Peuskens Joseph, De Hert Marc, Mortimer Ann
UPC Katholieke Universiteit Leuven, Campus Kortenberg, Kortenberg, Belgium.
Int Clin Psychopharmacol. 2007 May;22(3):145-52. doi: 10.1097/YIC.0b013e3280148c29.
The use of certain atypical antipsychotics has been associated with metabolic disturbances. We have assessed the evolution of body weight and glycaemia during a 6-month randomized comparative trial of amisulpride and olanzapine. Three hundred and seventy-seven adult patients with schizophrenia were randomized to either amisulpride (200-800 mg/day) or olanzapine (5-20 mg/day) for 6 months. Body weight and fasting blood glucose were measured. Both treatments showed comparable antipsychotic activity. Weight gain over the study was significantly greater (P=0.0004) in the olanzapine group (3.9+/-5.3 kg) than in the amisulpride group (1.6+/-4.9 kg). Mean fasting blood glucose increased in the olanzapine group by 4.42 mg/dl to a mean maximum value (118+/-38 mg/dl). In the amisulpride group, mean glucose levels fell by 2.82 mg/dl. The difference between groups was significant at 2 (P=0.0066) and 6 months (P=0.017). One olanzapine-treated patient was diagnosed with diabetes. Metabolic changes in the amisulpride group were restricted to patients with high body mass index at inclusion. At doses that provide comparable control of psychosis, treatment with olanzapine was associated with greater increase in weight and blood glucose compared with amisulpride. This should be taken into account in assessing risk-benefit of treatment options in schizophrenia.
某些非典型抗精神病药物的使用与代谢紊乱有关。我们在一项为期6个月的氨磺必利和奥氮平随机对照试验中评估了体重和血糖的变化情况。377例成年精神分裂症患者被随机分为氨磺必利组（200 - 800毫克/天）或奥氮平组（5 - 20毫克/天），为期6个月。测量体重和空腹血糖。两种治疗方法显示出相当的抗精神病活性。在研究期间，奥氮平组的体重增加（3.9±5.3千克）显著高于氨磺必利组（1.6±4.9千克）（P = 0.0004）。奥氮平组的平均空腹血糖增加了4.42毫克/分升，达到平均最大值（118±38毫克/分升）。在氨磺必利组，平均血糖水平下降了2.82毫克/分升。两组之间的差异在2个月时显著（P = 0.0066），在6个月时也显著（P = 0.017）。一名接受奥氮平治疗的患者被诊断患有糖尿病。氨磺必利组的代谢变化仅限于入组时体重指数较高的患者。在提供相当的精神病控制效果的剂量下，与氨磺必利相比，奥氮平治疗与体重和血糖的更大增加有关。在评估精神分裂症治疗方案的风险效益时应考虑到这一点。
