利培酮治疗首发精神分裂症的血药浓度与副反应、糖脂代谢的影响

Relationship between serum concentration of risperidone and its side effects and glycolipid metabolism in schizophrenic patients with first-episode

目的观察利培酮的血药浓度治疗首发精神分裂症患者的临床疗效、副反应的相关性及其对血糖、血脂的影响。方法以82例首发精神分裂症患者为研究对象,于治疗前及治疗第2、4、8周末监测患者血药浓度、血糖(Glu)、总胆固醇(Tch)、三酰甘油(TG),同时采用阳性与阴性症状量表(PANSS)评定患者的临床症状及疗效,用不良反应症状量表(TESS)评定副反应。结果与治疗前相比较,在第2、4、8周末PANSS的减分均有显著性降低(P<0.01),但第4周末与第8周末的减分率无明显差异(P>0.05);利培酮与9-羟利培酮血药浓度与TESS评分呈正相关(r>0.50,P<0.05),随着血药浓度的增加,血糖、血脂均有不同程度的升高,差别有显著性(P<0.05)。结论随着利培酮和9-羟利培酮血药浓度的升高,疗效不一定增加,但副反应的可能性增加,同时会对血糖、血脂产生影响。

Objective To explore the relationship between serum concentration of risperidone and clinical side effects and glycolipid metabolism in schizophrenic patients with first-episode.Methods 82 schizophrenic patients with first-episode were treated with single-dosage risperidone for 8 weeks.The serum concentration of risperidone,blood glucose（Glu）,total cholesterol in the blood fat（Tch）,triglycerides（TG） were tested at baseline,week 2,4and 8.Efficacy and adverse events were assessed by the positive and negative symptom scale（PANSS） and the treatment emergent symptom scale（TESS）.Results PANSS total scores significantly decreased（P〈0.01） in the end of 2th,4th,8th week treatment,but the scores did not continue to decrease at the end of 8th week treatment compared with the 4th week（P〉0.05）.The serum concentrations of risperidone and 9-hydroxyl risperidone showed a weak relationship with the scores of TESS（r〉 0.50,P〈 0.05）.Blood glucose,total cholesterol in the blood fat,triglycerides significantly increased with the blood drug concentration increased.Conclusions When serum levels of risperidone and 9-hydroxyl risperidone are higher than threshold concentration,the clinical effects may be not improved,but the rate of adverse events,blood glucose and blood fat may increase.