Rubio Gabriel, Gómez-de-la-Cámara Agustín, Ledesma Francisco, Burón José A, Rodríguez-Morales Alexander, Martínez-Junquera Guadalupe
Centro de Salud Mental de Retiro, Area 1, Insalud, Madrid, Spain.
Med Clin (Barc). 2006 Apr 1;126(12):441-4. doi: 10.1157/13086323.
Atypical antipsychotics have been related with hyperglycaemia, diabetes mellitus, weight gain and lipid alterations in some patients. This study analyzed whether continuous treatment with risperidone, olanzapine, or clozapine entails a risk of glucose or lipid metabolism alterations in schizophrenic patients.
Patients included in this study were schizophrenics who had received mono-therapeutic with clozapine, olanzapine or risperidone for a period of 1 to 3 years. Those schizophrenic patients who were diagnosed as diabetic during psychiatric treatment and those who showed fasting glycemia greater than or equal to 126 mg/dl in two consecutive measurements were considered cases. The remaining schizophrenic patients who were receiving treatment and did not show these alterations were considered controls.
In the adjusted analysis (multivariate logistic regression) of the effect of antipsychotic treatment on the presence of diabetes, which also assessed age and body-mass index, the adjusted odds ratio (OR) for olanzapine relative to risperidone was 2.22 (95% confidence interval [CI], 1.12-4.22), (p = 0.0228); and that for clozapine relative to risperidone was 2.87 (95% CI, 1.19, 6.93), (p = 0.0192). Both results reveal a significantly greater risk for the appearance of diabetes mellitus in patients treated with olanzapine or clozapine than in those treated with risperidone. There were significant differences in the risk of increase in triglycerides in patients receiving olanzapine (OR = 1.34; p = 0.0075) and clozapine (OR = 1.58; p = 0.0028).
The risk of the appearance of diabetes mellitus in patients treated with olanzapine is twice as high as that in patients treated with risperidone, and the risk in patients treated with clozapine is nearly triple as high as that found in patients treated with risperidone. Risperidone appears to be a safer antipsychotic drug in the long term, with regard to the risk of alterations in glucose and lipid metabolism.
部分患者使用非典型抗精神病药物后出现了高血糖、糖尿病、体重增加及血脂改变。本研究分析了使用利培酮、奥氮平或氯氮平持续治疗是否会使精神分裂症患者有发生糖代谢或脂代谢改变的风险。
本研究纳入的患者为接受氯氮平、奥氮平或利培酮单药治疗1至3年的精神分裂症患者。在精神科治疗期间被诊断为糖尿病的精神分裂症患者，以及连续两次测量空腹血糖大于或等于126mg/dl的患者被视为病例组。其余正在接受治疗且未出现这些改变的精神分裂症患者被视为对照组。
在对使用抗精神病药物治疗与患糖尿病之间关系的校正分析（多因素逻辑回归）中，该分析同时评估了年龄和体重指数，奥氮平相对于利培酮的校正比值比（OR）为2.22（95%置信区间[CI]，1.12 - 4.22），（p = 0.0228）；氯氮平相对于利培酮的校正比值比为2.87（95%CI，1.19，6.93），（p = 0.0192）。这两个结果均显示，使用奥氮平或氯氮平治疗的患者患糖尿病的风险显著高于使用利培酮治疗的患者。接受奥氮平治疗的患者（OR = 1.34；p = 0.0075）和接受氯氮平治疗的患者（OR = 1.58；p = 0.0028）甘油三酯升高风险存在显著差异。
使用奥氮平治疗的患者患糖尿病的风险是使用利培酮治疗患者的两倍，使用氯氮平治疗的患者患糖尿病的风险几乎是使用利培酮治疗患者的三倍。就糖代谢和脂代谢改变的风险而言，从长期来看，利培酮似乎是一种更安全的抗精神病药物。
