托吡酯与二甲双胍治疗抗精神病药致肥胖的疗效的对照研究

Comparative study on efficacy of topiramate and metformin in the treatment of obesity induced by antipsychotics

目的:探讨托吡酯与二甲双胍治疗抗精神病药致肥胖的作用及安全性。方法:随机将62例抗精神病药致肥胖、且病情稳定的精神分裂症患者分为托吡酯组及二甲双胍组;在原抗精神病药种类、剂量治疗的基础上分别给予托吡酯及二甲双胍。分别于干预前、干预后进行阳性和阴性症状量表(PANSS)评估,测量体质量、体质量指数(BMI)、腰臀比(WHR),并进行安全性评价。结果:①与基线比较,托吡酯组在第4、8、12周时体质量、BMI、WHR,第12周时PANSS总分及一般病理分差异有统计学意义(P均<0.01);二甲双胍组在第4、8、12周时WHR,在第8、12周时体质量、BMI,第12周时PANSS总分差异均有统计学意义(P<0.05或P<0.01)。②干预后,托吡酯组各时间点体质量变化率,第4、8周WHR明显高于二甲双胍组(P<0.05或P<0.01),PANSS总分、阴性症状分、一般病理分明显低于二甲双胍组(P均<0.01);体质量下降>7%的比例两组比较差异无统计学意义。③干预38周后两组体质量、BMI与基线相比差异有统计学意义(P均<0.05)。结论:托吡酯、二甲双胍辅助治疗降低抗精神病药致肥胖患者的体质量的近、远期作用显著,安全性好;且托吡酯的作用更优,改善患者阴性症状。

Objective:To explore the efficacy and safety of topiramate and metformin in the treatment of obesity induced by antipsychotics.Method:62 schizophrenic patients with obesity and stable condition caused by antipsychotics were randomly divided into topiramate group and metformin group.On the basis of the type and dose of the original antipsychotics,the corresponding topiramate and metformin were given.Positive and Negative Symptom Scale(PANSS)was used to evaluate,and body weight,body mass index(BMI)and waist hip ratio(WHR)were measured before and after intervention;meanwhile,the safety was evaluated.Results:①Compared with baseline,there were significant differences in body mass,BMI and WHR at 4,8 and 12 weeks,the total score of PANSS and general pathological score at 12 weeks in the topiramate group(all P<0.01),while in the metformin group there were significant differences in WHR at 4,8 and 12 weeks,body mass and BMI at 8 and 12 weeks,the total score of PANSS at 12 weeks compared with baseline(P<0.05 or P<0.01).②The change rate of body mass at each time point,the WHR at 4 and 8 weeks after intervention in the topiramate group were significantly higher than those in the metformin group(P<0.05 or P<0.01).The total score of PANSS,negative symptom score and general pathological score in the topiramate group were significantly lower than those in the metformin group(all P<0.01).The proportion of body mass decrease>7%was not significantly different between the two groups.③After 38 weeks of intervention,there were significant differences in body weight and BMI between the two groups compared with baseline(all P<0.05).Conclusion:Topiramate and metformin have significant short-term and long-term effects on reducing body weight of patients with obesity induced by antipsychotics,with good safety,and topiramate has better effect on improving negative symptoms of patients.