不同剂量二甲双胍对抗精神病药物所致肥胖的疗效

Effects of Different Doses of Metformin on Obesity Induced by Antipsychotic Drugs

目的：探讨二甲双胍治疗抗精神病药物导致的体质量增加的疗效与剂量关系。方法将长期服抗精神病药物治疗（≥1年）伴肥胖的246例患者，按随机数字表法分为研究A组61例、研究B组62例、研究C组61例、对照组62例。研究A组、研究B组、研究C组分别给予二甲双胍750 mg·d-1、1000 mg·d-1、1500 mg·d-1治疗6个月，对照组不予干预直接随访；分别于入组前及入组后1、2、3、6个月测定身高、体质量、空腹血糖。结果各研究组体质量和BMI变化与对照组比较：研究A组在入组后1、2、3、6个月时差异均无统计学意义（均P＞0.05）；研究B组在入组后1、2个月时差异无统计学意义（均P＞0.05），在3、6个月时差异有统计学意义（体质量明显下降，均P＜0.05）；研究C组在入组后1个月时差异无统计学意义（P＞0.05），在2、3、6个月时差异有统计学意义（体质量明显下降，P＜0.05或P＜0.01）。各研究组空腹血糖减分值在各时间点差异均无统计学意义（均P＞0.05）；而在入组后6个月各研究组空腹血糖稳定或略降，对照组则呈升高趋势，各研究组血糖减分值分别与对照组比较，差异均有统计学意义（均P＜0.01）。结论二甲双胍能有效降低长期抗精神病药物治疗伴肥胖患者的体质量，其剂量在1000～1500 mg·d-1效果更明显。

Objective To investigate the effects of different doses of metformin on body weight gain induced by antipsychotic drugs. Methods A total of 246 patients who had received long-term antipsychotic treatment （≥1 year）were randomized into four groups. Group A （n=61）, B （n=62） and C （n=61） were treated with metformin 750, 1 000 and 1 500 mg·d-1 for 6 months, respectively. Control group （n=62） received no intervention. The height, weight and fasting glucose levels were measured before treatment and at 1, 2, 3 and 6 months after treatment. Results There were no significant differences in body weight and body mass index （BMI） between control group and group A at 1, 2, 3 and 6 months after treatment（P〉0.05）. Compared with control group, body mass significantly decreased in group B at 3 and 6 months after treatment and in group C at 2, 3 and 6 months after treatment （P〈0.05 or P〈0.01, respectively）. However, there were no significant differences in body mass between control group and group B at 1 and 2 months after treatment, as well as between control group and group C at 1 month after treatment （P〉0.05）. In addition,there were no significant differences in subtr-action score of fasting blood glucose among group A, group B and group C at all time points （P〉0.05）. At 6 months after treatment, patients in study groups had stable or slightly decreased fasting blood glucose levels, while patients in control group showed a rising trend in fasting blood glucose levels. The subtraction score of fasting blood glucose in control group was significantly different from that in group A, B or C （P〈0.01）.Conclusion Metformin, especially at doses of 1 000-1 500 mg·d-1, can effectively improve body weight in obesity patients who have received long-term antipsychotic treatment.