第二代抗精神病药物在儿童和青少年中的应用：一项在未经药物治疗的患者中进行的为期六个月的前瞻性队列研究。
Second-generation antipsychotic use in children and adolescents: a six-month prospective cohort study in drug-naïve patients.
机构信息
Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, and Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Madrid.
Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, and Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Madrid.
出版信息
J Am Acad Child Adolesc Psychiatry. 2014 Nov;53(11):1179-90,1190.e1-4. doi: 10.1016/j.jaac.2014.08.009. Epub 2014 Sep 2.
OBJECTIVE
To assess weight and metabolic effects of 6 months of treatment with second-generation antipsychotics in naïve/quasi-naïve youths.
METHOD
This study looked at a nonrandomized, naturalistic, multicenter, inception cohort study of 279 patients aged 4 to 17 years (mean = 14.6 ± 2.9 years). Of those, 248 (88.8%) received a single antipsychotic (risperidone, olanzapine, or quetiapine) and completed 2 visits, and 178 (63.8%) completed the 6-month follow-up. Patients had schizophrenia-spectrum disorders (44.5%), mood-spectrum disorders (23.2%), disruptive behavioral disorders (17.3%), or other disorders (15.1%). Fifteen age- and gender-matched, healthy, nonmedicated individuals served as a comparison group.
RESULTS
From baseline to 1 month, 3 months, and 6 months, all anthropometric measures increased significantly with each antipsychotic, that is, 6-month changes with risperidone (n = 157; 7.1 kg and 0.66 body mass index [BMI] z score), olanzapine (n = 44; 11.5 kg and 1.08 BMI z score), and quetiapine (n = 47; 6.3 kg and 0.54 BMI z score), but not in healthy control participants (-0.11 kg and 0.006 BMI z score). Fasting metabolic parameters increased significantly with risperidone (glucose [3.8] mg/dL, insulin [4.9] mU/L, homeostasis model assessment of insulin resistance [HOMA-IR: 1.2], triglycerides [15.6] mg/dL), and olanzapine (glucose [5.0] mg/dL, total cholesterol [21.2] mg/dL, and low-density lipoprotein cholesterol [44.6] mg/dL), but not with quetiapine or in healthy control participants. The percentage of research participants considered to be "at risk of adverse health outcome" increased during the 6 months from 8.9% to 29.2% for risperidone (p < .0001), 6.8% to 38.1% for olanzapine (p < .0001), and 6.3% to 4.0% for quetiapine (p = .91).
CONCLUSION
Olanzapine, quetiapine, and risperidone increase body weight but have different cardiometabolic side effect profiles and different temporal side effect patterns.
目的
评估第二代抗精神病药在初治/准初治青少年中治疗 6 个月的体重和代谢影响。
方法
本研究为一项非随机、自然、多中心、入组队列研究，纳入 279 名 4 至 17 岁（平均 14.6±2.9 岁）的患者。其中，248 名（88.8%）患者接受了单一抗精神病药物（利培酮、奥氮平或喹硫平）治疗并完成了 2 次就诊，178 名（63.8%）完成了 6 个月随访。患者患有精神分裂症谱系障碍（44.5%）、心境障碍谱系障碍（23.2%）、破坏性行为障碍（17.3%）或其他障碍（15.1%）。15 名年龄和性别匹配的、健康的、未用药的个体作为对照组。
结果
从基线到 1 个月、3 个月和 6 个月，所有人体测量指标均随每种抗精神病药物显著增加，即利培酮（n=157；7.1kg 和 0.66 体重指数[BMI]z 评分）、奥氮平（n=44；11.5kg 和 1.08 BMI z 评分）和喹硫平（n=47；6.3kg 和 0.54 BMI z 评分）的 6 个月变化，但健康对照组参与者的变化不明显（-0.11kg 和 0.006 BMI z 评分）。空腹代谢参数随利培酮（血糖[3.8]mg/dL、胰岛素[4.9]mU/L、胰岛素抵抗评估的稳态模型[HOMA-IR：1.2]、甘油三酯[15.6]mg/dL）和奥氮平（血糖[5.0]mg/dL、总胆固醇[21.2]mg/dL 和低密度脂蛋白胆固醇[44.6]mg/dL）显著增加，但喹硫平或健康对照组参与者的参数未显著增加。在 6 个月内，认为存在“不良健康结果风险”的研究参与者比例从 risperidone 的 8.9%增加到 29.2%（p<0.0001），从 olanzapine 的 6.8%增加到 38.1%（p<0.0001），从 quetiapine 的 6.3%增加到 4.0%（p=0.91）。
结论
奥氮平、喹硫平和利培酮均增加体重，但具有不同的心脏代谢副作用特征和不同的时间副作用模式。
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