帕利哌酮和阿立哌唑对奥氮平所致体重增加的精神分裂症患者替代治疗研究  

The effect of paliperidone or aripiprazole alternative therapy on schizophrenia patients with Olanzapine-induced Weight Gain

作　　者：马奇[1] 李丽霞[1] 连和谈[1] 

机构地区：[1]福建省泉州市第三医院精神科,泉州362000

出　　处：《国际精神病学杂志》2018年第1期59-61,91,共4页Journal Of International Psychiatry

摘　　要：目的奥氮平治疗后出现体重增加的精神分裂症患者,使用帕利哌酮或阿立哌唑替代治疗,观察血糖脂、脂联素、瘦素等指标变化。方法 98例奥氮平治疗后出现体重增加的精神分裂症患者随机分为两组,每组49例,分别替换成帕利哌酮或阿立哌唑治疗,换药前、后第4、8、12周评估阳性和阴性症状量表(PANSS)、不良反应量表(TESS),检测空腹血糖(FBS)、甘油三酯(TG)、胆固醇(TC)、脂联素、瘦素、胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)。结果 (1)与换药前比较:两组TG、TC和BMI第8、12周下降(P<0.05),两组第4、8、12周脂联素持续升高(P<0.05)和瘦素、HOMA-IR下降(P<0.05);帕利哌酮组PANSS总分和阿立哌唑组FBS与治疗前无明显差异(P>0.05),但帕利哌酮组FBS第8、12周显著下降(P<0.05),而阿立哌唑组第4周PANSS显著升高(P<0.05)。(2)组间比较:两组第4、8、12周TG、TC、脂联素、瘦素、HOMA-IR和BMI无差异(P>0.05);帕利哌酮组PANSS总分在治疗后第4、8周和FBS在治疗后第8、12周均显著低于阿立哌唑组(P<0.05);(3)帕利哌酮组不良反应率为14.2%,阿立哌唑为20.4%。结论奥氮平换药为帕利哌酮或阿立哌唑能改善患者糖脂代谢、胰岛素抵抗和体重指数,对脂联素和瘦素的调节可能是作用机制之一,但帕利哌酮比阿立哌唑能更好控制精神症状且安全性更好。Objective To investigate the effect of paliperidone or aripiprazole alternative therapy on schizophre- nia patients with Olanzapine-induced weight gain. Methods Schizophrenia patients with clinically significant weight gain induced by olanzapine were randomly divided into paliperidone （ n=49 ） and aripiprazole （ n=49 ） . The PANSS, TESS, FBS, TG, TC, adiponectin, leptin, BMI and HOMA-IR were measured before and 4, 8, 12 weeks after alternative therapy. Results （1） After the drug change, TG, TC and BMI of the two groups were reduced （P〈0.05） . Increased adiponectin and decreased leptin, HOMA-IR were observed in two group after 4, 8, 12 weeks treatment （ P〈0.05 ） . FBS decreased after 8, 12 weeks and PANSS increased after 4 week respectively showed only in pali- peridone and aripiprazole group （ P 〈 0.05 ） . （2） Comparison between the two groups, there were no differences in TG, TC, adiponectin, leptin, HOMA-IR and BMI at any time point of the study. The PANSS at 4, 8 weeks and FBS at 8, 12 weeks in paliperidone group were lower than that in the aripiprazole （P 〈 0.05 ） . （3）The adverse reaction rates were 14.2 % in Paliperidone and 20.4 % in aripiprazole group. Conclusion In schizophrenia patients with Olanzapine- induced Weight Gain, paliperidone or aripiprazole ahernative therapy is help to ameliorate the HOMA-IR and BMI, regulating the levels of adiponectin and leptin may be the potential mechanism. But Paliperidone are slightly better in controlling psychotic symptoms and reducing adverse effects.

关 键 词：奥氮平 帕利哌酮 阿立哌唑 精神分裂症 

分 类 号：R749.05[医药卫生—神经病学与精神病学]