背景:使用不同的抗精神病药物治疗可导致精神病患者的各种代谢副作用,影响长期预后。本研究旨在比较奥氮平和齐拉西酮治疗患者胰岛素抵抗的变化和临床疗效。
方法:对80例精神分裂症患者的临床资料进行回顾性分析。将患者分为奥氮平治疗组和齐拉西酮治疗组。包括体重在内的参数,体重指数(BMI),空腹血糖(FPG),空腹血浆胰岛素(FPI),胆固醇(CHO),甘油三酯(TG),高密度脂蛋白(HDL),低密度脂蛋白(LDL),胰岛素抵抗指数,记录并比较治疗前后的阳性和阴性症状量表(PANSS)评分。
结果:BMI,FPG,FPI,胰岛素抵抗的稳态模型评估(HOMA-IR),CHO,两组TG、LDL均较治疗前显著升高(p<0.05)。奥氮平组的这些参数显著高于齐拉西酮组(p<0.05)。两组患者治疗后HDL水平均显著下降,奥氮平组治疗后HDL水平明显低于齐拉西酮组(p<0.05)。治疗后,两组治疗后PANSS总分及评分均显著低于治疗前(p<0.05)。治疗后,两组总评分和PANSS评分比较差异无统计学意义(p>0.05)。奥氮平组胰岛素抵抗(IR)的发生率明显高于齐拉西酮组(χ2=4.021,p<0.05)。在IR组中,BMI,FPG,FPI,TG,LDL水平高于非IR组(p<0.05)。多变量分析表明,BMI,FPG,FPI,TG,LDL是IR的独立危险因素(奇数比值(OR)>1,p<0.05)。
结论:奥氮平和齐拉西酮治疗可改善精神分裂症患者的临床症状,但是增加了胰岛素抵抗的风险。奥氮平的代谢副作用更为明显。
BACKGROUND: Treatment with different antipsychotics can lead to various metabolic side effects in patients with psychosis, impacting long-term prognosis. This study aimed to compare the changes and clinical efficacy of insulin resistance in patients treated with
olanzapine and ziprasidone.
METHODS: A retrospective analysis was conducted on the clinical data of 80 patients with schizophrenia. The patients were divided into
olanzapine treatment group and ziprasidone treatment group. Parameters including body weight, body mass index (BMI), fasting plasma glucose (FPG), fasting plasma insulin (FPI), cholesterol (CHO), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), insulin resistance index, and Positive and Negative Syndrome Scale (PANSS) scores were recorded and compared before and after treatment.
RESULTS: BMI, FPG, FPI, homeostatic model assessment of insulin resistance (HOMA-IR), CHO, TG and LDL in both groups were significantly higher than before treatment (p < 0.05). These parameters were significantly higher in the
olanzapine group than in the ziprasidone group (p < 0.05). The level of HDL in both groups was significantly decreased after treatment, and the level of HDL in the olanzapine group was significantly lower than that in the ziprasidone group after treatment (p < 0.05). After treatment, the total score and score of PANSS in both groups were significantly lower than before treatment (p < 0.05). After treatment, there was no significant difference in total score and PANSS score between both groups (p > 0.05). The incidence of insulin resistance (IR) was significantly higher in the
olanzapine group compared to the ziprasidone group (χ2 = 4.021, p < 0.05). In the IR group, BMI, FPG, FPI, TG, and LDL levels were higher than in the non-IR group (p < 0.05). Multivariate analysis indicated that BMI, FPG, FPI, TG, and LDL were independent risk factors for IR (odd ratio (OR) >1, p < 0.05).
CONCLUSIONS: Treatment with olanzapine and ziprasidone improves clinical symptoms in patients with schizophrenia, but increases the risk of insulin resistance. The metabolic side effects of
olanzapine are more pronounced.