精神分裂症患者服用抗精神病药导致糖尿病的临床分析

Clinical analysis of diabetes mellitus caused by antipsychotics in patients with schizophrenia

目的探讨分析精神分裂患者服用抗精神病药导致糖尿病(diabetes mellitus,DM)的临床情况,以为临床防治提供依据。方法选取2014年5月至2017年12月收治的精神分裂患者276例,根据治疗药物的不同分为A组(采用氯氮平治疗)、B组(采用奥氮平治疗)、C组(采用齐拉西酮治疗)和D组(采用阿立哌唑治疗),每组69例。观察比较上述药物对血糖、血脂、BMI的影响及DM检出率。结果A、B组患者治疗后空腹血糖、餐后2 h血糖、糖化血红蛋白、总胆固醇、三酰甘油、BMI较治疗前差异有统计学意义(P<0.05)。C、D组患者上述指标与治疗前对比无明显变化,与A、B组比较差异有统计学意义(P<0.05)。患者不良反应发生率B、C、D组与A组比较差异有统计学意义(P<0.05);C、D组与B组比较差异有统计学意义(P<0.05);C、D组间比较差异无统计学意义(P>0.05)。患者糖尿病、体重增加检出率C、D组与A、B组比较差异有统计学意义(P<0.05);A、B组间比较差异无统计学意义(P>0.05)。结论部分抗精神分裂症药物如氯氮平、奥氮平可诱发糖尿病,而齐拉西酮、阿立哌唑等对代谢影响小,安全性好,适合临床推广。

Objective To investigate the clinical status of diabetes mellitus(DM)caused by antipsychotics in patients with schizophrenia in order to provide evidence for clinical prevention and treatment.Methods A total of 276 patients with schizophrenia who were admitted and treated in our hospital from May 2014 to December 2017 were enrolled in the study,who were divided into group A(clozapine treatment)and group B(olanzapine treatment)according to different medications.The patients in group C were treated by ziprasidone,and the patients in group D were treated by aripiprazole,with 69 cases in each group.The effects of the above drugs on blood glucose,blood lipids,BMI and the detection rate of DM were observed and compared among the four groups.Results After treatment the levels of fasting blood glucose,2h postprandial blood glucose,glycosylated hemoglobin,total cholesterol,triglyceride and BMI in group A and B were significantly lower than those before treatment(P<0.05).However there were no significant differences in the above indexes in group C and group D before treatment and after treatment(P>0.05),however,there were significant differences in the above indexes between group C,group D and group A,group B(P<0.05).Moreover the incidence rates of adverse reactions in group A,B,C and D were 50.72%,36.23%,18.84%and 8.7%,respectively,there were significant differences in the incidence rates of adverse reactions between group B,C,D and group A,and between group C,D and group B(P<0.05),however,there were no significant differences in the above indexes between group C and group D(P>0.05).In addition the detection rates of DM and weight gain were significant differences between group C,D and group A,B(P<0.05),however,there were no significant differences between group A and group B(P>0.05).Conclusion The partial anti-schizophrenia drugs including clozapine and olanzapine can induce DM,while ziprasidone and aripiprazole have little effect on metabolism,with goof safety,thus,which are suitable for clinical promotion.