抗精神病药对肝脏酶学及检测方法的影响

The Effect of Antipsychotic Agents to Liver Enzyme and Examination Method

目的探讨3种抗精神病药物(氯氮平、氯丙嗪、利培酮)对精神分裂症患者肝脏相关酶学的影响及对其检测方法的干扰。方法应用日立7060C全自动生化分析仪,对我院单一服用氯氮平、氯丙嗪和利培酮的精神分裂症患者各40例,取0、4、8、12周血清分别测定其肝脏相关指标,运用重复测量方差分析进行服药前后比较。并在正常混合血清添加不同浓度的3种药物,进行其检测方法的干扰试验。结果①服用氯氮平后,天冬氨酸转移酶(AST)、丙氨酸转移酶(ALT)均有升高趋势,8、12周后有明显升高。服用氯丙嗪12周后,AST、ALT、升高有统计学意义。服用利培酮后患者AST、ALT有升高的趋势,但升高无统计学意义。②体外药物干扰试验显示,氯氮平在(0.8 mg/L)对AST、ALT的检测存在正向干扰,使检测结果升高;氯丙嗪在(0.8 mg/L)对AST的检测可能存在正向干扰,使检测结果升高,利培酮未发现对这些项目检测方法的干扰。结论服用(氯氮平、氯丙嗪和利培酮)均对患者肝脏有不同程度的损伤,主要是氯氮平和氯丙嗪,但肝脏酶学的升高并不完全是肝脏损伤所导致,部分是由于一定浓度的药物对相应肝脏酶学检测方法产生干扰所致。

Objective To explore the effect of the three kinds of antipsychotic agents（clozapine,chlorpromazine,risperidone）on liver enzyme in patients with schizophrenia and discuss the interference of the three kinds of anti-psychotics to detective methods.Methods To use the Hitachi 7060C automatic biological and chemical analyzer and to take each 40 samples with clozapine,chlorpromazine,risperidone in mental hospital of Yunnan and determine liver enzyme on 0,4,8,12 weeks,the results were compared between before treatment and after treatment with repeated measures analysis of variance.Then adding three kinds of medicine with different concentration to the normal mixed serum,the interference tests about detection methods of liver enzyme were carry out.Results ①After taking clozapine,AST and ALT tended to increase,after 8 and 12 weeks,the level of AST and ALT are obviously increased.After taking chlorpromazine 12 weeks,AST,ALT increased significantly.After taking risperidone,AST,ALT has increased,but no significant different（P0.05）.②The interference tests outside the body indicated that clozapine in（0.8 mg/L）on the AST,ALT testing have a positive interference,to the test results increased,chlorpromazine in（0.8 mg/L）on the AST testing have a positive interference,so the test results increased.Risperidone did not detect the interference detection of these projects.Conclusion Taking（clozapine,chlorpromazine and risperidone）are on different levels in patients with liver damage,mainly clozapine and chlorpromazine,liver enzyme elevation is not entirely the result of liver damage.Part of a liver enzyme increase is due to the influence of drugs.