摘要
目的:探讨非典型抗精神病药氯氮平、利培酮对精神分裂症患者糖耐量、胰岛素和C肽释放的影响,比较两者之间的差异,探讨药物影响血糖的可能机制。方法:病例来源于2002-01/2004-01首都医科大学附属北京安定医院住院患者,共计40例,其中利培酮治疗组19例、氯氮平组21例完成6周的试验。在抗精神病药治疗前和6周末时分别进行简化的糖耐量试验、胰岛素和C肽释放试验。血糖由葡萄糖氧化酶法测定,胰岛素和C肽水平由化学发光免疫分析法测定。同时观察记录患者的一般资料、体质量指数等,并用阳性及阴性症状量表(PANSS)评定患者的临床症状。结果:①治疗6周末时,氯氮平组较利培酮组有更高的空腹血糖犤(4.88±0.62)和(4.43±0.63)mmol/L犦,差异有显著性(t=-2.270,P=0.029)。②与基础水平相比,氯氮平组6周末空腹血糖犤(4.88±0.62)和(4.55±0.50)mmol/L犦、餐后1h血糖犤(9.90±2.73)和(8.12±1.88)mmol/L犦、餐后2h血糖犤(7.81±2.92)和(5.83±1.33)mmol/L犦及餐后2hC肽胰岛素犤(7.90±3.39)和(5.88±1.70)μg/L犦均有显著升高,差异均有显著性(t=-2.452,-3.044,-2.754,-2.511;P=0.023,0.006,0.012,0.021);而利培酮组仅餐后1h胰岛素犤(71.22±44.36)和(48.24±31.79)mIU/L犦有显著升高,差异有显著性(t=-2.830,P=0.011)。?
AIM: To study the effect of clozapine and risperidone on the glucose tolerance, insulin and C peptide release of schizophrenic patients, and compare the difference between them and investigate possible mechanism of drugs in influencing blood glucose.METHODS:Forty inpatients with schizerphrenia were selected from Beijing Anding Hospital,Capital University of Medical Sciences from January 2002 to January 2004, and 19 of them were treated with risperidone and 21 with clozapine for 6 weeks respectively. All the patients were given simplified oral glucose tolerance test(OGTT), insulin and C peptide release tests before and after 6 week treatment of antipsychotic drug respectively. Serum glucose was measured with the method of glucose oxidase microcide, while levels of insulin and C peptide were determined with chemiluminoimmunoassay.General information and body mass index(BMI) of the patients were recorded, and the clinical symptoms were assessed with the positive and negative symptom scale(PANSS).RESULTS: ①After 6 week treatment, patients in the clozapine group[(4.88±0.62) mmol/L] had significantly higher fasting glucose level than those in the risperidone group[(4.43±0.63) mmol/L] (t=-2.270, P=0.029). ②After 6 week treatment, there were significantly increases of fasting glucose [(4.88±0.62) vs (4.55±0.50) mmol/L], 1 hour postpradial glucose [(9.90±2.73) vs (8.12±1.88) mmol/L, 2 hour postpradial glucose [(7.81±2.92) vs (5.83±1.33) mmol/L]and 2 hour postpradial C peptide [(7.90±3.39) vs (5.88±1.70) μg/L] in the clozapine group as compared with the baseline levels (t=-2.452,-3.044,-2.754,-2.511;P=0.023,0.006,0.012,0.021), but only significantly increase of 1 hour postpradial insulin [(71.22±44.36) vs (48.24±31.79) mIU/L] was observed in the risperidone group (t=-2.830,P=0.011). ③In the clozapine group, the changes of fasting glucose and 2 hour postpradial glucose levels were positively correlated with the change of the insulin resistance index (Rs=0.545,P=0.011;Rs=0.434,P=0.049).CONCLUSION: Clozapine has greater influence on the blood glucose metabolism than risperidone, which is possibly related with the mechanism of insulin resistance.
出处
《中国临床康复》
CSCD
北大核心
2005年第4期116-118,共3页
Chinese Journal of Clinical Rehabilitation
基金
北京市重点扶持学科经费及首都医学发展科研基金(首都ZD199816)~~
