长期住院精神分裂症患者甲状腺功能和催乳素随访8年变化研究

Eight-year trajectories of thyroid function and prolactin levels in long-term hospitalized patients with schizophrenia

目的探讨长期住院精神分裂症患者甲状腺功能和催乳素(PRL)随访8年变化。方法回顾性选取2014年1月至2022年9月在深圳市康宁医院长期住院的105例精神分裂症患者为研究对象,以患者参加长期住院计划的年份为基线,随访频率1次/年,共随访8年。每个年末统计甲状腺功能指标[包括促甲状腺激素(TSH)、T_(3)、T_(4)、FT_(3)、FT_(4)]和PRL水平,以当年各项指标平均值作为记录值。采用重复测量混合模型分析精神分裂症患者整体以及不同性别随访8年甲状腺功能指标和PRL变化,进一步分析各项指标与抗精神病药物剂量的交互关系以及抗精神病药物种类与PRL的交互关系。结果与基线比较,精神分裂症患者TSH在第2~8年末均较高(均P<0.05);T_(3)先降后升,在第2年末较低(P<0.05),在第7、8年末均较高(均P<0.01);T_(4)在第5~7年末均较低(均P<0.01);FT_(3)在第1~4年末以及第7、8年末均较高(均P<0.01);FT_(4)在第1~8年末均较高(均P<0.01);PRL在第1~8年末与基线比较差异均无统计学意义(均P>0.05)。与女性患者比较,男性精神分裂症患者第6年末TSH较低(P<0.05),第7年末T_(3)较低(P<0.05),第8年末T_(4)较低(P<0.01),第7、8年末FT_(3)均较高(均P<0.05),第1~3年末以及第7年末PRL均较低(均P<0.05)。T_(3)、PRL与抗精神病药物剂量(奥氮平等效剂量)均存在交互关系(均P<0.05),阿立哌唑、氨磺必利、利培酮、氯氮平、舒必利剂量与PRL均存在交互关系(均P<0.01)。结论长期住院精神分裂症患者在8年随访期间甲状腺功能指标持续变化,而PRL变化虽不明显,但不同性别、抗精神病药物剂量及种类患者之间存在一定的差异。

Objective To analyze the eight-year trajectories of thyroid function and prolactin(PRL)levels in long term hospitalized patients with schizophrenia.Methods A total of 105 patients with schizophrenia who were hospitalized in Shenzhen Kangning Hospital from January 2014 to September 2022 were enrolled.The visit frequency was once a year,with a total follow-up period of 8 years.At the end of each year,the average values of thyroid function indicators,including thyroid stimulating hormone(TSH),T_(3),T_(4),FT_(3),FT_(4),and PRL were documented,and the average value of each index was taken as the record value.The analysis of repeated measurements with mixed-model was applied to identify the 8-year trajectories of the thyroid function indicators and PRL levels.The interaction between thyroid function indicators and the dose of antipsychotic drugs,and between the types of antipsychotic drugs and PRL were further analyzed.Results Compared with the baseline data,TSH level was higher at the end of 2th to 8th year(all P<0.05);T_(3) decreased first and then increased,it was lower at the end of the 2nd year(P<0.05)and higher at the end of the 7th and 8th year(both P<0.01);T_(4) level was lower at the end of 5th and 7th year(both P<0.01);FT_(3) was higher at the end of the 1st to 4th year and the end of the 7th and 8th year(all P<0.01);FT_(4) was higher at the end of 1st to 8th year(all P<0.01).There was no significant difference in PRL levels at the end of 1st to 8th year(all P>0.05).Compared with females,male patients had lower level of TSH at the end of 6th year(P<0.05),lower level of T_(3) at the end of 7th year(P<0.05),lower level of T_(4) at the end of 8th year(P<0.01),and higher FT_(3) at the end of 7th and 8th year(both P<0.05),lower level of PRL at the end of 1st to 3rd year and the end of 7th year(all P<0.05).There was an interaction between T_(3),PRL and the dose of antipsychotic agents(equal dose of olazine)(both P<0.05),and between PRL and the dose of aripiprazole,amisulpride,risperidone,clozapine,sulpiride(all P<0.01).Conclusion Long-term hospitalized patients with schizophrenia exhibit sustained and significant changes in thyroid function over an 8-year follow-up period.While the changes of prolactin level are not noticeable,prolactin levels are correlated to gender,dosage,and type of antipsychotic drugs.