利培酮、奥氮平、帕利哌酮对首发女性精神分裂症患者腰围和相关代谢指标的影响

Effects of Risperidone,Olanzapine and Paliperidone on Waist Circumference and Related Metabolic Indicators in Female Patients with First-episode Schizophrenia

目的探讨利培酮、奥氮平、帕利哌酮对首发女性精神分裂症(SP)患者腰围和相关代谢指标的影响。方法将126例首发女性SZ患者分为利培酮组(40例)、奥氮平组(42例)、帕利哌酮组(44例),分别给予利培酮、奥氮平、帕利哌酮单药治疗8周,比较治疗前后阳性和阴性症状量表(PANSS)评分、体质量指数(BMI)、腰围、空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)及不良反应。结果3组治疗后PANSS各因子及总分均明显降低(P<0.05),奥氮平组阳性症状评分明显低于利培酮组(P<0.05),帕利哌酮组阳性症状、阴性症状及总分均低于利培酮组、奥氮平组(P<0.05),3组一般精神病理评分无显著差异(P>0.05);帕利哌酮组治疗后BMI无明显变化(P>0.05),奥氮平组和利培酮组治疗后BMI均明显升高(P<0.05),奥氮平组BMI高于利培酮组(P<0.05);3组治疗后腰围均明显大于治疗前(P<0.05),奥氮平组和利培酮组腰围大于帕利哌酮组(P<0.05),奥氮平组腰围大于利培酮组(P<0.05);利培酮组和帕利哌酮组治疗后FPG均无明显变化(P>0.05),奥氮平组治疗后FPG明显升高(P<0.05),帕利哌酮组治疗后TG、TC、LDL、HDL均无明显变化(P>0.05),利培酮组和奥氮平组治疗后TG、TC、LDL均明显升高(P<0.05),HDL明显降低(P<0.05);利培酮组和奥氮平组治疗后TG、TC、LDL均明显高于帕利哌酮组(P<0.05),HDL明显低于帕利哌酮组(P<0.05),利培酮组和奥氮平组TG、TC、LDL、HDL无显著差异(P>0.05);3组不良反应发生率无显著差异(P>0.05)。结论利培酮、奥氮平、帕利哌酮治疗首发女性SP疗效相当,但奥氮平对患者腰围、BMI及糖脂代谢的影响最大,利培酮次之,帕利哌酮最小。

Objective To explore the effects of risperidone,olanzapine and paliperidone on waist circumference and related metabolic indexes in female patients with first-episode schizophrenia(SP).Methods A total of 126 female patients with first-episode SZ were divided into risperidone group(40 cases),olanzapine group(42 cases)and paliperidone group(44 cases),and they were given monotherapy of risperidone,olanzapine and paliperidone for 8w respectively.The positive and negative symptom scale(PANSS)score,body mass index(BMI),waist circumference,fasting plasma glucose(FPG),triglyceride(TG),total cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL)and adverse reactions were compared before and after the treatment. Results The factor scores and total score of PANSS in the three groups were significantly decreased after the treatment(P<0.05), and the scores of positive symptoms in olanzapine group were significantly lower than those in risperidone group (P<0.05), and the scores of positive symptoms and negative symptoms and total score in paliperidone group were lower than those in risperidone group and olanzapine group (P<0.05), and there was no significant difference in the general pathology score among the three groups (P > 0.05). There was no significant change in the BMI after the treatment in paliperidone group (P > 0.05), and BMI was significantly increased in olanzapine group and risperidone group after the treatment (P<0.05), and the BMI in olanzapine group was higher than that in risperidone group (P<0.05). The waist circumference in the three groups after the treatment was significantly larger than that before the treatment (P<0.05), and the waist circumference in olanzapine group and risperidone group was larger than that in paliperidone group (P<0.05), and the waist circumference in olanzapine group was larger than that in risperidone group (P<0.05). There was no significant change in FPG after the treatment in risperidone group and paliperidone group (P > 0.05), and the FPG was significantly increased after the treatment in olanzapine group (P<0.05), and there were no significant changes in TG, TC, LDL and HDL in paliperidone group after the treatment (P > 0.05), and the TG, TC and LDL were significantly increased in risperidone group and olanzapine group after the treatment (P<0.05) while the HDL was significantly decreased (P<0.05). The TG, TC and LDL after the treatment in risperidone group and olanzapine group were significantly higher than those in paliperidone group (P<0.05) while the HDL was significantly lower than that in paliperidone group(P<0.05), and there were no significant differences in the TG, TC, LDL and HDL between risperidone group and olanzapine group(P > 0.05). There was no significant difference in the incidence rate of adverse reactions among the three groups(P > 0.05). Conclusion Risperidone, olanzapine and paliperidone have equal efficacy in the treatment of female patients with first-episode SP, but olanzapine has the greatest effects on waist circumference,BMI and glycolipid metabolism, followed by risperidone and paliperidone.