氯氮平对首发精神分裂症帕罗西汀激发试验的影响

Effect of clozapine on paroxetine neuroendocrine challenge test in first-episode schizophrenics

目的 探讨首发精神分裂症的中枢 5 羟色胺 (5 HT)系统的功能 ,以及氯氮平对神经内分泌激发试验的影响。方法 无重大躯体疾病、既往未服过药物治疗的首发分裂症患者 2 4例 (患者组 ) ,另选择与患者组年龄、性别相匹配的 15名正常人为对照组。口服 4 0mg帕罗西汀作为激发剂 ,每隔 1 5h共 5次 (包括试验前 )连续抽取静脉血 ,使用酶联免疫吸附法测定血浆皮质醇 (COR)及催乳素 (PRL)浓度。患者组分别在氯氮平治疗前后各做 1次激发试验 ,对照组仅做 1次激发试验。氯氮平的平均日剂量为 (2 6 8± 75 )mg ,疗程为 12周。结果 治疗前患者组血浆基础PRL及COR浓度明显高于对照组 (P <0 0 5 ) ,PRL、COR对帕罗西汀的反应明显高于对照组 (P <0 0 5～ 0 0 1)。氯氮平治疗后 ,患者组PRL、COR对帕罗西汀反应明显迟缓 ,与对照组的反应的显差异无显著性 (P >0 0 5 ) ,氯氮平显著提高了外周血COR浓度 (P <0 0 5～ 0 0 1)。结论 首发精神分裂症患者中枢 5 HT功能可能存在亢进。

Objective To study the central serotonergic function of medication-naive first-episode schizophrenics. Methods A paroxetine induced cortisol and prolactin response test was conducted in 24 inpatients [17 males and 7 females;mean age (31±11)years;mean illness duration (13±8)months] with first episode schizophrenia before and after 12-week clozapine treatment. The mean clozapine daily dose was (268±75)mg. Fifteen age-,gender- matched normal individuals [11M,4F;(29±10)years] were recruited as control. The concentrations of plasma cortisol and prolactin were determined with enzyme-linked immuno-sorbent assay. Results There were significantly higher baseline levels of plasma cortisol and prolactin in patients compared with controls (P<0.05). Before treatment,prolactin and cortisol responses to paroxetine in patients were significantly higher than in controls (P<0.05-0.01). After treatment,the patients′ prolactin and cortisol responses to paroxetine were much lower compared with pre-treatment,and was not significantly different from that in controls (P>0.05). Conclusion The results suggest that central serotonergic hyperactivity occurs in first episode schizophrenics.