3种抗精神病药物治疗精神分裂症对糖脂代谢、肝功能及心功能的影响

Effects of three antipsychotic drugs on glucose and lipid metabolism,liver function and cardiac function in patients with schizophrenia

目的:探讨3种抗精神病药物治疗精神分裂症对糖脂代谢、肝功能及心功能的影响。方法:选取精神分裂症患者145例为研究对象,按照随机数表法分为奥氮平组(n=50)、利培酮组(n=46)和喹硫平组(n=49),各组疗程均为8周。观察各组治疗前后阳性和阴性症状量表(PANSS)评分,威斯康星卡片分类测验(WCST)评分;比较各组治疗前后糖脂代谢指标空腹血糖(FBS)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)和低密度脂蛋白-胆固醇(LDL-C),肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)和心功能指标左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及左室射血分数(LVEF);采用副反应量表(TESS)评估各组不良反应情况。结果:治疗8周后,各组PANSS评分明显降低(P<0.05),组间比较,差异无统计学意义(P>0.05);WCST总正确数、完成分类数评分明显升高(P<0.05),持续错误数、随机错误数评分明显下降(P<0.05),组间比较,差异无统计学意义(P>0.05);FBS、TC、TG、LDL-C水平明显升高(P<0.05),HDL-C水平显著下降(P<0.05),组间比较,差异无统计学意义(P>0.05);LVEDD、LVESD和LVEF指标较治疗前降低(P<0.05),组间比较,差异无统计学意义(P>0.05);利培酮组和喹硫平组TESS评分均低于奥氮平组(P<0.05),利培酮组和喹硫平组比较,差异无统计学意义(P>0.05)。治疗前后,各组肝功能指标总异常率比较,差异无统计学意义(P>0.05)。结论:奥氮平、利培酮和喹硫平均可有效改善精神分裂症患者的精神症状和认知功能,对糖脂代谢、肝功能和心功能影响较小。利培酮和喹硫平不良反应较轻,具有较好的应用价值。

Objective:To investigate the effects of three antipsychotic drugs on glucose and lipid metabolism,liver function and heart function in the treatment of schizophrenia.Methods:145 cases of schizophrenic patients were selected as research objects.They were divided into olanzapine group(50 cases),risperidone group(46 cases)and quetiapine group(49 cases)according to the random table method.The treatment course of each group was 8 weeks.The score of positive and negative symptom scale(PANSS)and Wisconsin card classification test(WCST)were observed before and after treatment.Comparison between groups before and after treatment glucolipid metabolism index fasting blood sugar(FBS),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C),liver function index of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL)and cardiac function index of left ventricular end-diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)and left ventricular ejection fraction(LVEF),adverse reactions were assessed by TESS.Results:After 8 weeks of treatment,PANSS score was significantly reduced(P<0.05),and there was no significant difference between the groups(P>0.05).The total correct number and the number of completed classification scores were significantly increased(P<0.05),the number of persistent errors and random errors were significantly decreased(P<0.05),and there was no significant difference between groups(P>0.05).After 8 weeks of treatment,FBS,TC,TG and LDL-C levels were significantly increased(P<0.05),and HDL-C levels were significantly decreased(P<0.05).There was no significant difference between groups(P>0.05).After 8 weeks of treatment,LVEDD,LVESD and LVEF indexes were lower than those before treatment(P<0.05),and there was no significant difference between groups(P>0.05).After 8 weeks of treatment,TESS score of risperidone group and quetiapine group was lower than that of the olanzapine group(P<0.05),while there was no significant difference between risperidone group and quetiapine group(P>0.05).Before and after treatment,there was no statistically significant difference in the total abnormal rate of liver function indicators in each group(P>0.05).Conclusion:Olanzapine,risperidone and quetiapine can effectively improve the mental symptoms and cognitive function of patients with schizophrenia,but have little effect on glucose and lipid metabolism,liver function and heart function.Risperidone and quetiapine have mild adverse reactions and have good application value.