗的改善作用有关。

The Correlation between Influence of Metformin on Lipid and Insulin Resistance in Schizophrenia Patients with Olanzapine Treatment

Objective To explore the dynamic changes of lipids in olanzapine-treated schizophrenia patients with metformin addition and its relationship with insulin resistance .Methods Schizophrenia patients with olanzapine mono therapy （ n=48 ） received metformin （750mg/d）therapia for 8 weeks.Serum level of TG,TC,LDL-C,HDL-C and the homeostasis model assessment of insulin resistance index（HOMA-IR）were assessed pre and 4,8 weeks pro metformin addition.Results The serum level of TG,TC and LDL-C （t=2.084~2.674,P=0.042~0.018）were significantly decreased 4,8 weeks after metformin treatment .An uniform lowing of HOMA-IR （t=2.870,2.904;P=0.009,0.007） were observed at the same time point of the study .There was a positive relationship between the diversify of TG and HOMA-IR at the time of 4,8 weeks（r=0.354,0.386;P=0.016,0.008）post metformin addition.Conclusion The improvement of insulin resistance might be one of origin of modulation effects for metformin on lipids in schizophrenia patients with olanzapine treatment .