二甲双胍治疗喹硫平致精神分裂症患者糖脂代谢紊乱的研究

王仰国++++黄腊根

[摘要]目的 探讨二甲双胍对喹硫平所致精神分裂症患者糖脂代谢紊乱的影响，初步探讨其作用发挥的可能机制。方法 选取2011年5月～2013年8月江西康宁医院口服喹硫平所致肥胖（体质量指数>25 kg/m2）的精神分裂症患者（严格符合CCMD-3诊断标准）105例，按随机数字表法，分为治疗组（53例）和对照组（52例）。治疗组患者在使用喹硫平和饮食行为干预的基础上增加二甲双胍治疗，而对照组则单用喹硫平和饮食行为干预治疗。两组患者均治疗6个月，于治疗前（0个月）及治疗后2、4、6个月测量患者的血压、体质量指数（BMI）、腰围（WAIST）、腰臀比（WHR）等体重指标并进行一系列血清学检查，主要涵盖空腹血糖（FBG）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、空腹胰岛素（INS）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、催乳素（PRL）等指标，评估阳性及阴性症状量表（PANSS）并进行疗效评分。结果 治疗前（0个月）两组患者的临床表现以及各项检查指标比较，差异无统计学意义（P>0.05）；治疗2、4、6个月后两组除HDL-C、TG等几个实验室检查指标外，其余各时间段大多数实验室检查数值与治疗前（0个月）比较，差异均有统计学意义（P<0.05）；治疗6个月后治疗组除HDL-C外其余实验室检查数值与同期对照组比较，差异有统计学意义（P<0.05）。结论 二甲双胍与饮食行为干预单一或联合治疗对喹硫平致精神分裂症患者糖脂代谢紊均有良好的疗效，但二甲双胍联合饮食行为干预的疗效最好。

[关键词]精神分裂症；喹硫平；二甲双胍；饮食行为；干预；糖脂代谢

[中图分类号] R749.3 [文献标识码] A [文章编号] 1674-4721（2016）10（a）-0156-04

[Abstract] Objective To explore the influence of Metformin on glucose and lipid metabolism disorder in patients with Quetiapine-induced schizophrenia，and discuss its possible mechanism of action.Methods 105 cases of obese patients （BMI>25 kg/m2） with oral Quetiapine-induced schizophrenia in Jiangxi Kangning Hospital from May 2011 to August 2013 were selected （strictly in accordance with CCMD-3 diagnostic criteria），and divided into the treatment group （n=53） and control group （n=52） according to the random number representation.The patients in treatment group，based on the use of Quetiapine and dietary behavior intervention，received the Metformin treatment，while those in control group received the Quetiapine and dietary behavior intervention.Patients in both groups were treated for 6 months， and the blood pressure，body mass index （BMI），waist circumference （WAIST），waist-to-hip ratio （WHR） and other body weight indexes were measured before the treatment （0 month） and at the 2nd，4th and 6th month after treatment，and a series of serological examination was conducted，mainly including the fasting blood glucose （FBG），low density lipoprotein cholesterol （LDL-C），triacylglycerol（TG），high-density lipoprotein cholesterol （HDL-C），fasting insulin （INS），alanine aminotransferase （ALT），aspertate aminotransferase （AST） and prolactin （PRL）；positive and negative syndrome scale （PANSS） were evaluated，followed by curative effect rating.Results There was no obvious difference in various examination indexes of patients in both groups before treatment （0 month），and the differences had no statistical significance （P>0.05）；except HDL-C and TG，the differences had statistical significance （P<0.05） in most of laboratory examination values at the 2nd， 4th and 6th month after treatment，compared with those before treatment （0 month）；except HDL-C，there were large difference in the laboratory examination values in treatment group after 6 month，compared with those in control group in the same period；the data comparison had statistical significance （P<0.05）.Conclusions The single treatment or combined treatment of Metformin and dietary behavior intervention have good curative effect on glucose and lipid metabolism disorder in patients with Quetiapine-induced schizophrenia，but the combined treatment of Metformin and dietary behavior intervention has the best curative effect.

[Key words]Schizophrenia；Quetiapine；Metabolism；Dietary behavior；Intervention；Glucolipid metabolism

精神分裂症主要依靠长期的药物治疗，典型抗精神病药如氯丙嗪、奋乃静在治疗中可产生锥体外系副反应，并导致催乳素水平升高[1]，限制了其临床应用，而非典型抗精神病药如利培酮、喹硫平等恰恰弥补了典型抗精神病药的不足，现在已有取代典型抗精神病药成为精神分裂症治疗一线药物的趋势[2]。