糖化血红蛋白异常在抗精神病药诱发糖代谢疾病中的意义  

Abnormal glycosylated hemoglobin as a predictive factor for sugar metabolism disease in antipsychotic treatment

作　　者：徐乐平[1] 纪菊英[1] 端义扬[1] 施辉[1] 张斌[1] 邵亚琴[1] 孙剑[1] 

机构地区：[1]解放军第一○二医院精神科,常州213003

出　　处：《中华精神科杂志》2006年第1期1-4,共4页Chinese Journal of Psychiatry

摘　　要：目的探讨糖化血红蛋白(HBA1C)异常在抗精神病药诱发糖代谢疾病中的意义。方法对152例空腹血糖(FPG)、糖耐量试验2H血糖(2HPG)正常的精神分裂症女性患者,按HBA1C正常/异常分层后随机分HBA1C正常组(115例,以下简称正常组)及HBA1C异常组(37例,以下简称异常组),分别给予利培酮(正常组37例,异常组12例)、氯氮平(正常组40例,异常组13例)及氯丙嗪(正常组38例,异常组12例)治疗,治疗前及治疗第6周后测定各组患者的FPG及2HPG。结果(1)仅氯氮平异常组患者治疗后2HPG[(9·5±1·8)MMOL/L]较治疗前[(7·2±1·4)MMOL/L]增高,差异有统计学意义(P<0·01)。(2)各组内治疗前、后FPG的差异均无统计学意义(P均>0·05)。(3)HBA1C水平因素与药物因素对治疗后2HPG存在交互作用(P<0·01)。(4)氯氮平异常组患者治疗后2HPG高于利培酮异常组[(7·4±1·7)MMOL/L]及氯丙嗪异常组[(7·3±1·6)MMOL/L],差异有统计学意义(P<0·01)。各正常组患者治疗后2HPG的差异均无统计学意义(P均>0·05)。(5)各异常组患者治疗前、后的合计2HPG[(7·1±1·6)MMOL/L],[(8·1±1·9)MMOL/L]均高于各正常组的合计2HPG[(6·2±1·4)MMOL/L],[(6·5±1·4)MMOL/L],差异均有统计学意义(P<0·01,<0·001)。(6)异常组与正常组比较,接受抗精神病药治疗后发生糖代谢疾病的比值比(OR)经标化为9·5,差异有统计学意义(P<0·001)。结论HBA1C异常的精神分裂症患者可能是抗精神病药诱发糖代谢疾病的高危人群。Objective This study was to explore the influence of antipsychotic （APS） therapy on sugar metabolism, and its relationship to the abnormal glycosylated hemoglobin. Methods After the glycosylated hemoglobin （HbA1 c） was determined, 152 patients with schizophrenia were divided into normal or abnormal HbA1 c group, and then were randomly given risperidone, clozapine or chlorpromazine treatment for 6 weeks. The fasting plasma glucose （FPG） and 2-hour plasma glucose in oral glucose tolerance test （2HPG） was measured at baseline and after treatment. Results Although no significant difference between baseline and after treatment in the FPG was found in all patients, the 2HPG was increased from [ （7. 2 ±1.4） mmol/L] at baseline to [ （9.5 ± 1.8） mmol/L] after clozapine therapy （P 〈0. 01 ）. In patients with abnormal HbA1c, the 2HPG after treatment was higher in clozapine [ （9.5 ± 1.8） mmol/L] than that in risperidone [ （7.4 ± 1.7） mmol/L] and chlorpromazine [ （7.3 ± 1.6） mmol/L] group （P 〈0.01 ）, but in patients with normal HbA1 c, no significant difference was found between the three APS group （P 〉 0. 05 ）. The 2HPG were [ （7. 1 ±1.6） mmol/L] at baseline and [ （8. 1 ± 1.9） mmol/L] after treatment in patients with abnormal HbAlc, which were significantly higher than that [ （6. 2 ± 1.4） mmol/L and （6. 5 ± 1.4） mmol/L, respectively] in patients with normal HbA1c. The patients with abnormal HbA1c were at higher risk of developing ASP-induced sugar metabolism than those with normal HbA1c （ standard OR = 9. 5 ）. Conclusion The results indicate that schizophrenic patients with abnormal HbA1 c are likely to develop antipsychotic-induced sugar metabolism disease.

关 键 词：抗精神病剂 精神分裂症 血红蛋白A 糖基化 血糖 

分 类 号：R595.3[医药卫生—内科学]