氯氮平、利培酮对精神分裂症病人血糖-胰岛素稳态的影响及相关因素分析

Effect and related factors of clozapine and risperidone on glucose-insulin homeostasis in schizophrenic patients

目的 通过观察精神分裂症病人服用氯氮平或利培酮后糖-胰岛素稳态的变化,探讨抗精神病药物与糖代谢的关系。方法 入组病人符合CCMD-3有关精神分裂症的诊断标准,1月内未服用任何抗精神病药物,排除糖尿病等重大躯体疾病史。共入组63例,分入氯氮平组(n=33)和利培酮组(n=30),治疗8周。治疗前后测身高、体重、腰围、空腹血糖、血清瘦素及胰岛素浓度。结果 (1)药物治疗后8周两组病人空腹血糖均略有下降,在利培酮组此种差异已达统计学意义(P=0.049);(2)两组血清胰岛素浓度及胰岛素分泌指数(HOMA-β cell secretion index,HBCI)均升高(P<0.05),治疗后胰岛素浓度与腰围及瘦素浓度相关;(3)胰岛素抵抗指数(HOMA-insulin resistance,HOMA-IR)升高,胰岛素敏感指数(insulin sensitivity index,ISI)下降,在氯氮平组这些差异达统计学意义(P<0.05)。结论 有必要对服用氯氮平或利培酮病人的糖代谢指标进行监测,避免或减轻药物引起的不良反应,提高病人的生活质量。

Objective: To study the relationship between antipsychotics and glucose metabolism by observing the change of glucose-insulin homeostasis after taking clozapine and risperidone. Methods: Sixty-three schizophrenics who met CCMD-Ⅲ criteria for schizophrenia and were free of antipsychotics for at least one month were enrolled in this study, patients with severe somatic diseases were excluded. They were treated either with clozapine or with risperidone for 8 weeks. Height, body weight and fasting blood samples for glucose, insulin and leptin were measured before and after 8-week treatment. In addition, HOMA-β cell secretion index (HBCI), HOMA-insulin resistance (HOMA-IR), insulin sensitivity index (ISI) were calculated. Results: (1) Fast plasma glucose level decreased in both groups, with risperidone group showing significant difference (P =0.049) ; (2) Insulin level and HBCI increased in both groups (P<0.05). The insulin level was associated with body weight and leptin level after treatment. (3) ISI decreased and HOMA-IR increased. There had significant difference in clozapine group (P < 0. 05). Conclusion: Both clozapine and risperidone could increase serum insulin level. Clozapine affect insulin resistance and insulin sensitivity much more. It is essentially to regularly monitor schizophrenic patients' indexes about glucose-insulin homeostasis, in order to aroid adverse effects induced by drugs and to inevease life quality of patients.