氯氮平对儿童少年精神分裂症患者肝脏功能的影响

Influence of clozapine on liver function of hobbledehoy schizophrenics

目的通过动态检测青少年精神分裂症患者氯氮平治疗后多项生化指标的变化,了解患者用药过程中肝脏功能损害和适应性。方法选取未经治疗的首发青少年精神分裂症患者70例,于治疗前和治疗2周-6周每周末及7周以上时段,检测患者血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、乳酸脱氢酶（LDH）、γ-谷氨酰转肽酶（γ-GT）、胆碱酯酶（CHE）、总胆汁酸（TBA）、总胆红素（T-Bil）、直接胆红素（D-Bil）、间接胆红素（I-Bil）、总蛋白（TP）、白蛋白（ALB）、球蛋白（GLO）、前白蛋白（P-ALB）,并同时于2、4、6、8周采用简明精神病评定量表（BPRS）和副反应量表（TESS）评定疗效和副反应。结果患者BPRS和TESS量表评分,治疗前后相比较均具有显著性差异（P〈0.05）,治疗2周与其它周相比差异具有显著性（P〈0.05）。ALT、AST、ALP、γ-GT趋势性变化明显,用药2周时上升至高峰,第3周下降至治疗前水平,甚至略低于治疗前,第4周又升高,第5周以后逐渐下降,并维持在略高于治疗前水平;LDH从第2周开始上升,第4周达高峰,然后逐渐下降,第6周后维持在略高于治疗前水平;T-Bil、I-Bil治疗2周-6周显著低于治疗前（P〈0.05-P〈0.01）,7周后恢复到治疗前水平（P〉0.05）;D-Bil在治疗2周及4周时低于治疗前（P〈0.05）;P-ALB在治疗3、4、6周及7周以上时显著高于治疗前（P〈0.05）;CHE、TBA、TP、ALB、GLO治疗前后始终无显著性改变（P〉0.05）。治疗第3周与其它周比较,ALT均具有显著性差异（P〈0.01）,而其它项目差异无显著性（P〉0.05）。结论氯氮平治疗青少年精神分裂症疗效确切,引起的肝脏损害具有规律性,且较轻微,随着治疗的深入,人体可以逐渐适应用药状况。

Objective To test several kinds of biochemical indexes in hobbledehoy schizophrenics who were treated by clozapine dynamically and to explore the damage and the adaptability of the liver function according the change of these indexes. Methods A total of 70 untreated hobbledehoys with first-episode schizophrenia were enrolled this study. The enzyme levels were measured before and 2-7 weeks after treatment which including ALT, AST, ALP, LDH,γ-GT, CHE, TBA, T-Bil, D-Bil, I-Bil, TP, ALB, GLO, P-ALB. The curative effect and side reaction were evaluated with BPRS and TESS. Results The scores of BPRS and TESS had significant differences between before and after treatment（P〈0.05）. There had significant differences between the first 2 weeks＇ treatment and the other weeks（P〈0.05）. The trend pattern of ALT,AST,ALP and γ-GT changed obviously,they rose up to the peak after two weeks＇ treatment, dropped to the same as before treatment,even a little lower in the third week,rose again in the forth week,dropped gradually after the fifth week,and kept the level a little higher than before treatment. LDH began rise after the second week,reached the peak in the forth week,and then dropped gradually,and kept the level a little higher than before treatment after the sixth week. The levels of T-Bil and I-Bil at 2-6 week treatment were significantly lower than before treatment （P〈0.05-P〈0.01） ,and dropped to the same as before treatment after 7 weeks（P〉0.05）. The levels of D-Bil after 2 and 4 weeks treatment were significantly lower than that before treatment（P〉0.05）. The levels of P-ALB at 3nd, 4th, 6th, 7th and 8th week were significantly higher than before treatment（P〈0.05）. The levels of CHE,TBA,TP.ALB.GLO had no significant change after treatment（P〉0.05）. The level of ALT at third week and other weeks has significant differences（P〈0.01）. The other items had no significant change after treatment. Conclusion Clozapine is effective for hobbledehoy schizophrenics, the liver damage has regularity and is light. The damage can be adapt gradually with treatment.