利培酮所致的体质量、瘦素、瘦素基因变化与精神症状的相关性

Relation of risperidone-induced changes in body weight,serum leptin concentration and leptin gene with psychosis

目的探讨抗精神病药利培酮治疗后的体质量增加与血浆瘦素水平及瘦素基因启动子区-2548G/A多态性和精神症状减分率间有无相关性。方法利培酮单药治疗10周,测定66例患者治疗前后体质量指数(BMI)、腹围及血浆瘦素浓度;PCR-RFLP方法分析66例精神分裂症或分裂样精神病患者瘦素基因启动子区-2548G/A多态性;PANSS量表评定患者治疗前后精神症状;分析体质量指标变化值与血浆瘦素浓度、瘦素基因多态性和PANSS减分率的相关性。结果治疗后患者体质量指标均有显著性增加(P=0.000,0.002);平均BMI变化为(1.52±1.28)kg/m2,腹围为(4.08±4.32)cm。此外,血浆瘦素水平在治疗期间也有增加,但没有统计学差异(P=0.102)。基础体质量指标显著影响体质量指标变化值,差异有显著性;不同治疗时期的体质量指标显著影响相应时期的血浆瘦素水平和瘦素水平变化值,瘦素基因多态性和PANSS减分率对血浆瘦素水平或瘦素水平变化值的影响的差异均没有显著性(P>0.05)。结论瘦素基因-2548G/A多态性不是利培酮所致的体质量增加的主要遗传因素;体质量增加不是利培酮临床疗效的指标。

Objective To analyze the relation of serum leptin concentration and leptin gene -2548G/A polymorphism with risperidone-induced body weight change and treatment response. Methods We recruited 66 Chinese Han-nationality patients with schizophrenia or schizophrenia-like psychosis. Waistline and body mass index （BMI） were measured on admission and every 2 weeks subsequently for all the patients; plasma leptin level was also measured on admission, at 4-week and 10-week treatment. The polymorphism of leptin gene was determined with PCR-RFLP technique in the patients. The Positive and Negative Symptom Scale （PANSS） was used for the evaluation of the improvement of clinical symptoms. Results After 10 weeks’ risperidone treatment, patients’ waistline and BMI increased significantly （P=0.000, 0.002）. There was an average increase of （1.52±1.28）kg/m2 in BMI and （4.08±4.32）cm in waistline. In addition, leptin was increased during treatment without significance （P=0.102）. The change in index of the body weight was associated with the baseline index of the body weight. The index of the body weight was also associated with the plasma leptin level and the change in plasma leptin level. Plasma leptin level and the changed leptin level were not associated with the genotypes, allele frequencies or the response to risperidone treatment in the patients （P〉0.05）. Conclusion The -2548G/A polymorphism in promoter region of leptin gene is unlikely to play an important role in risperidone-induced weight gain. Increase in body weight is unlikely to be an indicator of response to risperidone treatment in schizophrenia or schizophrenia-like psychosis.