Morlán-Coarasa María José, Arias-Loste María Teresa, Ortiz-García de la Foz Víctor, Martínez-García Obdulia, Alonso-Martín Carmen, Crespo Javier, Romero-Gómez Manuel, Fábrega Emilio, Crespo-Facorro Benedicto
Department of Medicine and Psychiatry. Psychiatry Unit. IDIVAL, Instituto de Investigación Valdecilla, Hospital Universitario Marques de Valdecilla, 39008, Santander, Spain.
Gastroenterology and Hepatology Department. Infection, Immunity and Digestive Pathology Group. IDIVAL, Instituto de Investigación Valdecilla, Hospital Universitario Marques de Valdecilla, 39008, Santander, Spain.
Psychopharmacology (Berl). 2016 Dec;233(23-24):3947-3952. doi: 10.1007/s00213-016-4422-7. Epub 2016 Sep 12.
Patients with schizophrenia spectrum disorders have increased morbidity and mortality, largely due to cardiovascular disease, which is associated with antipsychotic treatment.
Because of the link between cardiometabolic risk, non-alcoholic fatty liver disease (NAFLD), and antipsychotics, we aimed to investigate the development of NAFLD during the first 3 years of antipsychotic treatment in first episode non-affective psychosis patients.
A sample of 191 subjects was included in final analyses, randomly assigned to aripiprazole (N = 83), risperidone (N = 12), quetiapine (N = 46), and ziprasidone (N = 50). At intake, 180 patients were antipsychotic naïve. The NAFLD fibrosis score, FIB-4 score, and the fatty liver index (FLI) were calculated at baseline, at 3 months, and then yearly for 3 years. None of the patients showed significant liver fibrosis according to the mentioned scores at baseline, prior to randomization. At 3 years follow-up, 25.1 % individuals showed a FLI score ≥60, which is a predictor of steatosis. Of the individuals considered indeterminate at baseline, 64.7 % developed a FLI score ≥60 and only 16.6 % who had a FLI score <30 at baseline, showed a FLI score predictor of steatosis at endpoint. The FLI score ≥60 at endpoint was associated with an increase of more than 7 % of the body mass index (FLI score ≥ 60, 91.7 %; FLI < 60, 55.9 %; p < 0.001), increased triglyceride levels (FLI score ≥ 60, 54.2 %; FLI < 60, 5.6 %; p < 0.001), decreased HDL levels (FLI score ≥ 60, 41.7 %; FLI < 60, 17.5 %; p = 0.001), hypertension (FLI score ≥ 60, 19.5 %; FLI < 60, 4.5 %; p = 0.002), and waist circumference increase (steatosis 68.8 %; FLI < 60, 14.0 %; p < 0.001).
Our results support the importance of assessing the potential development of NAFLD in schizophrenia spectrum patients receiving antipsychotic medication.
精神分裂症谱系障碍患者的发病率和死亡率增加，主要是由于心血管疾病，这与抗精神病药物治疗有关。
由于心脏代谢风险、非酒精性脂肪性肝病（NAFLD）和抗精神病药物之间的联系，我们旨在研究首发非情感性精神病患者在抗精神病药物治疗的前3年中NAFLD的发展情况。
191名受试者的样本纳入最终分析，随机分为阿立哌唑组（N = 83）、利培酮组（N = 12）、喹硫平组（N = 46）和齐拉西酮组（N = 50）。入组时，180名患者未服用过抗精神病药物。在基线、3个月时以及随后3年每年计算NAFLD纤维化评分、FIB-4评分和脂肪肝指数（FLI）。在随机分组前的基线时，根据上述评分，没有患者显示出明显的肝纤维化。在3年随访时，25.1%的个体FLI评分≥60，这是脂肪变性的一个预测指标。在基线时被认为不确定的个体中，64.7%发展为FLI评分≥60，而在基线时FLI评分<30的个体中，只有16.6%在终点时显示出脂肪变性的FLI评分预测指标。终点时FLI评分≥60与体重指数增加超过7%相关（FLI评分≥60，91.7%；FLI<60，55.9%；p<0.001），甘油三酯水平升高（FLI评分≥60，54.2%；FLI<60，5.6%；p<0.001），高密度脂蛋白水平降低（FLI评分≥60，41.7%；FLI<60，17.5%；p = 0.001），高血压（FLI评分≥60，19.5%；FLI<60，4.5%；p = 0.002）和腰围增加（脂肪变性68.8%；FLI<60，14.0%；p<0.001）。
我们的结果支持在接受抗精神病药物治疗的精神分裂症谱系患者中评估NAFLD潜在发展的重要性。
