Smith Robert C, Lindenmayer Jean-Pierre, Bark Nigel, Warner-Cohen Jessy, Vaidhyanathaswamy Sumathi, Khandat Amaresh
Department of Psychiatry, New York University Medical School, Hewlett, NY 11557, USA.
Int J Neuropsychopharmacol. 2005 Jun;8(2):183-94. doi: 10.1017/S1461145705005110.
Some reports have indicated increased rates of diabetes and increased prevalence of glucose and lipid abnormalities during treatment with second-generation antipsychotics, with most concern raised about clozapine and olanzapine. Most of the findings have come from case reports, retrospective examination of laboratory values, and analysis of health-care claims databases. This study investigated fasting levels of glucose, lipids, and leptin in a non-randomized, cross- sectional study of 210 patients, with schizophrenic or schizoaffective disorder, treated with a single antipsychotic medication - clozapine, risperidone, olanzapine, or a conventional antipsychotic. Glucose tolerance tests (GTT), with a 75-g glucose load, were preformed in a subset of patients. In this sample most mean fasting glucose and lipid levels were within the normal range and were not significantly different across the four drug treatment groups. Patients treated with clozapine and olanzapine had higher triglyceride levels than risperidone patients. In patients receiving a GTT, risperidone-treated patients had higher glucose levels at 1 h than patients treated with olanzapine, and there were more patients on risperidone who met American Diabetes Association glucose metabolic criteria for diagnosis of diabetes. Although there were no significant differences in age or body mass index among the four drug groups, we cannot rule out some potential biasing factors we did not assess which could potentially influence our results. These include unknown physician preference in drug selection based on their beliefs about the weight-inducing or diabetes potential of different antipsychotics, differences in visceral fat, and differences in patients' antipsychotic drug history.
一些报告指出，在使用第二代抗精神病药物治疗期间，糖尿病发病率上升，血糖和血脂异常的患病率增加，其中氯氮平和奥氮平引发的担忧最多。大多数研究结果来自病例报告、实验室值的回顾性检查以及医疗保健索赔数据库分析。本研究在一项非随机横断面研究中，调查了210例患有精神分裂症或分裂情感性障碍的患者的空腹血糖、血脂和瘦素水平，这些患者接受单一抗精神病药物治疗——氯氮平、利培酮、奥氮平或传统抗精神病药物。对部分患者进行了75克葡萄糖负荷的葡萄糖耐量试验（GTT）。在这个样本中，大多数空腹血糖和血脂水平处于正常范围内，四个药物治疗组之间没有显著差异。接受氯氮平和奥氮平治疗的患者甘油三酯水平高于接受利培酮治疗的患者。在接受GTT的患者中，利培酮治疗的患者在1小时时的血糖水平高于奥氮平治疗的患者，并且有更多服用利培酮的患者符合美国糖尿病协会糖尿病诊断的葡萄糖代谢标准。尽管四个药物组在年龄或体重指数方面没有显著差异，但我们不能排除一些未评估的潜在偏倚因素，这些因素可能会影响我们的结果。这些因素包括医生基于对不同抗精神病药物致体重增加或糖尿病潜在风险的看法而在药物选择上的未知偏好、内脏脂肪差异以及患者抗精神病药物治疗史的差异。
