氯氮平对精神分裂症患者内分泌激素水平影响及并发代谢异常的因素分析

Effect of clozapine on endocrine hormone levels and investigation of factors causing metabolic abnormality in patients with schizophrenia

目的:探讨氯氮平对精神分裂症患者内分泌激素水平影响,并分析影响患者并发代谢异常的相关因素。方法:回顾性分析2021年1月至2023年1月到温州市第七人民医院治疗的精神分裂症患者102例的临床资料,所有患者采用氯氮平治疗,并根据患者治疗后是否发生代谢异常,分为代谢正常组(n=76)和代谢异常组(n=26)。记录并比较两组患者糖脂代谢水平、甲状腺功能及性腺激素水平,采用logistic回归分析影响患者并发代谢异常的相关因素。结果:治疗后,患者三酰甘油(TG)、低密度脂蛋白(LDL)、糖化血红蛋白(HbAlc)、三碘甲状腺原氨酸(T 3)及催乳素(PRL)水平均高于治疗前,雌二醇(E 2)水平低于治疗前,差异均有统计学意义(t=2.84、3.36、25.35、3.26、4.88,-5.76,均P<0.05)。代谢异常组身体质量指数(BMI)、病程、TG、HbAlc、T 3及PRL水平均高于代谢正常组,LDL、FT 4及E 2水平均低于代谢正常组,差异均有统计学意义(t=4.41、5.67、3.20、4.71、3.49、3.97、-4.84、-4.51、-4.25,均P<0.05)。logistic回归分析结果显示,BMI水平偏高(OR=7.410,95%CI=1.485~36.988)、病程较长(OR=1.385,95%CI=1.088~1.764)、LDL水平偏低(OR=0.003,95%CI=0.000~0.453)、HbAlc水平偏高(OR=4.222,95%CI=1.067~16.706)、FT 4水平偏低(OR=0.238,95%CI=0.086~0.655)及E 2水平偏低(OR=0.845,95%CI=0.726~0.984)均为影响患者并发代谢异常的相关因素(均P<0.05)。结论:采用氯氮平治疗精神分裂症,将对患者糖脂代谢、甲状腺及性腺激素水平造成影响,同时发现BMI水平偏高、病程较长、LDL水平偏低、HbAlc水平偏高、FT 4水平偏低及E 2水平偏低将提高患者并发代谢异常风险,因此应根据实际情况进行针对性干预。

Objective To investigate the effect of clozapine on endocrine hormone levels in patients with schizophrenia,and to analyze the factors causing metabolic abnormality.Methods The clinical data of 102 patients with schizophrenia who received treatment at the Wenzhou Seventh People's Hospital from January 2021 to January 2023 were retrospectively analyzed.All patients were treated with clozapine.They were divided into a normal metabolism group(n=76)and a metabolic abnormality group(n=26)according to whether or not metabolic abnormality occurred after treatment.The glycolipid metabolism levels,thyroid function,and gonadal hormone levels were recorded and compared between the two groups.Logistic regression analysis was then performed to determine the relevant factors influencing the occurrence of concurrent metabolic abnormality in these patients.Results After treatment,the levels of triglyceride,low-density lipoprotein,glycosylated hemoglobin,triiodothyronine,and prolactin in patients were all significantly increased compared with those measured before treatment,while estradiol level was significantly decreased compared with that measured before treatment(t=2.84,3.36,25.35,3.26,4.88,-5.76,all P<0.05).Body mass index,disease duration,and the levels of triglyceride,glycosylated hemoglobin,triiodothyronine,and prolactin in the metabolic abnormality group were significantly higher than those in the normal metabolism group,while the levels of low-density lipoprotein,FT4,and estradiol in the metabolic abnormality group were significantly lower than those in the normal metabolism group(t=4.41,5.67,3.20,4.71,3.49,3.97,-4.84,-4.51,-4.25,all P<0.05).The results of the logistic regression analysis indicated that high body mass index(OR=7.410,95%CI=1.485-36.988),prolonged disease duration(OR=1.385,95%CI=1.088-1.764),low low-density lipoprotein level(OR=0.003,95%CI=0.000-0.453),elevated glycosylated hemoglobin level(OR=4.222,95%CI=1.067-16.706),decreased FT4 level(OR=0.238,95%CI=0.086-0.655),and low estradiol level(OR=0.845,95%CI=0.726-0.984)were the factors associated with metabolic abnormality(all P<0.05).Conclusion The use of clozapine in the treatment of schizophrenia will affect the patient's glycolipid metabolism,thyroid function,and gonadal hormone levels.At the same time,it is found that high body mass index,long disease duration,low low-density lipoprotein level,high glycosylated hemoglobin level,low FT4 level,and low estradiol level will increase the risk of metabolic abnormality in patients.Therefore,targeted interventions should be carried out according to the actual situation.