盐酸二甲双胍治疗奥氮平导致的精神分裂症患者代谢综合征的疗效及其与慢性炎症状态的关系  

Efficacy of metformin in the treatment of metabolic syndrome in patients with schizophrenia and its relationship with chronic inflammatory state

作　　者：李美花 朱程[1] 郑克[2] 刘家洪[1] 吕伟 LI Meihua;ZHU Cheng;ZHENG Ke;LIU Jiahong;LYU Wei(Department of General Psychiatry,Kangning Hospital Affiliated to Wenzhou Medical University,Wenzhou 325000,China;Department of Behavioral Medicine,Kangning Hospital Affiliated to Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属康宁医院普通精神科,浙江温州325000 [2]温州医科大学附属康宁医院行为医学科,浙江温州325000

出　　处：《温州医科大学学报》2022年第5期382-387,共6页Journal of Wenzhou Medical University

基　　金：温州市基础性科研项目(Y20180561)。

摘　　要：目的:分析二甲双胍治疗奥氮平导致的精神分裂症患者代谢综合征(MS)的疗效,并进一步分析治疗过程中C-反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)的变化。方法:按照入组病历号随机选取满足入组标准和排除标准的精神分裂症患者100例,依据随机数字表分为研究组和对照组各50例,干预治疗前和24周后分别检测患者体质量指数(BMI)、稳态胰岛素评价指数(HOMA-IR)、空腹血浆葡萄糖(FPG)、糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、CRP和TNF-α,并进行统计分析。结果:两组患者性别、受教育程度、婚姻、家族史、病程、年龄和奥氮平治疗剂量分布差异无统计学意义(P>0.05)。盐酸二甲双胍治疗后研究组BMI、HOMA-IR、FPG、HbA1c、HDL-C、LDL-C、TC、TG、CRP、TNF-α的差值明显高于对照组(P<0.05)。研究组CPR和TNF-α与BMI和HOMA-IR呈显著正相关,ΔCPR可以分别解释ΔBMI变异的13.4%,ΔHOMA-IR变异的11.4%;ΔTNF-α可以分别解释ΔBMI变异的12.5%,ΔHOMA-IR变异的14.2%。结论:二甲双胍可以有效改善精神分裂症患者的MS;MS的改善可能与炎症反应的减轻有一定的关联。Objective:To analyze the efficacy of metformin in the treatment of metabolic syndrome in patients with schizophrenia,and to further analyze the effect of the C-reactive protein(CRP)changes and tumor necrotic factor-α(TNF-α)on metabolic syndrome.Methods:According to the medical record number,100 patients with schizophrenia who met the inclusion criteria and exclusion criteria were randomly divided into study group(n=50)and control group(n=50).Body mass index(BMI),homeostasis insulin evaluation index(HOMA-IR),fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglyceride(TG),CRP,TNF-αwere measured before and 24 weeks after intervention treatment.Collected data were analyzed by SPSS.Results:There was no significant difference in sex,education,marriage,family history,course of disease,age and dose distribution of olanzapine between the study group and the control group(P>0.05).ΔBMI,ΔHOMA-IR,ΔFPG,ΔHbA1c,ΔHDL-C,ΔLDL-C,ΔTC,ΔTG,ΔCRP,ΔTNF-αin the study group was significantly higher than those in the control group after intervention(P<0.05).ΔCRP andΔTNF-αin the study group had significantly positive correlation withΔBMI andΔHOMA-IR.ΔCRP could explain 13.4%of theΔBMI variation and 11.4%of theΔHOMA-IR variation,while 12.5%of theΔBMI variation and 14.2%of theΔHOMA-IR variation could be respectively explained byΔTNF-α.Conclusion:Metformin can effectively improve the metabolic syndrome in patients with schizophrenia,while the improvement of metabolic syndrome may be related to the reduction of inflammatory state.

关 键 词：精神分裂症 代谢综合征 二甲双胍 炎症因子 体质量指数 糖代谢 脂代谢 

分 类 号：R749[医药卫生—神经病学与精神病学]