氯氮平、阿立哌唑对精神分裂症患者血浆神经肽Y、瘦素水平的影响及其与体质量变化的关系

目的:探讨氯氮平和阿立哌唑对精神分裂症患者血浆神经肽Y、瘦素水平的影响及其与体质量变化的关系。方法:60例精神分裂症患者随机分为氯氮平组和阿立哌唑组各30例,分别接受氯氮平和阿立哌唑治疗6周。于治疗前及治疗3周和6周后分别测定两组血浆神经肽Y、瘦素水平及体质量,并进行治疗前后的比较及回归分析。结果:重复测量方差分析显示,血浆神经肽Y、瘦素水平及体质量存在交互效应(F=11.203,P=0.000;F=5.981,P=0.033;F=7.523,P=0.003)和组别主效应(F=6.772,P=0.023;F=37.771,P=0.000;F=5.674,P=0.039)。治疗3周和6周时,氯氮平组血浆神经肽Y水平(F=30.764,P=0.000;F=59.963,P=0.000)、体质量(F=5.424,P=0.042;F=11.423,P=0.000)均高于治疗前;治疗6周时,血浆瘦素水平显著高于治疗前(F=10.132,P=0.004)。阿立哌唑组血浆神经肽Y(F=0.143,P=0.708;F=0.293,P=0.593)、瘦素水平(F=1.343,P=0.256;F=1.030,P=0.326)、体质量(F=2.743,P=0.113;F=0.132,P=0.722)与治疗前比较差异无统计学意义。逐步回归分析显示,治疗3周和6周时神经肽Y变化值可以解释同期体质量变化值变异的41.9%和21.8%。结论:与阿立哌唑比较,氯氮平可显著增加精神分裂症患者血浆神经肽Y、瘦素水平;神经肽Y水平增高可能是氯氮平导致患者体质量增加的内因之一。

Effects of clozaPine and ariPiPrazol on neuroPePtide Y,lePtin and body mass in schizoPhrenic Patients

Objective:To analyze and compare the effects of clozapine and aripiprazol treatment on neu-ropeptide Y(NPY),leptin and body mass in schizophrenias. Method:Sixty schizophrenic patients were as-signed to clozapine and aripiprazol treatment group respectively,30 patients for each group,and body neuropep-tide Y,leptin and body mass of both groups were measured at baseline,weekend 3 and weekend 6. Results:There were significant interactions between groups and time in NPY,leptin and body weight(F = 11. 203,P =0. 000;F = 5. 981,P = 0. 033;F = 7. 523,P = 0. 003),and main effects of group(F = 6. 772,P = 0. 023;F =37. 771,P = 0. 000;F = 5. 674,P = 0. 039). Both plasma NPY( F = 30. 764,P = 0. 000;F = 59. 963,P =0. 000)levels and the body mass(F = 5. 424,P = 0. 042,F = 11. 423,P = 0. 000)in clozapine group at weekend 3 and weekend 6 were significantly higher compared to the baseline,and leptin(F = 10. 132,P = 0. 004)levels were significantly higher at weekend 6 compared to baseline. The differences of body weight(F = 2. 743,P =0. 113;F = 0. 132,P = 0. 722)and plasma NPY(F = 0. 143,P = 0. 708;F = 0. 293,P = 0. 593),leptin(F =1. 343,P = 0. 256;F = 1. 030,P = 0. 326)levels at each time point in aripiprazol group were not statistically sig-nificant compared to the baseline. Stepwise regression analysis showed plasma NPY change value entered regres-sion equation when body weight change value as dependent variable,plasma NPY change value can explain 41. 9%variance in 3 nd weekend and 21. 8% variance in 6th weekend of body weight change value. Conclusion:Clozapine significantly increased body weight in schizophrenia patients compared with aripiprazol,and the change of neuropeptide Y may be one of the intrinsic causes of body weight increase of patients.