新型抗精神病药物对肝功能的影响及帕利哌酮的优势

The effect of atypical antipsychotic on liver function of schizophrenia patients and paliperidone' superiority

目的探索新型抗精神病药对肝功能的影响,以及帕利哌酮与其他新型抗精神病药相比是否具有优势。方法采用病例回顾研究方法,收集2010年1月-2014年2月北京回龙观医院新入院精神分裂症患者91例,均符合《国际疾病分类(第10版)》(ICD-10)诊断标准。给予单一或联合新型抗精神病药系统治疗,于治疗前后检测血清丙氨酸转氨酶(ALT)、门冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、血清总胆汁酸(TBA)、总胆红素(T-BIL)、直接胆红素(D-BIL)、间接胆红素(I-BIL)、白蛋白/球蛋白(A/G)水平。结果使用新型抗精神病药物治疗后肝功能异常率为14.28%。用药后ALT、GGT、TBA水平增加,ALT、TBA异常率增加,差异有统计学意义(P<0.05)。T-BIL、D-BIL、I-BIL水平下降,I-BIL异常率下降,差异有统计学意义(P<0.05)。方差分析显示,帕利哌酮组、利培酮组和其他组三组间血清ALT水平差异有统计学意义(F=3.664,P=0.03),多重比较显示,帕利哌酮组分别与其他两组血清ALT水平差异有统计学意义(P<0.05)。结论新型抗精神病药物对肝功能的影响主要体现在对肝细胞实质的影响。帕利哌酮与其他新型抗精神病药相比对肝脏的安全性更好。

Objective To explore the effect of atypical antipsychotics on liver function and paliperidonebuperiority compared to other atypical antipsychotics. Methods With retrospective study method, data related to liver function of newly admitted schizophrenic patients during 2010 -2014 before and after taking atypical antipsychotics was collected, including alanine aminotransferase （ALT）, aspartate aminotransferase （ AST）, glutamyl transpeptidase （ GGT）, serum total bile acid （ TBA）, total bilirubin （ T - BIL）, direct bilirubin （ D - BIL）, indirect bilirubin （ I - BIL）, albumin / globulin （A/G）. The differences before and after treatment were ana- lyzed by paired t test and chi square test. The effect of atypical antipsychotics was analyzed by ANOVA. Results The rate of liver function abnormality after atypical antipsyehotic treatment was 14.28%. The level of ALT, GGT,TBA increased, the abnormal rate of ALT,TBA increased after treatment （P 〈0.05）. The level of T - BIL,D - BILl - BIL decreased, the abnormal rate of I - BIL de- creased after treatment （ P 〈 0.05 ）. Compared groups of Paliperidone ,Risperidone and others, the differences of ALT had statistical sig- nificance （P 〈 0.05 ）. The group of Paliperidone compared with other groups, the differences of ALT had statistical significance （P 〈 0.05）. Conclusion Effect of atypical antipsychotie on liver function is mainly on liver cell essence. ALT,TBA,I - BIL are the most sensitive indexs to evaluation liver damage induced by drugs. Paliperidone is more secure to liver compared with other atypical antipsy- ehotics.