非典型抗精神病药物所致葡萄糖不耐受
Glucose intolerance with atypical antipsychotics.
作者信息
Hedenmalm Karin, Hägg Staffan, Ståhl Malin, Mortimer Orjan, Spigset Olav
机构信息
Drug Epidemiology Unit, Medical Products Agency, Uppsala, Sweden.
出版信息
Drug Saf. 2002;25(15):1107-16. doi: 10.2165/00002018-200225150-00005.
BACKGROUND
Previous studies have suggested that the atypical antipsychotics clozapine and olanzapine may be associated with an increased risk of glucose intolerance and diabetes mellitus. Early studies have also suggested an association between use of conventional antipsychotics and the development of glucose intolerance.
OBJECTIVE
To examine quantitatively the association between glucose intolerance including diabetes mellitus and the use of the atypical antipsychotics clozapine, olanzapine or risperidone, and to identify possible risk factors for the development of glucose intolerance during treatment with these drugs.
METHODS
All reports suggestive of glucose intolerance for clozapine, olanzapine and risperidone were identified in the WHO database for adverse drug reactions. In the analyses of possible risk factors for glucose intolerance all other reports of adverse drug reactions for clozapine, olanzapine and risperidone were used as reference. Using the Bayesian Confidence Propagation Neural Network method, the strengths of the associations over time between glucose intolerance and the use of these drugs were analysed. For comparison, the strengths of the associations between glucose intolerance and the use of the conventional antipsychotics haloperidol and chlorpromazine were also analysed.
RESULTS
Clozapine, olanzapine and risperidone were significantly associated with glucose intolerance. In contrast, chlorpromazine and haloperidol were not associated with glucose intolerance. For clozapine, olanzapine and risperidone grouped together, the following potential risk factors for glucose intolerance were identified: an underlying diabetic condition (odds ratio [OR] 10.22, 95% CI 8.20-12.73), an increase in weight (OR 2.36, 95% CI 1.76-3.17), male gender (OR 1.27, 95% CI 1.11-1.47), and concomitant use of valproic acid (OR 1.97, 95% CI 1.61-2.40), selective serotonin reuptake inhibitors (OR 1.63, 95% CI 1.33-1.99) or buspirone (OR 2.24, 95% CI 1.33-3.77).
CONCLUSION
Treatment with clozapine, olanzapine or risperidone appears to be associated with an increased risk of glucose intolerance.
背景
既往研究表明，非典型抗精神病药物氯氮平和奥氮平可能会增加葡萄糖不耐受和糖尿病的风险。早期研究还提示，使用传统抗精神病药物与葡萄糖不耐受的发生有关。
目的
定量研究包括糖尿病在内的葡萄糖不耐受与使用非典型抗精神病药物氯氮平、奥氮平或利培酮之间的关联，并确定在使用这些药物治疗期间发生葡萄糖不耐受的可能风险因素。
方法
在世界卫生组织药物不良反应数据库中，找出所有提示氯氮平、奥氮平和利培酮与葡萄糖不耐受有关的报告。在分析葡萄糖不耐受的可能风险因素时，将氯氮平、奥氮平和利培酮的所有其他药物不良反应报告用作对照。采用贝叶斯置信传播神经网络方法，分析葡萄糖不耐受与这些药物使用之间随时间变化的关联强度。为作比较，还分析了葡萄糖不耐受与传统抗精神病药物氟哌啶醇和氯丙嗪使用之间的关联强度。
结果
氯氮平、奥氮平和利培酮与葡萄糖不耐受显著相关。相比之下，氯丙嗪和氟哌啶醇与葡萄糖不耐受无关。对于氯氮平、奥氮平和利培酮合并分析，确定了以下葡萄糖不耐受的潜在风险因素：潜在糖尿病病情（比值比[OR]10.22，95%可信区间8.20 - 12.73）、体重增加（OR 2.36，95%可信区间1.76 - 3.17）、男性（OR 1.27，95%可信区间1.11 - 1.47）以及同时使用丙戊酸（OR 1.97，95%可信区间1.61 - 2.40）、选择性5-羟色胺再摄取抑制剂（OR 1.63，95%可信区间1.33 - 1.99）或丁螺环酮（OR 2.24，95%可信区间1.33 - 3.77）。
结论
使用氯氮平、奥氮平或利培酮治疗似乎会增加葡萄糖不耐受的风险。
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