精神分裂症患者的d-芬氟拉明激发试验与利培酮治疗的关系  

Effects of risperidone on d-fenfluramine-evoked neuroendocrine responses in schizophrenics

作　　者：于靖[1] 王传跃[1] 姜涛[1] 刘瑞玫[1] 程宇航[1] 蔡焯基[1] 

机构地区：[1]首都医科大学附属北京安定医院,北京100088

出　　处：《中国新药杂志》2002年第2期131-134,共4页Chinese Journal of New Drugs

基　　金：北京市卫生局科学基金;北京卫生重点学科基金和首都医学发展科研基金 (2D199816)

摘　　要：目的 :通过催乳素 (PRL)、皮质醇 (COR)对d 芬氟拉明 (d FF)激发试验的反应 ,研究精神分裂症患者的中枢 5 HT功能 ,探讨非典型抗精神病药利培酮的抗精神病作用机制。方法 :以d FF为探针 ,用酶联免疫法测定 15例精神分裂症患者利培酮治疗前后血清PRL和COR水平 ,以阳性和阴性症状量表 (PANSS)对患者精神症状进行评估。结果 :利培酮治疗后PRL基础值显著高于治疗前 (P <0 .0 1) ,COR基础值则显著低于治疗前 (P <0 .0 5 )。经基线校正后的PRL曲线下面积 (AUC)和皮质醇AUC比治疗前降低 ,但无显著性差异 (P >0 .0 5 )。利培酮治疗后患者的精神症状得到全面改善。Spearman相关分析显示 ,PRL的AUC减分率与思维障碍因子的减分率显著相关 (n =15 ,r =0 .5 33,P <0 .0 5 ) ,COR的AUC与阳性症状量表分 (n =15 ,r =0 .6 5 3,P <0 .0 1)和思维障碍因子分 (n =15 ,r =0 .884 ,P <0 .0 1)显著相关。结论 :利培酮治疗后PRL ,COR对d FF激发试验反应迟钝。精神分裂症患者于治疗前可能存在中枢 5 HT功能亢进。利培酮的抗精神病作用机制与 5 HT2a/D2Objectives:To study the central serotonergic function in schizophrenia and to investigate the pharmacological mechanisms of risperidone by a neuroendocrine strategy.Methods:15 drug free schizophrenic subjects were treated with risperidone for 6 weeks;d fenfluramine( d FF) challenge tests were performed before and after treatment with concurrent clinical rating(PANSS) made at the time of testing.Results:All patients showed clinical improvement following treatment with risperidone. After treatment, baseline serum prolactin(PRL) levels were significantly higher than that of before ( P <0.01),whereas serum cortisol(COR) concentrations were significantly lower( P <0.05).Corrected by the baseline levels,the area under the curve ( AUC ) of PRL and COR were both decreased,but there were no significant differences( P >0.05). Changes in symptom ratings correlated significantly with reduction in PRL and COR responses to d FF challenges.Conclusion:Risperidone may cause the bluntness of d FF evoked neuroendocrine responses in schizophrenia;the antipsychotic mechanism of risperidone may be related to its dual inhibitory effects on 5 HT 2a /5 HT 2c receptors, and these data suggest that there exist a serotonergic hypersensitivity in schizophrenics.

关 键 词：精神分裂症 利培酮 d-芬氟拉明 催乳素 皮质醇 治疗 

分 类 号：R749.305[医药卫生—神经病学与精神病学]