非典型抗精神病药对精神分裂症病人PRL和血脂影响

目的探讨4种非典型抗精神病药物对精神分裂症病人血清催乳素（PRL）和血脂水平的影响,以及药物疗效与PRL、血脂水平的相关性。方法将120例精神分裂症病人随机分为4组,分别给予利培酮、喹硫平、奥氮平、阿立哌唑治疗12周。于治疗前及治疗第12周末（治疗后）进行阳性与阴性症状量表（PANSS）评定,并测定血总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）及血PRL水平。结果治疗后4组病人的阳性症状分、阴性症状分、一般精神病理分、PANSS总分与治疗前比较差异均有显著性（t=10.01-17.38,P〈0.01）。4组间治疗后阳性症状分、阴性症状分、一般精神病理分、PANSS总分差异均无显著性（F=0.18-4.37,P〉0.05）。与治疗前比较,治疗后利培酮组TG、LDL显著升高（t=3.31、5.07,P〈0.01）,奥氮平组TG、TC、LDL显著升高（t=2.33-5.51,P〈0.05、0.01）,喹硫平组TC显著升高（t=5.94,P〈0.01）,阿立哌唑组LDL显著升高（t=2.21,P〈0.05）;利培酮组治疗后PRL水平明显升高（t=38.48,P〈0.01）。治疗后利培酮组TG水平显著高于喹硫平组和阿立哌唑组（F=13.00,q=5.21、5.17,P〈0.01）,奥氮平组显著高于喹硫平组和阿立哌唑组（q=7.05、7.01,P〈0.01）;奥氮平组和喹硫平组TC水平显著高于利培酮组（F=5.49,q=3.02、4.60,P〈0.05、0.01）,喹硫平组显著高于阿立哌唑组（q=4.78,P〈0.01）;利培酮组LDL水平显著高于其他3组（F=4.29;q=2.49-5.05,P〈0.05、0.01）,奥氮平组显著高于喹硫平组（q=2.18,P〈0.05）,喹硫平组显著高于阿立哌唑组（q=2.56,P〈0.05）。PANSS减分率与PRL、血脂水平变化情况均无相关（r=0.22、0.17,P〉0.05）。结论 4种药物均可升高血脂,利培酮可升高PRL;药物疗效与PRL、血脂水平无关。

THE EFFECTS OF ATYPICAL ANTIPSYCHOTICS ON PROLACTIN AND BLOOD LIPIDS IN PATIENTS WITH SCHIZOPHRENIA

Objective To explore the effects of four kinds of atypical antipsychotic drugs（AAD） on the levels of serum prolactin and blood lipids and their correlation with drug efficacy in patients with schizophrenia.Methods This study consisted of 120 patients with schizophrenia,who were divided into risperidone-,olanzapine-,quetiapine-and aripiprazole-treatment groups in random,the course being 12 weeks.The Positive and Negative Symptom Scale（PANSS） was conducted before and at the end of week 12.Levels of blood total cholesterol（TC）,triacylglycerol（TG）,high density lipoprotein（HDL）,low density lipoprotein（LDL） and prolactin were detected.Results The difference of PANSS score between before and after therapy in each of the four groups was significant（t=10.01-17.38,P〈0.01）.After treatment,the differences among the four groups were not significant in terms of the points of positive and negative symptoms,general psychopathology and total PANSS（F=0.18-4.37,P〈0.05）.Compared with before treatment,the levels of TG and LDL in risperidone group were increased（t=3.31,5.07;P〈0.01）,that of TG,TC and LDL in olanzapine group elevated（t=2.33-5.51;P〈0.05,0.01）,that of TC in quetiapine group increased（t=5.94,P〈0.01）,and that of LDL in aripiprazole group heightened significantly（t=2.21,P〈0.05）.After therapy： the levels of serum prolactin in risperidone group increased（t=38.48,P〈0.01）,TG level in risperidone group was higher than quetiapine and aripiprazole groups（F=13.00;q=5.21;5.17;P〈0.01）,that in olanzapine group was higher than quetiapine and aripiprazole groups（q=7.05,7.01;P〈0.01）;the levels of TC in olanzapine and quetiapine groups were higher than risperidone group（F=5.49;q=3.02,4.60;P〈0.05,0.01）,that of TC in quetiapine group was higher than aripiprazole group（q=4.78,P〈0.01）;the level of LDL in risperidone group was significantly higher than the other three groups（F=4.29;q=2.49-5.05;P〈0.05,0.01）,that in olanzapine group was higher than quetiapine group（q=2.18,P〈0.05）,and that in quetiapine group was higher than aripiprazole group（q=2.56,P〈0.05）.The score-dropping rate of PANSS was not associated with the changes of prolactin or blood lipid（r=0.22,0.17;P〉0.05）.Conclusion All the four drugs studied can increaseblood lipid level,and risperidone can raise serum prolactin.There is no correlation between curative effect of the drugs and the levels of serum prolactin and lipid.