Birkenaes Astrid B, Birkeland Kåre I, Engh John A, Faerden Ann, Jonsdottir Halldora, Ringen Petter Andreas, Friis Svein, Opjordsmoen Stein, Andreassen Ole A
Section for Psychosis Research, Division of Psychiatry, Ulleval University Hospital and Institute of Psychiatry, Oslo, Norway.
J Clin Psychopharmacol. 2008 Apr;28(2):132-7. doi: 10.1097/JCP.0b013e318166c4f7.
Antipsychotic (AP) treatment, in particular with some second-generation drugs, is associated with weight gain and other metabolic side effects. However, the relationship between drug-induced weight gain and dyslipidemia is not well understood. We investigated how cardiometabolic risk factors were related to body mass during treatment with different APs under real-life conditions.
This cross-sectional naturalistic study included 242 subjects with severe mental disorders who were on monotherapy with olanzapine (OLZ) or clozapine (CLZ) (n = 80), monotherapy with other APs (n = 80), or unmedicated (n = 82). Groups were adjusted for age and compared for prevalence of the metabolic syndrome and its components. Groups were further adjusted for body mass and compared for mean values of blood pressure, lipids, and fasting glucose.
There was no significant intergroup difference in the prevalence of metabolic syndrome, obesity, hypertension, or hyperglycemia. Despite similar body mass index, OLZ/CLZ-treated subjects had significantly higher prevalence of dyslipidemia (high triglyceride and low HDL cholesterol levels) than unmedicated subjects. They also had higher mean values of triglycerides (P = 0.003) and lower mean values of HDL cholesterol (P < 0.001). Patients treated with other APs had intermediate values.
Intergroup differences in body mass index were minimal in this naturalistic setting, probably because of awareness of this treatment hazard among clinicians. However, independently of body mass, dyslipidemia was significantly associated with AP treatment, in particular with OLZ and CLZ. These findings indicate a primary effect of APs on lipid regulation, important in understanding their mechanism of action, and with clinical implications.
抗精神病药物（AP）治疗，尤其是某些第二代药物，与体重增加及其他代谢副作用相关。然而，药物引起的体重增加与血脂异常之间的关系尚未完全明确。我们研究了在现实生活条件下，不同AP治疗期间心脏代谢危险因素与体重之间的关系。
这项横断面自然主义研究纳入了242名患有严重精神障碍的受试者，他们分别接受奥氮平（OLZ）或氯氮平（CLZ）单药治疗（n = 80）、其他AP单药治疗（n = 80）或未接受药物治疗（n = 82）。对各组进行年龄调整，并比较代谢综合征及其组分的患病率。进一步对各组进行体重调整，并比较血压、血脂和空腹血糖的平均值。
代谢综合征、肥胖、高血压或高血糖的患病率在组间无显著差异。尽管体重指数相似，但接受OLZ/CLZ治疗的受试者血脂异常（高甘油三酯和低高密度脂蛋白胆固醇水平）的患病率显著高于未接受药物治疗的受试者。他们的甘油三酯平均值也更高（P = 0.003），高密度脂蛋白胆固醇平均值更低（P < 0.001）。接受其他AP治疗的患者数值居中。
在这种自然主义环境中，组间体重指数差异极小，可能是因为临床医生意识到了这种治疗风险。然而，独立于体重之外，血脂异常与AP治疗显著相关，尤其是与OLZ和CLZ。这些发现表明AP对脂质调节有主要作用，这对于理解其作用机制具有重要意义，并具有临床意义。
