精神分裂症患者长期服用第二代抗精神病药物导致肝损伤的影响因素分析  

Analysis of factors influencing liver injury caused by long-term use of second-generation antipsychotics in patients with schizophrenia

作　　者：申变红 汪程鹏 高可润 张开元 张智雯 朱春燕 方玲 汤剑平 SHEN Bianhong;WANG Chengpeng;GAO Kerun;ZHANG Kaiyuan;ZHANG Zhiwen;ZHU Chunyan;FANG Ling;TANG Jianping(Department of Psychiatry,Hangzhou Seventh People's Hospital(Affiliated Mental Health Center of Zhejiang University School of Medicine),Hangzhou,Zhejiang 310013,China)

机构地区：[1]杭州市第七人民医院(浙江大学医学院附属精神卫生中心)精神科,浙江杭州310013

出　　处：《中华全科医学》2023年第10期1693-1697,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2021RC025,2019RC073)。

摘　　要：目的 通过回顾性研究,探讨精神分裂症患者长期服用帕利哌酮、齐拉西酮等第二代抗精神病药物相关肝功能受损的危险因素。方法 选择2021年4月—2023年4月杭州市第七人民医院收治的长期服用第二代抗精神病药物的120例精神分裂症患者进行回顾性研究,根据是否发生肝损伤将其分为2组,36例发生肝损伤的患者为观察组,84例未发生肝损伤的患者为对照组,采用单因素、多因素logistic回归分析研究肝损伤的危险因素。结合logistic回归分析结果,通过R软件构建预测精神分裂症患者长期服用第二代抗精神病药物导致肝损伤的列线图预测模型,绘制受试者工作曲线(ROC),计算曲线下面积(AUC),分析该模型的预测区分度。结果 Logistic回归分析显示,病程>10年、肝病史、饮酒史、营养不良、结核病、抗精神病药物服用种类≥3种是精神分裂症患者长期服用第二代抗精神病药物导致肝损伤的危险因素(均P<0.05)。Hosmer-Lemeshow拟合优度检验,χ2=3.049,P=0.405;C-index=0.910;AUC为0.910(95%CI:0.804~0.946)。结论 精神分裂症患者长期服用第二代抗精神病药物引发肝损伤的影响因素是病程,危险因素包括肝病史、饮酒史、营养不良、结核病、抗精神病药物服用种类≥3种,构建预测模型的预测效能较高。Objective A retrospective study was conducted to investigate the risk factors for liver dysfunction associated with long-term use of paliperidone,ziprasidone and other second-generation antipsychotics in patients with schizophrenia.Methods A retrospective study was conducted on 120 patients with schizophrenia who were on long-term second-generation antipsychotics in Hangzhou Seventh People's Hospital from April 2021 to April 2023.They were divided into 2 groups according to whether they had liver injury or not.Thirty-six patients with liver injury were set as the observation group,and 84 patients without liver injury were set as the control group.The risk factors of liver injury were investigated by univariate and multivariate logistic regression analysis.Combined with the results of logistic regression analysis results,R software was used to build a nomogram prediction model for predicting liver injury caused by long-term use of second-generation antipsychotics in schizophrenia patients,and the receiver operating curve(ROC)was plotted,the area under the curve(AUC)was calculated,and the predictive ability of this model was analyzed.Results Logistic regression analysis showed that disease duration>10 years,history of liver disease,history of alcohol consumption,malnutrition,tuberculosis and type of antipsychotic drugs≥3 were risk factors for long-term use of second-generation antipsychotics in schizophrenia patients(P<0.05).Hosmer-Lemeshow goodness of fit test,χ2=3.049,P=0.405;C-index=0.910;AUC was 0.910(95%CI:0.804-0.946).Conclusion Influencing factors for liver injury induced by long-term use of second-generation antipsychotics in schizophrenia patients were disease duration,and risk factors included liver disease history,alcohol consumption,malnutrition,tuberculosis and type of antipsychotics≥3 types.The prediction model had a high predictive power.

关 键 词：精神分裂症 抗精神病药物 肝损伤 影响因素 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R971.41[医药卫生—临床医学]