从中医角度浅述抗精神病药物所致代谢综合征

On Metabolic Syndrome Caused by Antipsychotic Drugs from the Perspective of Chinese Medicine

中医从痰瘀论治抗精神病药物所致代谢综合征,以扶正祛邪、化痰活血、健脾益肾为主要治则,通过辨证论治组成中药配方,在病变的早期阶段利湿化痰为主,中期理气化痰活血为主,后期温补脾肾、调和阴阳为主,可改善患者血脂、体质量、血糖等水平,减轻抗精神药物的不良反应,提高患者生活质量,从而提高患者服药依从性,降低精神疾病复发率。但目前研究存在如下问题:①缺乏抗精神病药物所致代谢综合征的中医临床流行病学调查研究;②目前各个医家对抗精神病药物所致代谢综合征的辨证依据和辨证分型不一致,缺乏证候学、体质学和证候动态演变规律研究;③临床科研设计过于简单,缺乏前瞻性临床研究,缺乏多中心、大样本的研究;④已有研究表明瘦素、食欲素A、炎症因子等参与了代谢综合征的发生发展,但缺乏对抗精神病药物所致代谢综合征的中医干预性生物学研究。因此,对症状、证候进行规范,把抗精神病药物所致代谢综合征作为一个整体进行统一的分阶段辨证分型治疗,加强对抗精神病药物所致代谢综合征的干预性生物学研究是今后研究的方向。

TCM treats the metabolic syndrome caused by antipsychotic drugs from phlegm and blood stasis,with the main treatment principles of strengthening the vital qi and removing pathogenic factors,resolving phlegm and activating blood circulation,strengthening the spleen and benefiting the kidney as the main treatment principle.TCM prescription is composed by syndrome differentiation and treatment.In the early stage of the disease,it is mainly to promote dampness and phlegm,in the middle stage,it is mainly to regulate qi,phlegm and blood circulation,in the later stage,it is mainly to warm the spleen and kidney,regulate yin and yang,which can improve the blood lipid,body mass,blood sugar and other levels of patients,reduce the adverse reactions of antipsychotics,improve the quality of life of patients,so as to improve the compliance of patients with medication and reduce the recurrence rate of mental illness.However,the current research has the following problems:①There is a lack of TCM clinical epidemiological investigation on metabolic syndrome caused by antipsychotics.②At present,there is a lack of research on syndrome differentiation basis and syndrome differentiation type of various physicians,and there is a lack of research on syndrome waiting,physique and dynamic evolution of syndrome.③The design of clinical research is too simple,lack of prospective clinical research,lack of multi center,large sample research.④The existing research shows that leptin,orexin A,inflammatory factors,etc.participate in the occurrence and development of metabolic syndrome,but lack of TCM intervention biological research on metabolic syndrome caused by antipsychotics.Therefore,the future research direction is to standardize the symptoms and syndromes,to treat the metabolic syndrome caused by antipsychotics as a whole,and to strengthen the intervention biological research of the metabolic syndrome caused by antipsychotics.