非典型抗精神病药对男性精神分裂症患者勃起功能及血浆催乳素水平的影响

The influence of atypical antipsychotics on erectile function and plasma prolactin concentrations in male schizophrenic patients of convalescence period

目的:探讨非典型抗精神病药(AAP)对恢复期男性精神分裂症患者勃起功能及血浆催乳素(PRL)水平的影响。方法:采用国际勃起功能指数-5问卷(IIEF-5)对以氯氮平、喹硫平、奥氮平、利培酮、阿立哌唑、氨磺必利、帕利哌酮及齐拉西酮单一治疗≥6个月、具有稳定性伴侣的恢复期男性精神分裂症患者各30例进行总体勃起功能障碍(ED)评定,以IIEF-5≤21分定义为ED;同时采用放免法检测患者的血浆PRL水平。结果:ED发生率氨磺必利组显著高于氯氮平组、喹硫平组及阿立哌唑组(P均<0.001),利培酮组显著高于阿立哌唑组(P<0.01)。血浆PRL水平氨磺必利组、齐拉西酮组及利培酮组显著高于氯氮平组、喹硫平组、奥氮平组及阿立哌唑组(P均<0.001),帕利哌酮组显著高于阿立哌唑组(P<0.001)。IIEF-5评分与全部患者及氨磺必利组、帕利哌酮组和齐拉西酮组血浆PRL水平呈正相关(P均<0.001)。结论:AAP中氨磺必利较易导致ED,利培酮次之;且氨磺必利、齐拉西酮及利培酮可能导致血浆PRL水平增高。

Objective： To explore the influence of atypical antipsychotics（ AAP） on erectile function and plasma prolactin（ PRL） concentration in male schizophrenic patients of convalescence period. Method： Total240 male schizophrenic patients in convalescence period,who were living with a stable sexual partner and receiving single AAP（ clozapine,quetiapine,olanzapine,risperidone,aripiprazole,amisulpride,paliperidone and ziprasidone,30 cases in each AAP group,respectively） for at least 6 months were recruited. Erectile dysfunction（ ED） was assessed using the international index of erectile function（ IIEF-5）,and IIEF-5≤21 was defined as ED. The level of plasma PRL was detected by double antibody radioimmunoassay（ RIA）. Results： The incidence of ED in amisulpride group was significantly higher than groups of clozapine,quetiapine and aripiprazole（ all P〈0. 001）; and also risperidone group was significantly higher than aripiprazole groups（ P〈0. 01）. The levels of plasma PRL in groups of amisulpride,ziprasidone and risperidone were significantly higher than groups of clozapine,quetiapine,olanzapine and aripiprazole（ all P〈0. 001）; also which in paliperidone group was significantly higher than aripiprazole groups（ P〈0. 001）. The IIEF-5 score was positive correlated with the levels of plasma PRL in whole patients and the groups of amisulpride,paliperidone,ziprasidone（ all P〈0. 001）.Conclusion： Among AAPs,amisulpride can easily lead to ED,and so can risperidone. Amisulpride,ziprasidone and risperidone can easily lead to increase the level of plasma PRL.