奥氮平合并不同剂量二甲双胍对精神分裂症患者体质量和糖脂代谢的影响  

The effect of metformin plus olanzapine on weight and glucolipid metabolism in early intervention for patients with schizophrenia

作　　者：贾杰[1] 王姗[1] 张娅妮[1] 王赞利[1] 刘显阳[1] 王康健[1] 钟意娟[1] 李界兴[1] 党伟[1] 陈英[1] JIA Jie;WANG Shan;ZHANG Ya-ni;WANG Zan-li;LIU Xian-yang;WANG Kang-jian;ZHONG Yi-juan;LI Jie-xing;DANG Wei;CHEN Ying(Mental Health Center of Xian,Xian 710061,China)

机构地区：[1]陕西省西安市精神卫生中心,710061

出　　处：《临床精神医学杂志》2018年第3期205-207,共3页Journal of Clinical Psychiatry

基　　金：西安市科技计划社发-医学攻关项目(SF1322-1)

摘　　要：目的:探讨二甲双胍早期干预对精神分裂症患者体质量和糖脂代谢的有效性和安全性。方法:150例首发精神分裂症患者分为治疗组(奥氮平联合二甲双胍)和对照组30例(奥氮平单药),治疗组根据联合二甲双胍不同剂量(即奥氮平10～20 mg/d+二甲双胍250 mg/d、500 mg/d、750 mg/d)分为治疗1组(30例)、治疗2组(30例)及治疗3组(28例)。分别于治疗前和治疗4、8及12周测定体质量指数(BMI)及空腹血糖(FBG)、糖化血红蛋白(HbA 1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL);采用阳性和阴性症状量表(PANSS)治疗前后评定疗效,并记录不良事件评定安全性。结果:治疗12周,各组体质量及BMI均较治疗前显著增加,治疗3组与对照组比较差异有统计学意义(χ2=10.138,t=2.905;P<0.01);各组TC、TG、LDL、对照组及治疗1组FBG、HbA 1c较治疗前增加(P均<0.05)、HDL较治疗前降低(P<0.05);各组间比较,治疗2组和治疗3组TC、TG、HDL、LDL与对照组比较差异有统计学意义(P均<0.05);治疗3组胃肠道不适症状较多。结论:早期合并二甲双胍(>500 mg/d)干预奥氮平所致的体质量增加和糖脂代谢紊乱的效果有限。Objective： To explore the efficacy and safety of metformin plus olanzapine in the early intervention of patients with schizophrenia. Method： One hundred and fifty patients with first-episode schizophrenia were randomly divided into two groups： the olanzapine group（ control group） and olanzapin in combination with metformin group. And then,the combination group was further divided into three subgroups of research 1,research 2,research 3 according to the dose of metformin（ 250,500,750 mg/d）. BMI and some glucolipid metabolism indicators（ FBG,HbA 1 c,TC,TG,HDL,LDL） were measured before treatment,at the end of the fourth week,8 th week and the 12 th week after treatment respectively. At the same time,the comparison of the indicators within and between the two groups before and after treatment was conducted. Results： After 12 weeks,the body weight and BMI of each group increased significantly compared with those before treatment. The difference between research 3 and control group was statistically significant（ χ^2= 10. 138,t = 2. 905; P〈0. 01）. TC,TG,LDL in each group,FBG and HbA 1 c in research 1 and control group increased after treatment（ P〈0. 05）; while HDL is lower than before treatment（ P〈0. 05）. There were significant differences in TC,TG,HDL and LDL between research 2 and research 3 in treatment group（ P〈0. 05）. Comparing the adverse reactions of each group,there were more gastrointestinal symptoms in research 3. Conclusion： The early combination of metformin（ 〉500 mg/d） has a limited effect on olanzapine induced body weight gain and glucose and lipid metabolism disorders.

关 键 词：精神分裂症 体质量 二甲双胍 奥氮平 糖脂代谢 

分 类 号：R749.3[医药卫生—神经病学与精神病学]