非典型抗精神病药物对痴呆精神行为症状患者糖代谢的影响  

Effect of Atypical Antipsychotic Drugs on Glycometabolism of Patients with Psychotic Symptoms of Dementia

作　　者：罗克勇[1] 陈峰[1] 张华[1] 张翠丽 王立轻 蒋乃[1] 

机构地区：[1]解放军白求恩国际和平医院256临床部精神卫生中心,河北正定050800

出　　处：《解放军医药杂志》2017年第11期89-92,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省卫生厅资助项目(20130684)

摘　　要：目的观察痴呆精神行为症状(BPSD)患者应用非典型抗精神病药物治疗糖代谢变化情况。方法收集2016年6月—2017年5月在解放军白求恩国际和平医院256临床部门诊及住院的BPSD患者72例,根据用药不同分为奥氮平组16例,利培酮组18组,喹硫平组26例和阿立哌唑组12例。所有受试者分别在治疗前、治疗3个月后接受口服葡萄糖耐量试验(OGTT)、体重指数(BMI)及腰围检测,并分析新发血糖异常的危险因素。结果奥氮平组、利培酮组和喹硫平组新发糖尿病、空腹血糖异常和(或)糖耐量异常发生率均高于阿立哌唑组(P<0.05)。奥氮平组、喹硫平组和利培酮组治疗后空腹血糖、OGTT 1 h血糖、2 h血糖水平以及BMI和腰围高于治疗前(P<0.01),阿立哌唑组治疗后空腹血糖、BMI和腰围低于治疗前(P<0.01)。治疗后,奥氮平组、喹硫平组、利培酮组空腹血糖、OGTT1 h血糖、2 h血糖水平以及BMI和腰围高于阿立哌唑组(P<0.01)。治疗前OGTT 2 h血糖水平、抗精神病药物的种类与新发血糖异常呈正相关(P<0.05)。结论使用非典型抗精神病药物治疗BPSD诱发血糖异常的风险可能与药物类型、治疗前OGTT 2 h血糖水平相关,治疗前3个月血糖异常发生率高,需注意筛查和及时干预。Objective To observe changes of glycometabolism in patients with psychotic symptoms of dementiaafter treatment of atypical antipsychotic drugs. Methods A total of 72 patients with psychotic symptoms of dementia admitted during June 2016 and May 2017 were divided into Olanzapine group （ n = 16） ,Risperidone group （ n = 18） ,Quetiapine group （ n = 26）and Aripiprazole group （ n = 12）according to different use of drug. Oral glucose tolerance test（ OGTT） ,body mass index （ BMI）and waist circumference assessment were performed before treatment and 3 months after treatment in all patients,and risk factors of new pathogenesy of blood glucose abnormalities were analyzed. ResultsIncidence rates of new pathogenesy of diabetes mellitus,abnormal fasting blood glucose and （ or）glucose tolerance weresignificantly higher in Olanzapine,Risperidone and Quetiapine groups than those in Aripiprazole group （ P 〈 0. 05） . After treatment,values of fasting blood glucose,1 h and 2 h OGTT blood glucose levels,BMI and waist circumference weresignificantly higher than those before treatment in Olanzapine,Quetiapine and Risperidone groups （ P 〈 0. 01） ,and values of fasting blood glucose,BMI and waist circumference were significantly lower than those before treatment in Aripiprazole group （ P 〈 0. 01） . After treatment,values of fasting blood glucose, 1 h and 2 h OGTT blood glucose levels,BMIand waist circumference were significantly higher in Olanzapine,Quetiapine and Risperidone groups than those in Aripiprazole group （ P 〈 0. 01） . Before treatment,OGTT 2 h blood glucose level and types of antipsychotic drugs were associated with new pathogenesy of blood glucose abnormalities （ P 〈 0. 05） . Conclusion The risk of atypical antipsychotic drugs in treatment of patients with psychotic symptoms of dementia may be associated with types of antipsychotic drugs,and OGTT 2 h blood glucose level before treatment,and clinicians should pay attention to screening and time

关 键 词：痴呆 精神行为症状 非典型抗精神病药 葡萄糖代谢障碍 

分 类 号：R749.16[医药卫生—神经病学与精神病学]