氯丙嗪和利培酮对精神分裂症患者血糖调节功能影响的动态观察

The blood glucose regulation function in patients with one year chlorpromazine and risperidone treatment

目的 观察抗精神病药在治疗的不同时间精神分裂症患者血糖代谢的变化特点，探讨预防血糖调节功能损害（IGR）的有效方法。方法 将213例住院精神分裂症患者分为氯丙嗪组（108例，200—650mg／d）和利培酮组（105例，3—6mg／d），均单一用药，分别于入院时、治疗第1，2，3，6个月末及1年末测定多项血糖浓度并进行对照研究。结果 （1）治疗后随时间延长，两组血糖浓度均不断上升。治疗第3个月末餐后2h血糖（2hPBG）和2h糖耐量（2hPG）浓度开始升高，治疗第6个月末空腹血糖（FPG）和空腹糖化血红蛋白（HbA1c）开始升高，治疗1年末所有血糖指标均升高（均P〈0．05—0．01）。（2）组内治疗前后比较，氯丙嗪组治疗第3个月末2hPG[（5．77±1．28）mmol／L]和2hPBG[（5．93±1．10）mmol／L]、治疗第6个月末HbA1c[（5．49±0．76）mmol／L]、治疗1年FPG浓度[（5．29±0．71）mmol／L]均高于治疗前[分别为（mmol／L）5．31±0．58，5．48±0．60，5．22±0．50和4．96±0．49]，均P〈0．05—0．01；利培酮组治疗1年末2hPBG浓度[（5．70±0．89）mmol／L]高于治疗前[（5．35±0．77）retool／L；P〈0．05]。（3）两组比较，氯丙嗪组治疗第3个月末2hPBG和HbA1c[（5．41±0．63）mmol／L]、治疗1年末2hPG[（5．92±1．34）mmol／L]和FPG[（5．29±0．71）mmol／L]浓度均高于利培酮组[分别为（mmol／L）5．55±0．83，5．23±0．50，5．54±0．91，5．08±0．59]，均P〈0．05—0．01。1年末，两种药物日剂量与各血糖浓度之间无显著相关性（P〉0．05）。（4）两组治疗后各时间点IGR的发生率均上升；治疗1年末，氯丙嗪组IGR发生率达36．1％，高于利培酮组（22．9％；P〈0．05）。（5）在完成1年观察的198例患者中，51例（25．8％）至少有1次符合IGR血糖浓度标准，但两组间的差异无统计学意义（P〉0．05）。结论 血糖浓度随药物治疗时间的延长而上升，其中氯丙嗪比利培酮更易引起IGR。

Objective To explore the clinical characteristics and related factors of impaired glucose regulation （IGR） in schizophrenics with one year chlorpromazine and risperidone treatment. Methods All 213 inpatients with schizophrenia were randomly divided into two treatment group, receiving monotherapy of chlorpromazine and risperidone, respectively. A series of parameters for measuring glucose metabolism were detected at baseline and after one, two, three, six and twelve month treatment. Results From three-month treatment, the blood glucose levels in the meal glucose tolerance test increased significantly as compared to the baseline in both groups, with significantly higher blood sugar level in chlorpromazine group than in risperidone group （P 〈0.05-0.01）. And after twelve month treatment, the rates of IGR were increased in both groups, with a higher rate in ehlorpromazine group （36. 1% ） than in risperidone group （22. 9% ）. Conclusion It indicates chlorpromazine have more severe effects on glucose regulation than risperidone, and the impaired glucose regulation exacerbates with treatment duration. It is necessary to make a comprehensive intervention to prevent impaired glucose regulation in antipsychotic treatment as early as possible.