男性精神分裂症患者雌激素水平及药物影响研究

The Effects of Anti-schizophrenia on Serum Level of Estrogen in Male Patients with Schizophrenia

目的探讨男性精神分裂症患者雌激素水平及抗精神病药物治疗对其的影响。方法将至少3个月未服药的男性精神分裂症患者55例随机分为利培酮组(n=25)和奥氮平组(n=30),治疗12周,使用阳性和阴性症状量表(Positive and Negative Syndrome Scale,PANSS)评定临床疗效,采用放免法测定治疗前后患者血清雌激素及泌乳素水平,以12名年龄、种族等相匹配的健康男性为正常对照。结果治疗前利培酮组雌激素水平为(23.0±7.6)pg/mL、奥氮平组为(27.3±10.8)pg/mL,均明显低于正常对照组(38.1±5.4)pg/mL,差异有统计学意义(P<0.001)。利培酮组和奥氮平组基线雌激素水平的差异无统计学意义。治疗12周末,利培酮组与奥氮平组雌激素水平均较治疗前提高(P<0.001),与正常对照组相比,差异无统计学意义。与治疗前相比,利培酮组泌乳素水平升高(P<0.001),奥氮平组泌乳素水平无明显变化。治疗第12周末,利培酮组和奥氮平组PANSS总分及各因子分均显著下降(均P<0.001),两组PANSS总分及各因子分减分的差异无统计学意义。治疗前和治疗12周末,利培酮组与奥氮平组患者雌激素水平均与PANSS阴性症状分呈负相关(P<0.05)。结论精神分裂症患者存在雌激素水平异常,其阴性症状严重程度可能与其有关。

Objective To explore the relationships between estrogen （E） and negative symptoms in male pa- tients with scizophrenia treated by risperidone or olanzapine. Methods Fifty-five male inpatients with schizophrenia were randomly assigned to receive 12-week treatment with risperidone （n = 25） or olanzapine （n = 30）. Clinical efficacy was assessed using the Positive and Negative Syndrome Scale （PANSS）. Serum E was assayed before and after treatment. Results At baseline evaluation, E levels were significantly lower in patients with schizophrenia [risperidone group （23.0± 7.6） pg/mL; olanzapine group （27.3 ± 10.8） pg/mL] compared with normal control group [（38.1 ±5.4） pg/ mL, P 〈 0.001 ]. There were no significant difference in E levels between risperidone and olanzapine groups. At the end of 12-week treatment, E levels were significantly increased in both risperidone and olanzapine group compared with those at baseline （P 〈 0.001）. E levels in either risperidone group or olanzapine group were not significantly different from those of control group. Prolactin level was significantly increased in risperidone group compared with those at base- line （P 〈 0.001 ） whereas prolactin level was not significantly different before and after treatment in olanzapine group. At the end of 12-week treatment, the total and subscores of PANSS were significantly decreased in both treatment groups （P 〈 0.001 ）. There were negative relationships between E levels and the scores of negative symptoms in both risperidone and olanzapine groups before and after treatment （P 〈 0.05）. Conclusions Hypoestrogenism occurs in male patient with schizophrenia, which may be associated with severity of negative symptoms.