Atasoy Nuray, Erdogan Ayten, Yalug Irem, Ozturk Ulkem, Konuk Numan, Atik Levent, Ustundag Yucel
Department of Psychiatry, Zonguldak Karaelmas University, Faculty of Medicine, Zonguldak, Turkey.
Prog Neuropsychopharmacol Biol Psychiatry. 2007 Aug 15;31(6):1255-60. doi: 10.1016/j.pnpbp.2007.05.005. Epub 2007 May 25.
Atypical antipsychotic drugs commonly cause asymptomatic increase in the liver enzymes and serum bilirubin levels. However they rarely may induce a serious hepatic toxicity. In this article we aimed to evaluate the effect of atypical antipsychotic drugs namely olanzapine, risperidone and quetiapine on the hepatic enzymes and serum bilirubin levels in psychiatric patients.
Chart reviews of 312 patient followed-up at Psychiatry Department of Zonguldak Karaelmas University Hospital were examined in detail. The patients whose baseline and follow-up liver function tests including alanine aminotransfeaminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphotase (ALP) and serum bilirubin that were measured before and within the treatment period of first and sixth months were enrolled. Forty eight males and 62 females whose ages ranging from 12 to 65 years were eligible for this study (no pregnant case was present).
The repartition according to treatment is as follows: olanzapine (n=33), risperidone (n=29), and quetiapine (n=48). Two of the 110 patients (1.8%) presented with increased AST levels of up to 4 fold and ALT of thrice the basal level and needed to stop treatment (AST increase in one female with olanzapine 20 mg/day; ALT increase in one male with olanzapine 30 mg/day). Thirty of the 110 patients (27.2%) showed asymptomatic increases in ALT, AST, GGT and serum bilirubin levels in the first month of the study. After 6 months of the treatment, abnormalities in the liver function tests were observed in 25 patients (22.7%).
These results were in accordance with previous studies that asymptomatic increase of liver enzymes are common but significant liver enzyme elevations are rare during atypical antipsychotic treatment. We suggest that obtaining baseline liver enzyme tests before atypical antipsychotic therapy and monitoring regularly specifically in patients with risk factors for liver damage during therapy.
非典型抗精神病药物通常会导致肝酶和血清胆红素水平无症状性升高。然而，它们很少会诱发严重的肝毒性。在本文中，我们旨在评估非典型抗精神病药物奥氮平、利培酮和喹硫平对精神病患者肝酶和血清胆红素水平的影响。
对宗古尔达克卡拉埃尔马斯大学医院精神科随访的312例患者的病历进行了详细检查。纳入在治疗的第一个月和第六个月之前及期间测量了基线和随访肝功能检查（包括丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）和血清胆红素）的患者。48名男性和62名女性，年龄在12至65岁之间，符合本研究条件（无妊娠病例）。
根据治疗方法的分布如下：奥氮平（n = 33）、利培酮（n = 29）和喹硫平（n = 48）。110名患者中有2名（1.8%）出现AST水平升高至4倍，ALT升高至基础水平的3倍，需要停止治疗（1名每天服用20 mg奥氮平的女性AST升高；1名每天服用30 mg奥氮平的男性ALT升高）。110名患者中有30名（27.2%）在研究的第一个月出现ALT、AST、GGT和血清胆红素水平无症状性升高。治疗6个月后，25名患者（22.7%）出现肝功能检查异常。
这些结果与先前的研究一致，即在非典型抗精神病药物治疗期间，肝酶无症状性升高很常见，但显著的肝酶升高很少见。我们建议在非典型抗精神病药物治疗前进行基线肝酶检查，并在治疗期间对有肝损伤危险因素的患者进行定期监测。
