利培酮治疗首发精神分裂症患者1年骨密度变化的病例对照研究(英文)

Case-control study of changes in bone mineral density in drug-nave patients in the first-episode of schizophrenia during the first year of treatment with risperidone

背景长期非典型抗精神病药利培酮治疗对骨密度的影响尚不清楚。假设长期利培酮治疗会对精神分裂症患者的骨密度有不利影响。方法 28例符合中国精神障碍分类与诊断标准的首发精神分裂症患者接受1年的利培酮治疗,分别于服药前及服药后第3、6、12月进行骨密度检测,结果以T值来表示。设立32例年龄、性别和种族匹配的健康对照,于入组时和1年后进行骨密度检测。结果基线时,首发精神分裂症组的年龄、性别以及骨密度与健康对照组之间的差异无统计学意义。与对照组相比,接受利培酮治疗12个月的精神分裂症组的骨密度降低(F=15.21,P<0.001)。精神分裂症组利培酮治疗的前6个月内骨密度下降无统计学差异,在利培酮治疗的后6个月内骨密度显著下降。在20例完成12个月利培酮治疗的患者中,分别有1例(5%)和8例(40%)符合世界卫生组织关于骨质疏松和骨量减少的标准。结论长期的利培酮治疗可能会降低精神分裂症患者的骨密度,这种骨密度变化在治疗6个月后最明显。因此,少于1年的随访往往无法发现这种与抗精神病药治疗相关的骨密度变化。

Background： The long-term effect of risperidone treatment on bone mineral density remains unclear. Hypothesis： Long-term treatment with risperidone in patients with schizophrenia has adverse effects on bone min- eral density. Methods： 28 drug-ha＇i＇ve patients in their first episode of schizophrenia （diagnosed according to Chinese diagnostic criteria） were treated with risperidone for a one-year period. Bone density assessments reported as T-values （that compare the subject＇s bone density to a reference value for young persons of the same gender and race） were made at baseline and at 3,6 and 12 months after initiating treatment. Bone density measurements were also conducted in 32 healthy control subjects at the time of enrollment and 1 year after enrollment. Results： There were no statistically significant differences in the age, gender or bone density of patients and con- trols at the time of the baseline assessment, but after 12 months the decrease in bone density in the patient group （ who received risperidone treatment） was significantly greater than in the control group （ F=15.21, P 〈0. 001 ）. In the patient group there was a non-significant gradual drop in bone mineral density during the first six months of treatment and a statistically significant rapid drop during the second six months of treatment. Among the 20 patients who completed 12 months of risperidone treatment, 1 （5%） met WHO criteria for osteoporosis and another 8 （40%） meet WHO criteria for bone mass loss. Conclusion： Long-term treatment with risperidone in patients with schizophrenia is associated with reduced bone mineral density. The most pronounced drop in bone density occurs after six months of treatment so follow-up stud- ies that last less than one year may not identify clinically important changes in bone mineral density associated with use of antipsychotics medications.