探讨奥氮平对首发精神分裂症伴肥胖患者认知功能、糖脂代谢及相关激素指标水平的影响

Effect of olanzapine on the cognitive function, glycolipid metabolism and related hormones in patients with first-episode schizophrenia and obesity

目的:探讨奥氮平对首发精神分裂症伴肥胖患者认知功能、糖脂代谢及相关激素指标水平的影响。方法:选取2015年3月至2017年5月某院收治的首发精神分裂症伴肥胖患者500例,采用随机数字表法分为观察组、对照组各250例。对照组患者给予利培酮,观察组在此基础上予以奥氮平,从小剂量(奥氮平片5 mg·d^(-1),利培酮口腔崩解片1 mg·d^(-1))开始,后逐渐加量,在1个月内达到治疗量(奥氮平片15～20 mg·d^(-1),利培酮口腔崩解片4～6 mg·d^(-1))。两组患者均治疗8周。应用阳性和阴性综合征量表(PANSS)、认知功能成套测验系统(MCCB)评估两组患者治疗前后症状、认知功能,并比较两组患者治疗前后体质量指数(BMI)、糖脂代谢指标[空腹血糖(FPG)、总胆固醇(TC)、低密度脂蛋白(LDL)、三酯甘油(TG)]、相关激素指标[泌乳素(PRL)、雌二醇(E_2)、睾酮(TESTO)],观察不良反应发生情况。结果:治疗8周后,两组患者PANSS评分均较治疗前显著下降(P<0.05),组间PANSS评分及PANSS减分率比较差异无显著性(P>0.05);MCCB测试中,观察组在连线测试、工作记忆、操作速度方面改善显著优于对照组(P<0.05);治疗后两组BMI、FPG、TC、LDL、TG均增加,且观察组各指标水平均高于对照组(P<0.05);两组治疗后PRL、E_2、TESTO水平均升高(P<0.05),组间对比差异均无显著性(P>0.05);两组不良反应发生率比较差异无显著性(P>0.05)。结论:相比单用利培酮,利培酮+奥氮平应用于首发精神分裂症伴肥胖患者,可明显改善其认知功能,但对糖脂代谢的不利影响可能更大,应加以监测,而2种治疗方案对相关激素水平改善效果相似。

OBJECTIVE To investigate the effect of olanzapine on the cognitive function,glycolipid metabolism and related hormones in patients with first-episode schizophrenia and obesity.METHODS 500 patients with first-episode schizophrenia and obesity who were admitted to the hospital from March 2015 to May 2017 were selected and randomly divided into the observation group and the control group by the random number table method,250 cases in each group.Patients in the control group were treated with risperidone.In addition to risperidone,patients in the observation group were additionally treated with olanzapine.The dose started from a small dose(Olanzapine Tablets 5 mg·d-1,Risperidone Orally Disintegrating Tablets 1 mg·d-1),and then gradually increased to reach the therapeutic dose within 1 month(Olanzapine Tablets 15-20 mg·d-1,Risperidone Orally Disintegrating Tablets 4-6 mg·d-1).Patients in both groups were given 8 weeks of treatment.The symptoms and cognitive function of patients were evaluated by the Positive And Negative Syndrome Scale(PANSS)and the MATRICS Consensus Cognitive Battery(MCCB)before and after treatment.The body mass index(BMI),glycolipid metabolism indexes[fasting plasma glucose(FPG),total cholesterol(TC),low density lipoprotein(LDL),triglyceride(TG)],related hormones[prolactin(PRL),estradiol(E2),testosterone(TESTO)]and adverse reactions were compared between the two groups of patients.The incidence of adverse reactions was observed.RESULTS After 8 weeks of treatment,PANSS scores of the two groups of patients were significantly lower than those before treatment(P<0.05).There was no significant difference in PANSS score or PANSS score reduction rate between groups(P>0.05).In MCCB,the observation group was significantly better than the control group with regard to connection test,working memory,and operation speed.(P<0.05).After treatment,the BMI,FPG,TC,LDL and TG in both groups were increased,and the level of each index in the observation group was higher than that in the control group(P<0.05).The levels of PRL、E2 and TESTO increased after treatmant in both groups(P<0.05),and no significant difference was observed between groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Compared with risperidone alone,risperidone combined with olanzapine can significantly improve the cognitive function in patients with first-episode schizophrenia and obesity.However,the adverse effects on glycolipid metabolism may be significant and should be monitored.Both treatment regimens have similar effects on the improvement of related hormone levels.