首发精神分裂症患者抗精神病药物治疗与代谢相关指标变化的关系

Relationship between antipsychotic medication and metabolic indicator changes in patients with first-episode schizophrenia

目的:观察奥氮平和阿立哌唑治疗前后,首发精神分裂症患者体重指数、瘦素及生长激素刺激肽的变化。方法:共99例门诊或住院的首发精神分裂症患者,随机选用奥氮平或阿立哌唑治疗,均单一用药。分别于治疗前、4周末、8周末及24周末测定体重指数,并进行瘦素和生长激素刺激肽测定,以阳性和阴性症状量表(PANSS)评定病情变化及疗效。结果:经奥氮平或阿立哌唑治疗后精神分裂症患者的血清瘦素水平均有不同程度的升高,并与体重指数呈正相关,且这种变化在治疗初期(4周末)即已显现,并持续至24周末。治疗后生长激素刺激肽与治疗后体重指数的相关性仅在阿立哌唑组观察到(r=-0.291,P<0.05)。结论:首发精神分裂症患者经奥氮平或阿立哌唑治疗,持续存在不同程度的瘦素水平升高;奥氮平组体重指数与血清瘦素水平的相关性较显著,而阿立哌唑组则与生长激素刺激肽水平的相关性较显著;阿立哌唑对体重指数的影响可能通过生长激素刺激肽的作用来实现。

AIM：To observe the changes of metabolic indicators in the treatment of first-episode schizophrenia with olanzapine or aripiprazole. METHODS：A total of 99 cases of first-episode schizophrenia inpatients randomly received olanzapine or aripiprazole treatment. Body mass index （BMI） and serum levels of leptin and ghrelin were measured before treatment and at the end of the 4th, 8th and 24th weeks during treatment. The status of the patients and the therapeutic efficacy were assessed using the Positive and Negative Syndrome Scale （PANSS）. RESULTS：Serum leptin level in these schizophrenia patients was elevated after treatment with olanzapine or aripiprazole, and was positively correlated with BMI. This change appeared at the early stage of treatment （the end of the 4th week）, and continued to the end of the 24th week. The relationship between serum ghrelin level and BMI after treatment was only observed in aripiprazole group （r=-0291, P〈0.05）. CONCLUSION：Serum leptin in first-episode schizophrenia patients after olanzapine or aripiprazole treatment remains at a high level. The correlation between BMI and serum leptin level is more significant in olanzapine group, while more significant correlation between BMI and serum ghrelin level is observed in aripiprazole group. The effect of aripiprazole on BMI may be achieved through the action of ghrelin.