阿立哌唑联合利培酮治疗对男性精神分裂症患者血清催乳素及糖脂代谢的影响

Effect of aripiprazole combined with risperidone on serum prolactin and glucose lipid metabolism in male patients with schizophrenia

目的观察阿立哌唑联合利培酮治疗对男性精神分裂症患者血清催乳素(PRL)及糖脂代谢的影响。方法将2016年10月至2017年5月在新乡医学医院第二附属医院收治的单一长期应用利培酮治疗的男性精神分裂症患者113例分为观察组和对照组。对照组59例患者给予利培酮4~6 mg·d-1,口服;观察组54例患者给予利培酮4~6 mg·d-1联合阿立哌唑10 mg·d-1,口服;疗程均为8周。于治疗前及治疗2、4、8周末测2组患者血清PRL水平;治疗前及治疗4、8周末采用阳性和阴性症状量表(PANSS)对2组患者精神症状进行评估,并测空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)水平及体质量指数(BMI)。结果治疗前2组患者血清PRL、FPG、TC、TG、HDL、LDL水平、PANSS总分、阳性症状分、阴性症状分、一般病理分及BMI比较差异无统计学意义(P>0.05)。与治疗前比较,治疗2、4、8周末对照组患者血清PRL水平升高(P<0.05),观察组患者血清PRL水平下降(P<0.05)。治疗2、4、8周末2组患者血清PRL水平不同时间点组内两两比较差异有统计学意义(P<0.05)。与对照组比较,观察组患者治疗2、4、8周末血清PRL水平显著低于对照组(P<0.05)。与治疗前比较,治疗4、8周末2组患者PANSS总分、阳性症状分、阴性症状分、一般病理分均显著降低,差异有统计学意义(P<0.05);治疗8周末2组患者PANSS总分、阳性症状分、阴性症状分、一般病理分均显著低于治疗4周末(P<0.05)。治疗4、8周末,观察组患者PANSS总分、阴性症状分、一般病理分均低于对照组(P<0.05);2组患者阳性症状分比较差异无统计学意义(P>0.05)。对照组患者治疗4、8周末FPG、TC、TG、HDL、LDL水平及BMI与治疗前比较差异无统计学意义(P>0.05);观察组患者治疗4周末FPG、TC、TG、HDL、LDL水平及BMI与治疗前比较差异无统计学意义(P>0.05),治疗8周末FPG、TC、TG、HDL水平与治疗前及治疗4周末比较差异无统计学意义(P>0.05),LDL水平及BMI低于治疗前及治疗4周末(P<0.05)。观察组患者治疗4周末FPG、TC、TG、HDL、LDL水平及BMI与对照组比较差异无统计学意义(P>0.05);治疗8周末FPG、TC、TG、HDL水平与对照组比较差异无统计学意义(P>0.05),LDL水平及BMI低于对照组(P<0.05)。治疗8周末,对照组患者静坐不能、口干、嗜睡、震颤、恶心、流涎发生率分别为5.08%、10.16%、10.16%、15.25%、6.77%、11.86%,观察组患者静坐不能、口干、嗜睡、震颤、恶心、流涎发生率分别为3.70%、14.81%、9.25%、16.67%、11.11%、9.26%,2组患者静坐不能、口干、嗜睡、震颤、恶心、流涎发生率比较差异无统计学意义(χ~2=0.207、0.106、0.159、0.326、0.091、0.162,P>0.05)。结论阿立哌唑联合利培酮治疗男性精分裂症患者有益于降低利培酮诱导的血清高PRL水平并改善患者脂代谢。

Objective To explore the effect of aripiprazole combined with risperidone on serum prolactin and glucolipid metabolism in male patients with schizophrenia. Methods A total of 113 male patients with schizophrenia who were treated with risperidone in the Second Affiliated Hospital of Xinxiang Medical University from October 2016 to May 2017 were selected. The patients were randomly divided into observation group and control group. Fifty-nine patients in the control group were given risperidone 4-6 mg·d-1 orally,while fifty-four patients in the observation group were given risperidone 4-6 mg·d-1 combined with aripiprazole 10 mg·d-1 orally,the course of treatment was 8 weeks. The serum prolactin（PRL） levels were measured before treatment and at 2,4,8 weeks after treatment. Positive and negative syndrome scale（PANSS） was used to evaluated the psychiatric symptoms in the two groups before treatment and at 4,8 weeks after treatment. The levels of fasting plasma glucose（FPG）,total cholesterol（TC）,triglyceride（TG）,low density lipoprotein（LDL）,high density lipoprotein（HDL）,body mass index（BMI） were measured in the two groups before treatment and at 4,8 weeks after treatment. Results A total of 113 patients completed the experiment,with 53 cases in the observation group and 59 cases in the control group. There was no significant difference in the level of PRL,FPG,TC,TG,HDL,LDL and the total score,positive symptom score,negative symptom score,general pathologic score of PANSS and BMI between the two groups before treatment（P〈0. 05）. At 2,4,8 weeks after treatment,the level of PRL in the control group was higher than that before treatment（P〈0. 05）,and in the observation group it was lower than that before treatment（P〈0. 05）. Compared between any two time points,there was significant difference in the PRL level at 2,4,8 weeks after treatment in the two groups（P〈0. 05）. Compared with the control group,the level of PRL in the treatment group was significantly lower at 2,4,8 weeks after treatment（P〈0. 01）. The total score,positive symptom score,negative symptom score,general pathologic score of PANSS in the two groups at 4,8 weeks after treatment were lower than those before treatment and at 4 weeks after treatment（P〈0. 05）. The total score,positive symptom score,negative symptom score,general pathologic score of PANSS in the two groups at 8 weeks after treatment were lower than those at 4 weeks after treatment（P〈0. 05）. The total score,negative symptom score,general pathologic score of PANSS in the observation group at 4,8 weeks after treatment were lower than those in the control group（P〈0. 05）,but there was no significant difference in the positive symptom score of PANSS between the two groups at 4,8 weeks after treatment（P〈0. 05）. There was no significant difference in the level of FPG,TC,TG,HDL,LDL and BMI in the control group at 4,8 weeks after treatment compared with that before treatment（P〈0. 05）. There was no significant difference in the level of FPG,TC,TG,HDL,LDL and BMI in the observation group at 4 weeks after treatment compared with that before treatment（P〈0. 05）. There was no significant difference in the level of FPG,TC,TG,HDL in the observation group at 8 weeks after treatment compared with that before treatment and at 4 weeks after treatment（P〈0. 05）. But the level of LDL and BMI in the observation group at 8 weeks after treatment were lower than those before treatment and at 4 weeks after treatment（P〈0. 05）. There was no significant difference in the level of FPG,TC,TG,HDL,LDL and BMI between the observation group and the control group at 4 weeks after treatment（P〈0. 05）. There was no significant difference in the level of FPG,TC,TG,HDL between the observation group and the control group at 8 weeks after treatment（P〈0. 05）. But the level of LDL and BMI in the observation group at 8 weeks after treatment were lower than those in the control group（P〈0. 05）. At 8 weeks after treatment,the incidence rate of akathisia,thirst,somnolence,tremor,nausea and salivation in the control group was 5. 08%,10. 16%,10. 16%,15. 25%,6. 77%,11. 86%,respectively; the incidence rate of akathisia,thirst,somnolence,tremor,nausea and salivation in the observation group was 3. 70%,14. 81%,9. 25%,16. 67%,11. 11%,9. 26%,respectively. There was no significant difference in the incidence rate of akathisia,thirst,somnolence,tremor,nausea and salivation between the two groups（χ-2= 0. 207,0. 106,0. 159,0. 326,0. 091,0. 162;P〉0. 05）. Conclusion Risperidone combined with aripiprazole in the treatment of male schizophrenia patients is beneficial to reduce the level of serum high PRL induced by risperidone and to improve lipid metabolism.