利培酮、氯氮平、氯丙嗪长期治疗对糖脂代谢的影响  

The glucose metabolism and lipid metabolism consequences of long term treatment with risperidone,clozapine,or chlorpromazine in schizophrenic patients

作　　者：焦玉梅[1] 章连生[2] 王立伟[1] 陈剑华[2] 周敏[2] 王金和[2] 路伟[2] 赵冬梅[2] 

机构地区：[1]复旦大学附属华山医院精神医学研究室,上海市精神卫生中心200040 [2]上海市精神卫生中心

出　　处：《上海精神医学》2006年第4期217-221,共5页Shanghai Archives of Psychiatry

摘　　要：目的了解利培酮、氯氮平、氯丙嗪长期治疗后糖脂代谢的情况及其之间的差别。方法检测42例利培酮、76例氯氮平、40例氯丙嗪单一治疗连续2年以上的精神分裂症患者的简易体质参数、空腹血糖和血脂,并与63例健康对照者的资料进行比较。结果利培酮、氯氮平、氯丙嗪治疗期间新出现的糖尿病病例数分别为2例、8例、2例,氯氮平组较多,但3组间无统计学差异(P>0.05)。氯氮平组BM I大于对照组、氯丙嗪组,腰围及腰臀比利培酮组、氯氮平组均大于对照组和氯丙嗪组(P<0.05或P<0.01);氯氮平组TG值大于对照组及氯丙嗪组(P<0.01),利培酮组、氯氮平组、氯丙嗪组HDL-ch、ApoA1值均小于对照组(P<0.05或P<0.01),两两比较利培酮组HDL-ch、ApoA1值大于氯氮平组及氯丙嗪组(P<0.01)。TG/HDL-ch值氯氮平组大于对照组(P<0.01)和氯丙嗪组(P<0.05)。TC/HDL-ch值三组均大于对照组(P<0.01),但三组间无明显差异。ApoB值三组与对照组相比无明显差异(P>0.05)。结论利培酮、氯氮平、氯丙嗪长期治疗的精神分裂症患者存在一定糖脂代谢紊乱,并且三者对糖脂代谢的影响存在一定差异,氯氮平治疗组脂代谢异常更明显,值得临床重视。Objeetive： To investigate the potential effects of long term medication on glucose metabolism and lipid metabolism among the patients with schizophrenia who had been treated with risperidone, elozapine, or chlorpromazine, Methods： The height, body weight, waist circumference, hip circumference, and the fasting blood glucose and lipid profile were measured in schizophrenia patients treated with risperidone （ 42 cases ）, clozapine （ 76 cases ）, or chlorpromazine （ 40 cases ） respectively for at least 2 years, and the data were compared with 63 normal controlls. Results： There were 2, 8, 2 new cases of diabetes during the treatment of risperidone, clozapine and chlorpromazine respectively, and no differences of the incidence were found among the three groups （P 〉 0.05 ）. The body mass index （BMI） in clozapine group was larger than those of chlorpromazine group and control group; waist circumference and waist/hip circumference ratio in risperidone group and clozapine group were larger than those of chlorpromazine group and control group（P 〈0.05 或 P 〈0. 01 ）. The triglyceride（TG） level in clozapine group was significantly higher than those of chlorpromazine group and control group （ P 〈 0.01 ）. The levels of apolipoprotein AI （APOAI） and high - density lipoprotein cholesterol （HDL -ch） were lower in all these three treatment groups than that of control group. The level of TG/HDL- c in clozapine group was higher than those of chlorpromazine group and control group. The level of cholesterol / HDL- eh （TC/HDL - c ） in the tratment groups was lower than that of control group, but there were no differences among the three groups. There were no differences in apolipoprotein B （ApoB） among four groups . Conclusion：There were some disturbance in glucose metabolism and lipid metabolism in the schizophrenia patients with long term treatment of these 3 antipsychotics, which had different impacts on the metabolism and clozapine had most severe effects on lipid

关 键 词：精神分裂症 利培酮 氯氮平 氯丙嗪 血糖 血脂 

分 类 号：R749.3[医药卫生—神经病学与精神病学]