Birkenaes Astrid B, Birkeland Kåre I, Friis Svein, Opjordsmoen Stein, Andreassen Ole A
Department of Psychiatry, Akershus University Hospital, Lørenskog, Norway.
J Clin Psychopharmacol. 2009 Apr;29(2):109-16. doi: 10.1097/JCP.0b013e31819b95fc.
Dyslipidemia independent of body mass has previously been reported in humans after antipsychotic treatment. The present study investigated the levels of several metabolic regulatory hormones in psychiatric outpatients treated with different antipsychotics under real-life conditions.
The study included cross-sectional data from 234 subjects on stable monotherapy with any of the following: olanzapine (n = 72), any other antipsychotic (n = 80), or no medications (n = 82). Groups were well matched for sex, body mass index (BMI), ethnicity, and smoking. After adjustment for differences in age and illness duration, groups were compared for the insulin resistance index (homeostatic model assessment of insulin resistance) and fasting concentrations of glucose, lipids, insulin, sex hormone-binding globulin (SHBG), adiponectin, leptin, and cortisol. Correlations were examined between serum olanzapine and hormonal levels, and between leptin concentrations and BMI in both sexes.
Significant intergroup differences in concentrations of insulin (P = 0.025), SHBG (P = 0.001), adiponectin (P = 0.017), and cortisol (P = 0.003) but no significant difference for homeostatic model assessment of insulin resistance (P = 0.051) were found, independent of body mass. Olanzapine-treated subjects had the highest insulin concentrations and the lowest SHBG, adiponectin, and cortisol concentrations. Olanzapine-treated female subjects had significantly higher leptin (P = 0.005) and lower SHBG (P = 0.023) concentrations than other subjects. In female subjects, serum olanzapine concentrations were correlated with hormonal levels, and a significant proportion of olanzapine-treated female subjects had abnormal correlations between serum leptin levels and BMI.
Alterations in several interrelated metabolic hormonal markers were associated with olanzapine treatment, independent of body mass, particularly in female subjects.
先前有报道称，抗精神病药物治疗后的人类存在独立于体重的血脂异常情况。本研究调查了在现实生活条件下接受不同抗精神病药物治疗的精神科门诊患者中几种代谢调节激素的水平。
该研究纳入了234名接受以下任何一种稳定单一疗法的受试者的横断面数据：奥氮平（n = 72）、任何其他抗精神病药物（n = 80）或未用药（n = 82）。各组在性别、体重指数（BMI）、种族和吸烟方面匹配良好。在调整年龄和病程差异后，比较各组的胰岛素抵抗指数（胰岛素抵抗稳态模型评估）以及空腹血糖、血脂、胰岛素、性激素结合球蛋白（SHBG）、脂联素、瘦素和皮质醇浓度。检测血清奥氮平与激素水平之间以及男女瘦素浓度与BMI之间的相关性。
发现胰岛素（P = 0.025）、SHBG（P = 0.001）、脂联素（P = 0.017）和皮质醇（P = 0.003）浓度存在显著组间差异，但胰岛素抵抗稳态模型评估无显著差异（P = 0.051），且与体重无关。接受奥氮平治疗的受试者胰岛素浓度最高，SHBG、脂联素和皮质醇浓度最低。接受奥氮平治疗的女性受试者瘦素浓度显著更高（P = 0.005），SHBG浓度显著更低（P = 0.023）。在女性受试者中，血清奥氮平浓度与激素水平相关，且接受奥氮平治疗的女性受试者中有很大比例血清瘦素水平与BMI之间存在异常相关性。
几种相互关联的代谢激素标志物的改变与奥氮平治疗有关，与体重无关，尤其是在女性受试者中。
