利培酮和氯氮平对精神分裂症患者血糖和脂代谢的影响

Effects of risperidone and clozapine on blood glucose and lipid metabolism in patients with schizophrenia

目的探讨长期使用利培酮和氯氮平对精神分裂症患者血糖和脂代谢的影响。方法收集2008年6月至2010年6月我院精神科门诊或住院首发精神分裂症患者70例,随机分为利培酮组和氯氮平组,每组35例。利培酮组采用利培酮治疗,氯氮平组采用氯氮平治疗。比较治疗前、治疗12个月后两组患者的BMI、腰围、臀围、腰臀比,FBS、TC、TG、HDL-c、LDL-c、TG/HDL-c、TC/HDL-c、ApoA1、ApoB,以及治疗12个月后糖尿病发生率。结果治疗12个月后两组患者BMI、腰围、臀围、腰臀比均较治疗前明显升高(P<0.05);但利培酮组BMI、腰围、腰臀比均明显低于氯氮平组,两组比较差异有统计学意义(P<0.05)。治疗12个月后,两组患者的FBS、TC、TG、HDL-c、LDL-c、TG/HDL-c、TC/HDL-c、ApoB均较治疗前明显升高,ApoA1较治疗前明显降低(P<0.05);但利培酮组的FBS、TC、TG、HDL-c、LDL-c、TG/HDL-c、TC/HDL-c、ApoB低于氯氮平组,ApoA1高于氯氮平组,两组比较差异有统计学意义(P<0.05);治疗12个月后,利培酮组糖尿病发生率明显低于氯氮平组(P<0.05)。结论氯氮平、利培酮均会对患者血糖、体重、脂代谢产生不良影响,而氯氮平的影响更明显,这种不良影响有可能会导致心脑血管并发症的发生和认知功能的损害。

Objective To investigate the effects of risperidone and clozapine on blood glucose and lipid me- tabolism in patients with schizophrenia. Methods 70 cases of first-episode schizophrenia patients in our hospital were selected and randomly divided into risperidone group and clozapine group, 35 cases in each group. Risperidone group were treated with risperidone, clozapine group were treated with clozapine. The BMI, waist circumference, hip circum- ference, waist-to-hip ratio, FBS, TC, TG, HDL-c, LDL-c, TG/HDL-c, TC/HDL-c, ApoAl, ApoB were recorded before treatment and at 12 months after treatment, and the incidence of diabetes in the two groups were compared. Results The BMI, waist circumference, hip circumference, waist to hip ratio of all the patients were significantly higher at 12 months after treatment （P 〈 0.05 ） ;the BMI, waist circumference, waist to hip ratio in risperidone group were signifi- cantly lower than those of clozapine group, there were significant differences between the two groups （ P 〈 0. 05 ）. The FBS,TC, TG, HDL-c, LDL-c, TG/HDL-c, TC/HDL-c, ApoB of the two groups were significantly higher at 12 months after treatment （ P 〈 0. 05 ） ; compared with clozapine group, the TG, TC, FBS, HDL-c, LDL-c, TG/HDL-c, TC/HDL- c, ApoB in risperidone group were lower, and the ApoA1 was higher,there were significant differences between the two groups （ P 〈 0. 05 ）. The diabetes incidence of risperidone group was significantly lower than that of clozapine group af- ter at 12 months of treatment （ P 〈 0.05 ）. Conclusion Both clozapine and risperidone have adverse effects on lipid metabolism, blood glucose and body weight, and the influence of clozapine is more obvious. The adverse effects may lead to the occurrence of cardiovascular complications and cognitive impairment.