盐酸小檗碱对精神分裂症患者糖脂代谢的影响

The influence of berberine hydrochloride on glucolipid metabolism of patients with schizophrenia

目的研究盐酸小檗碱对单一使用奥氮平的精神分裂症患者糖脂代谢的疗效以及安全性,为临床治疗提供依据。方法采用随机、双盲和安慰剂对照的方法,依照《精神疾病的诊断和统计手册》第4版(DSM-IV)诊断标准,选取68例精神分裂症患者为研究对象,随机分为盐酸小檗碱组和安慰剂组。盐酸小檗碱组在原治疗基础上合并使用盐酸小檗碱300 mg,3次/d,安慰剂组合并安慰剂治疗。收集两组患者的一般资料和血样样本,检测空腹血糖(FPG)、糖化血红蛋白(Hb A1C)、空腹胰岛素(FINS)、甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(Apo-A1)、载脂蛋白B(Apo-B)和脂蛋白a[Lp(a)],并应用阳性及阴性症状量表(PANSS)、临床疗效总评量表(CGI)和不良反应量表(TESS)进行评估。治疗第12周末重复检测上述指标,根据两组治疗前后糖脂代谢变化情况,应用SPSS 17.0软件对数据进行χ2检验和t检验。结果盐酸小檗碱组治疗后FPG、Hb A1C和FINS均较治疗前明显下降,差异均有统计学意义(P<0.01),且治疗后FPG、Hb A1C和FINS与安慰剂组相比,差异均有统计学意义(P<0.01)。安慰剂组治疗后FPG、Hb A1C较基线水平升高,差异均有统计学意义(P<0.05,P<0.01),治疗前后FINS比较,差异无统计学意义(P<0.05);盐酸小檗碱组治疗后与治疗前比较,TC、TG、LDL-C、Apo-A1、Apo-B和Lp(a)水平均明显下降,差异均有统计学意义(P<0.05),HDL-C治疗前后无明显变化。两组比较,盐酸小檗碱组TC、TG、LDL-C、Apo-A1、Apo-B和Lp(a)水平均低于安慰剂组,差异均有统计学意义(P<0.05);治疗12周后,两组PANSS总分和CGI评分比较,差异均无统计学意义(P>0.05);盐酸小檗碱组血糖升高和体重增加不良反应的发生率(分别为3.23%、12.90%)明显低于安慰剂组(分别为21.88%、34.38%),差异均有统计学意义(P<0.05)。结论盐酸小檗碱能明显改善精神分裂症患者的糖脂代谢异常,奥氮平合并盐酸小檗碱用于改善精神分裂症患者的糖脂代谢异常具有良好的临床用药安全性。

Objective To evaluate the effects and safety of berberine（BBR） on glucolipid metabolism in schizophrenia patients treated with olanzapine, and to provide the basis for clinical utilization. Methods Randomized double blind and placebo controlled method was used to select 68 patients with schizophrenia treated by olanzapine as the subjects, according to DSM- Ⅳ diagnostic criteria. The subjects were randomly divided into BBR（300 mg, 3 times/day） group and placebo group. The basic data and blood samples were collected for two groups to measure the levels of FPG, Hb A1 C, Fins, TG, TC, LDL-C, HDL-C, Apo-A1, Apo-B and Lp（a）. PANSS, CGI and TESS were evaluated in this study. In 12 weeks after treatment, above indicators were measured again.Chi-square test and t test were used to analyze the data with SPSS17.0. Results The levels of FPG, Hb A1 Cand FINS after treatment were significantly lower than those before treatment in BBR group（P〈0.01）. As compared with placebo group, the levels of FPG, Hb A1 Cand FINS decreased significantly（P〈0.01）. The levels of FPG and Hb A1 C after treatment were significantly higher than those before treatment in placebo group（P〈0.05）. The level of FINS after treatment and before treatment was not significantly different in placebo group（P〉0.05）. The levels of TG, TC, LDL-C, Apo-A1, Apo-B and Lp（a） after treatment were significantly lower than those before treatment in BBR group（P 〈0.05）, but HDL-C level did not change significantly. As compared with placebo group, the levels of TG, TC, LDL-C, Apo-A1, Apo-B and Lp（a） decreased significantly（P〈0.05）. In 12 weeks after treatment, there were no significant differences of PANSS total score and CGI score between groups（P〉0.05）. The rates of adverse effects（increased blood glucose and weight） in BBR group were 3.23% and 12.90%, which were significantly lower than those（21.88% and 34.38%） in placebo group（P〈0.05）. Conclusion Berberine can significantly improve the glucolipid metabolism of schizophrenia patients with olanzapine treatment. Berberine combined with olanzapine was safety in clinical treatment for schizophrenia patients.