不同剂量氯氮平与精神分裂症患者血脂、血糖代谢的对照研究  

Effects of varied dosage of clozapine on blood lipid and glucometabolism in schizophrenia

作　　者：刘素芳[1] 魏平[1] 王世贵[1] 王东平[1] 王云[1] 马慧娟[1] 贾福军 

机构地区：[1]新乡医学院第二附属医院精神科 [2]广东省精神卫生研究所

出　　处：《中华精神科杂志》2005年第2期82-85,共4页Chinese Journal of Psychiatry

摘　　要：目的探讨不同剂量氯氮平对精神分裂症患者治疗前后血脂、血糖的影响.方法 87例男性精神分裂症患者分为3组接受氯氮平治疗,低剂量组<150 mg/d(30例);中剂量组150～300 mg/d(29例);高剂量组>300 mg/d(28例).治疗前及治疗第6周后分别进行葡萄糖耐量试验(OGTT)、血脂检测,并计算体质量指数.结果治疗第6周后,3组患者甘油三酯(TG)均升高,差异有统计学意义(F=12.16,P=0.000),其中以低剂量组为著(P<0.05);低剂量组总胆固醇(TC)高于高剂量组(P<0.05);高剂量组高密度脂蛋白胆固醇(HDL)下降和低密度脂蛋白胆固醇(LDL)水平明显升高(P<0.05,P<0.01).3组患者血糖于餐后1 h升高,差异有统计学意义(F=4.67,P=0.015),其中高剂量组增高明显(P<0.01).同时,高剂量组OGTT异常的发生率明显高于低剂量组(χ2=5.087,P=0.024).3组患者治疗后体质量增加的差异无统计学意义(P>0.05).未发现体质量增加与血糖、TG、HDL 和LDL有明显相关关系(均P>0.05).结论氯氮平可导致精神分裂症患者不同程度的血脂水平改变、血糖升高及体质量增加,其程度可能与氯氮平的剂量有关.Objective To explore the effects of varied dosage of clozapine on blood lipid and glucometabolism in schizophrenics.Methods According to the daily clozapine dose in 6-week treatment, 87 male schizophrenics were divided into three groups: the high dose group with clozapine dose of over 300 mg, middle group of 150—300 mg, and the low group of less than 150 mg. The serum levels of total cholesterol, triglyceride (TG), high density lipoprotein-cholesterol (HDL), low density lipoprotein-cholesterol (LDL), apolipoprotein A-1 and apolipoprotein B were measured before and after treatment. The oral glucose tolerance test (OGTT) and the blood glucose at 0, 1, 2, and 3 hour after a meal were measured simultaneously. The body mass index of each patient was calculated before and after treatment.Results After 6-week treatment, the blood TG level were increased in all the three groups (F=12.16, P=0.000), and the marked increase was in the low clozapine dose group (P<0.05). In the high group, the HDL decreased (P<0.05) and LDL increased (P<0.01). The blood glucose at 1 hour after a meal increased in all the groups (F=4.67, P=0.015), especially in the high group (P<0.01). In the OGTT, the rate of impaired glucose tolerance(IGT) at 1-hour time point was higher in the high group than that in the lower ones (χ 2=5.087, P=0.024). The weight gain was not significantly different in the three groups (P>0.05). There was no correlation between the weight gain and the blood TG, HDL, LDL, glucose (P>0.05). Conclusions The results suggest that clozapine lead to some change of serum lipid, blood glucose and weight gain, and may be related to the clozapine dose.

关 键 词：精神分裂症患者 不同剂量 对照研究 血糖代谢 低密度脂蛋白胆固醇 高密度脂蛋白胆固醇 甘油三酯(TG) 体质量增加 葡萄糖耐量试验 OGTT异常 氯氮平治疗 高剂量 体质量指数 低剂量 统计学 治疗前后 血脂检测 总胆固醇 相关关系 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R971.2[医药卫生—临床医学]